Twice a week, Om Prasad Tamang travels all the way from Lazimpat to Dhapakhel on his scooter to undergo dialysis at Sumeru Hospital. As a kidney patient, the 55-year-old needs regular dialysis and cannot afford to miss even one of his appointments.

“If I don’t go to hospital, I might die, but if I keep visiting the hospital, I have a high risk of contracting Covid-19,” said Tamang. “I make sure that I put on a face mask every time I am outside.”

Although Tamang had a surgical mask on and a bottle of hand sanitiser with him, he is often in close proximity to other patients when he is at the hospital. Despite all his protective measures, Tamang is afraid that he might contract Covid-19 from a patient at the hospital.

People like Tamang—patients with chronic illnesses—are in a difficult situation. They cannot avoid going out to hospital as they require frequent check-ups and procedures, but they are also afraid that they might contract the coronavirus, which could prove fatal for those with chronic ailments and compromised immune systems.

These fears have been doubly heightened by news reports of health care workers being forced to carry out their duties without adequate personal protective equipment, despite guidelines from the Nepal Medical Council stating that all healthcare providers and staff should have access to appropriate gear, including surgical masks, goggles or face shields, gloves, gowns and caps. The guidelines have also recommended that visitors follow hand hygiene while limiting their movement within the facility.

But at many hospitals, visitors come and go without masks and there is often no sanitiser for visitors to use. At Sumeru Hospital, one of the nurses said that due to the shortage of surgical masks, the hospital has been providing them with one mask for 12 hours of duty.

“It is a critical situation here. We have neither caps nor gloves,” said the nurse who spoke on condition of anonymity.

According to public health experts, the lack of protective gear doesn’t just put health care workers at risk but also patients like Tamang who need to visit for chronic problems.

“The hospital management should not only take responsibility for finding out the reasons for a shortage but also provide an immediate alternative for protecting people,” said epidemiologist Dr Lhamo Yangchen Sherpa.

While health workers, patients and visitors are vulnerable towards the Covid-19 due to the mismanagement and shortage of PPE in the hospital, nurses also accuse patients and visitors of not taking precautions and putting everyone’s life at jeopardy.

Fears about possible infection at the hospital are already keeping chronic patients away. Fifty-two-year-old Nilima said that despite having unbearable pain in her left hand, she hasn’t visited the hospital. As both she and her husband have diabetes, they are at higher risk of morbidity if they happen to contract Covid-19.

“I want to get recommendations from the doctor, but I am worried about going to the emergency ward since I know that diabetes patients are more vulnerable to becoming severely ill with Covid-19,” said Nilima, who would regularly visit the outpatient department with her husband for follow-ups on their diabetes.

But most private hospitals across the country have closed their outpatient departments, with only the emergency, isolation ward and intensive care services in operation ever since the nationwide lockdown was instituted on March 24.

At a time when the entire Nepali population is confined to homes, hospitals should find alternative solutions for patients who might require consultations or need to undergo regular procedures like dialysis, said Sherpa.

“Hospitals can operate a medical helpline with doctors on standby to give suggestions to patients,” she said. “Hospitals can also make use of social media and websites to provide health-related advice, consultations and information on Covid-19.”

Governments across the world have cautioned patients to refrain from visiting the hospital for minor issues, as limited resources need to be conserved to deal with the Covid-19 outbreak. But patients of chronic ailments don’t have that choice. According to doctors and nurses, patients can themselves take necessary measures to protect themselves to the extent that is possible.

Wearing face masks, carrying and using hand sanitisers, maintaining proper physical distance, and putting on hospital gowns when asked can all greatly reduce the chances of contracting Covid-19.

According to another nurse at Sumeru Hospital, there have been numerous examples of patients not following hospital protocol. The nurse, who also did not wish to be identified, reported a case of a woman from Boudha who came in for dialysis but did not reveal that she had had a fever for a few days now.

“I was shocked. How can a patient be so careless?” said the nurse. “Upon learning that, we insisted that she move to the isolation ward but she refused.”