Covid pandemic exposes country’s economic divideLack of adequate public health facilities mean that those who can’t afford to pay for tests as well as treatment have nowhere to go.
Rita Bhandari is staying at her home at Imadol, Lalitpur and she is worried. After learning that four of her colleagues tested positive for Covid-19, she, along with one of her friends, tried to get tested for five consecutive days last week. Then they gave up.
“Every day, we had to return disappointed,” said Bhandari.
The first day they were late when they got to the Sukraraj Tropical and Infectious Disease Hospital. The second day they were told to try other hospitals that collect swabs. The third day they went to three hospitals, including a private one which asked for a fee of Rs 6,500. On the fourth and the fifth days, they went to Sukraraj Tropical and Infectious Disease Hospital at 5 am to get tokens for tests, distributed on a first- come first-served basis.
Every day over 1,000 people visit Sukraraj hospital for tests, but the hospital can test only 300 samples in a day, according to officials.
On the fourth day, Bhandari and her friend could not get tokens as others shoved their way through the queue. On the fifth day, there was a melee and police had to disperse the crowd.
“We threw our tickets in front of the doctors and the police and returned home," Bhandari told the Post. “We would rather die at home than seek a test at the hospital,” said Bhandari.
The Ministry of Health and Population has designated 14 hospitals in Kathmandu Valley—nine public, three private and one community-run—for swab sample collection but most of the designated hospitals are not complying with the directives.
The two public hospitals that Bhandari and her friend visited—Paropakar Maternity Hospital and Civil Hospital—turned them back.
There are others who have similar stories to tell. Pradeep Acharya and his wife also went to Sukraraj Tropical and Infectious Disease Hospital last week seeking tests after his brother, a health worker, tested positive for coronavirus. “We turned back fearing that we would get infected at the hospital,” said Acharya.
The Covid-19 crisis has not only exposed the fragile health care system, but also the economic divide within the society.
“Those who can afford it will pay and get tested, but the poor are being deprived of government facilities,” said Dr Bhagwan Koirala, who has advised the government on ways to tackle the pandemic. “Influential and well-off people are getting tested, which is not good. The government should take the responsibility for everyone, but it should always prioritise the poor.”
In addition to the 300 persons who stand in queue, Sukraraj Tropical and Infectious Disease Hospital has to perform tests of police personnel, employees of courts, and of those recommended by influential people, according to the hospital administration.
“Technicians at the hospitals work extra hours to perform the tests,” Dr Sagar Rajbhandari, director at the hospital told the Post.
While it used to take five days for results of tests at Sukraraj Tropical and Infectious Disease Hospital it now gives results in a day now.
In private hospitals too they come within a day. A doctor at a private hospital told the Post that it costs about Rs 60,000 a day to treat a Covid-19 patient and this could go up depending on the complications and the level of treatment. “This includes Rs 30,000 for personal protective equipment (PPE) for doctors and nurses who attend to the patient in three shifts,” he said.
Meanwhile, there are not enough isolation beds in Kathmandu. According to officials at the Epidemiology and Disease Control Division, around 70 percent people who tested positive for coronavirus infection are in home isolation due to lack of isolation beds in hospitals.
According to MInistry of Health, as of Tuesday 6,752 persons are in institutional isolation while 2,887 are in home isolation across the country. A total of 182 are in intensive care units, of which 52, the highest number, are in Bagmati Province. All of the eight persons on ventilator support are in Bagmati.
Kathmandu is among five districts with more than 500 active cases—the others being Morang, Parsa, Rautahat and Mahottari.
The government has said that all hospitals must allocate 20 percent of their beds for Covid-19 patients, but that comes with the risk of spreading the infection among health workers, and therefore other patients in those hospitals.
“We are not in a position to treat Covid patients as chances of spreading the virus will increase if we have Covid patients at our hospital,” said Kumar Thapa, chairman of Alka Hospital and former president of Association of Private Health Institutions of Nepal.
Private hospitals that have treated Covid-19 patients, meanwhile, say that there is immense pressure on them from influential people to treat them, although they are not authorised to do so.
“We tell the patient’s family to take them to a designated Covid-19 hospital, but they refuse to do so and we get phone calls,” said a doctor at a private hospital.
Decisions were taken to set up isolation beds, intensive care units and procure ventilators and billions of rupees were allocated. But authorities concerned have been scrambling to arrange isolation beds only after a number of cases started to spike.
“I have been telling officials at the health ministry since the beginning that our health facilities will be overwhelmed soon and we have to be prepared for the worst case scenario,” Koirala told the Post.
It was only earlier this month, more than four months after the government imposed a nationwide lockdown, that the government allowed 14 hospitals in Kathmandu Valley to collect swabs and conduct tests.
“This shows how serious we are about containing the spread of infection,” Dr Baburam Marasini, former director at the Epidemiology and disease Control Division, said.
“We make an excuse and say we can’t do anything,” an official at the Health Ministry said. “But this is a very good example of the failure of the state. There is no lack of resources, but we have not been able to arrange beds and equipment.”
Old fault lines have reappeared and the Covid-19 pandemic has exposed the results of historic “criminal negligence” of the public health sector, experts say.
“Improving the public health care system has never been a priority of any government including the incumbent government,” Dr Aruna Uprety, public health expert, told the Post. “Even after the decision to arrange beds, infractures, and allocate money, government decisions are not implemented and no one is being held accountable for it. Only those who can afford to pay are getting treatment.”