When the first cases of coronavirus were being detected in the country, the Ministry of Health and Population had announced to set up 300 isolation beds and a 25-bed intensive care unit equipped with 10 ventilators at Public Health Campus in Kirtipur. That was four months ago, and the proposed facility has not been established yet.

“We could not set up the intensive care facility in Kirtipur due to the lack of doctors and nurses,” Dr Dipendra Raman Singh, director general at the Department of Health Services, told the Post. “Without doctors, nurses and other technical human resources, setting up an intensive care unit is impossible.”

The department had signed a deal with the supplier to purchase 10 ventilators—eight fixed and two portable, 25, intensive care beds and 300 regular hospital beds for the facility.

A contract was also signed to procure 1,000 hospital beds for Covid treatment centres and isolation wards throughout the country.

A department official said that the contractors have supplied 7oo beds so far, and most of them remain unused.
Some of the beds were supplied to the districts with high Covid-19 cases while the majority of the beds are gathering dust at the department’s store, the official added.   

As for the ventilators and the intensive care beds, they have not arrived yet.

“The concerned supplier could not deliver the ventilators and beds because the international flights were suspended due to the pandemic,” said the official on condition of anonymity. “The supplier has been requesting us to receive the equipment, but we are not in a position to accept them because the Health Campus in Kirtipur does not have the people to operate them.”
The Health Ministry had also decided to set up intensive care unit beds in Armed Police Hospitals, increased intensive care beds at Sukraraj Tropical and Infectious Disease Hospital and in other state-run hospitals.

While an intensive care facility did get set up at the APF hospital, it is still not prepared to admit patients due to the lack of medical and technical staff. At Sukraraj Tropical and Infectious Disease Hospital, there are only a few intensive care beds in operation to look after the Covid-19 cases, and doctors there say they do not have the resources to treat critical patients.
Inadequate technical and human resources have hindered the country’s health facilities from mounting an effective battle against Covid-19. 

The government has managed to outfit the country’s Covid treatment facilities with only 581 isolation beds, 29 intensive care beds and 10 ventilators till date. Furthermore, only 18 health workers have been trained to treat severe cases of Covid-19.
“Technical human resources having years of experience are needed to run critical care units or intensive care,” Dr Hem Raj Paneru, general secretary of Nepalese Society of Critical Care Medicine told the Post, “If it was so easy, the government would have brought such units into operation long ago.”

According to Paneru, a big team of technical manpower comprising intensivist trained in critical care medicine, anesthesiologists trained in intensive care medicine, nurses trained to work in intensive care units, microbiologists, pharmacists, dieticians, physiotherapists, radiographer, biomedical engineers and cleaning staff are needed to run intensive care units.

He said only intensive care beds and ventilators are not sufficient to run a facility to treat Covid-19 patients. 

The facility also needs several other equipment, including a hemodialysis machine, a proper heating and ventilation system, and a central air conditioning system with appropriate filters for sterile air circulation, added Paneru.
“We had furnished a five-page long list of requirements for setting up an intensive care unit four months ago, but the Health Ministry did not pay heed to our suggestions.”

An official at the Ministry of Health and Population conceded to the lack of resources to run a well-functioning intensive care unit in Kirtipur, but he also claimed that there has been no Covid-19 patients requiring intensive care so far.   

“Serious Covid-19 cases who need intensive care have not increased yet,” Mahendra Prasad Shrestha, the Health Ministry official, told the Post. “Had the critical cases increased, there would have been some progress in setting up the intensive care unit in Kirtipur. Still, we are planning to set up a facility there.” 

Regarding the severe shortfall of health professionals working in the field of critical care, Shrestha said that the ministry plans to mobilise the officials from state-run medical universities to run the facility.

Public health experts are, however, doubtful about the ministry’s plan. 

They said infrastructure like intensive care units cannot be prepared overnight and waiting for patients to become critical to set up facilities means putting their lives at risk.

“We should prepare for the worst case scenario and the preparations should be started at the earliest,” Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj hospital, said.