It has been eight months since Manikala Rai’s husband Shirmani Rai died. Manikala, mother to seven children–five sons and two daughters, wonders if her husband would have been alive if she had been able to take him to a hospital on time.

But there are no hospitals in Diktel Rupakot Majhuwagadhi Municipality-12. When Shirmani lost consciousness on that fateful morning, Manikala wanted to take him to the district hospital 10 km away but the road to the hospital was blocked by a landslide.

“I couldn’t take him to the hospital that day. He never regained his consciousness,” said Manikala.

In times of medical emergencies, the residents of the municipality charter a helicopter to take their loved ones to a hospital but Manikala did not have the financial resources to book a helicopter for her husband.

“Now I’m a widow with seven children to look after. My husband would have been alive if I had enough money to charter a helicopter that day,” she said.

Manikala is one of the many in her village who have lost their loved ones due to a lack of timely treatment. The absence of good roads and fully equipped hospitals in the district compels the locals to rely on helicopters for medical emergencies but not everyone can afford the service.

Chartering a helicopter from Biratnagar or Dharan to Kathmandu costs at least Rs 180,000 to Rs 360,000. Poor families have to carry the burden of debt if they spend such a big amount to charter a helicopter.

Sangram Rai’s three-year-old child was badly injured on April 12. The resident of Rakha Bangdel in Aiselukharka Rural Municipality-1 had to charter a helicopter to take his son to Kathmandu for treatment. He spent Rs 180,000 on the fare.

Pawan Thapa, a 25-year-old man from the same village, fell off a swing last December and was badly injured. His family also had to spend Rs180,000 to reach Kathmandu for treatment.

Pregnant women suffer the most from a lack of good hospitals and roads in Khotang. While many pregnant women have been able to receive free services under the 'Rescue for Pregnant and Maternity Women at Risk in Remote Areas' programme under the Presidential Women's Upliftment Programme, the availability of helicopters in times of need is not guaranteed.

On April 23, Bimala Thapa Rai, a 29-year-old woman of Aiselukharka Rural Municipality-3, was admitted to a nearby health centre when she entered labour. Pregnant with twins, Bimala had to be taken to Thapathali-based maternity hospital in Kathmandu on a government helicopter the day after she was admitted to the health centre.

Sakuntala Rai, a 30-year-old woman of Nerpa in Diktel Rupakot Majhuwagadhi Municipality-6, gave birth at Diktel Hospital in the district headquarters on April 28. But soon her health deteriorated. She was rushed to Koshi Hospital in Biratnagar on a helicopter.

Assistant Chief District Officer Bikal Shrestha said that 15 pregnant women with health complications had to be rescued from the district by helicopter in the current fiscal year. Similarly, 103 pregnant women were rescued from across the country in the last fiscal year.

Manish Poudel, acting chief physician of the district hospital, said that due to a lack of adequate resources in the local health institutions, patients had to be airlifted by helicopter.

Many Khotang residents lost their lives due to untimely treatment during the time of Covid. Some of the casualties were patients who were airlifted by helicopter at a high cost.

According to Durga Ghimire, chairperson of the Senior Citizens' Association Khotang, the use of helicopters for medical emergencies in the district started around 2001. And even after more than two decades, there has been no significant improvement in the health services of the district. “Helicopter service has somewhat assuaged the sufferings of the locals but not everybody can afford it,” said Ghimire.

It has become a common thing for the district residents to go to Dharan, Biratnagar and Kathmandu for treatment. In the current fiscal year alone, 626 people have been referred from the district hospital to go out. Of these, 358 were referred from outpatient services, 89 from inpatient services and 179 from emergency services, according to the district hospital.

The government offices do not have the exact details of how much the people of Khotang spend annually on the treatment. For the people of Khotang, the government spends around Rs20 million annually in the district health office. And nearly the same amount is being spent by the locals while chartering a helicopter for treatment.

According to Vasant Shrestha, who is working as a liaison for helicopters of various airlines, around 100 helicopters are chartered annually in Khotang alone. And about ten of those are used by the political leaders, some are used by the hydropower companies and other wealthy people and except that all are used by the patients.

Based on Shrestha’s statement, the people of Khotang spend nearly Rs. 20 million annually by chartering a helicopter for medical treatment.

According to Khusnarayan Saiju, president of the Nepal Chamber of Commerce Khotang and former president of the Federation of Nepalese Chambers of Commerce & Industry Khotang said that not only the lives of the people but also the economic condition would be saved if improvement in the health sector was reliable. He also alleges that the local level is not even serious about improving the health facilities in the district.