Is Nepal’s health system on the verge of collapse?

Covid-19 patients being treated outside a Covid Special Hospital in Dang due to lack of beds. (Photo courtesy: Drona Oli)

Ashim Neupane

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On Friday, the Health Ministry issued a statement saying hospitals are unable to manage beds for new patients, indicating the system is collapsing

Kathmandu: Case I: On Wednesday, a kidney patient diagnosed with Covid-19 experienced sudden difficulty in breathing. As the patient needed immediate oxygen support, family members started searching for an ICU bed. But there were no ICU beds available in any hospitals in the Kathmandu Valley. Even the doctors in their family contact failed to manage a bed for the patient. After hours of attempt, they were finally able to manage an ICU bed with ventilator support at a private hospital in Kathmandu.

Case II: On Thursday at the Shukraraaj Tropical and Infectious Disease Hospital, family members of a 50-year-old Covid-19 patient were continuously making calls to find an ICU bed. There were no available ICU beds with ventilator support at the Teku Hospital. “There are no beds available in government hospitals. And we do not have enough money to take him to private hospital,” his wife told Nepal Live Today. After eight hours of continuous attempt, they finally got an ICU bed with ventilator support.

These two cases just prove how difficult it has become to find an ICU bed. And the statement issued by the Ministry of Health and Population on Friday sums up that the health system is crashing.

“As the number of cases is rising, hospitals are unable to provide beds for patients. Our health system is not able to handle this situation,” the statement reads.

On Friday, Nepal Live Today talked to a few government hospitals handling Covid-19 cases. As only a few beds are available and serious cases are increasing every day, doctors said that our health system is on the verge of collapse.

As Covid-19 cases have been surging at a significant rate, there are no beds available in hospitals in the Kathmandu Valley and some other districts.

As Covid-19 cases have been surging at a significant rate, there are no beds available in hospitals in the Kathmandu Valley and some other districts.

Teku Hospital, the only infectious disease hospital, is already out of beds for Covid-19 patients. The hospital, having 120 beds, does not have any beds for new Covid-19 patients. “The hospital is already overwhelmed with patients, and we are not able to admit new patients unless those admitted are discharged,” said Sagar Rajbhandari, director at the Teku Hospital.

Dr Rajbhandari further added that almost 90 percent of the patients admitted in the hospital need oxygen support. “The cases are surging at a massive rate, and if we fail to break the chain, we will not be able to handle the consequences,” he added.

In the last five days, the number of patients in ICU has increased by 20 percent, and on ventilator support by 34 percent.

When Nepal Live Today contacted Bir Hospital, Covid-19 focal person of the hospital said that eight serious patients were on the waiting list to get admission. “The infection rate is increasing at a massive rate. If we fail to break the infection chain in the community level, the health system will be unable to handle pandemic in the next few weeks,” said Dr Achyut Karki, Covid-19 focal person of Bir Hospital, further adding that the hospital can handle almost 60 Covid-19 patients.

“As cases are increasing, the hospital is adding 30 more beds for Covid-19 patients. But these beds will also be full of patients within two-three days,” said Dr Karki, adding that next few weeks are going to be hard for the entire health system.

“Even if there was no pandemic, Nepal needs at least 40,000 beds. There are only 27,000 beds in government and private hospitals.

The Health Ministry has predicted the number of daily cases would hit 11,000 in May.

According to Dr Bimal Pandey, clinical coordinator of Covid-19 management of Patan Hospital, the health system is unable to handle the pandemic as all the hospitals are full of patients. “Covid-19 patients have to wait to get admission. If cases increase at the current rate, Kathmandu will become like the Indian capital Delhi in the next few weeks,” said Dr Pandey, adding the second wave is more deadly than the first wave.

“Last time, when the country was hit by the first wave, almost 15-20 percent of patients needed oxygen support. But now, more than 80 percent of patients need oxygen for treatment,” Dr Pandey added.

As all the beds were full of patients, the Patan Hospital added 80 beds on Thursday for Covid-19 patients. “The newly-added beds will also be occupied within a few days,” added Dr Pandey.

On Friday, the Kathmandu Valley recorded almost 3,000 cases, with 2,404 cases in Kathmandu district, 419 cases in Lalitpur district, and 133 in Bhaktapur district.

The Armed Police Force Hospital in Balambu is also out of ICU beds. “I get around 40-50 calls from people searching for beds. We are helpless,” according to Dr Prabin Nepal, Covid-19 focal person of the hospital.

According to Dr Baburam Marasini, a former director at the Epidemiology and Disease Control Division, the government seems clueless how to battle the pandemic. “The government can turn stadiums, schools, and open places into temporary hospitals to treat Covid-19 patients. Yes, hospitals are out of ICU beds, but the government can manage this situation in no time,” said Dr Marasini.

“Even if there was no pandemic, Nepal needs at least 40,000 beds. There are only 27,000 beds in government and private hospitals. Our health system was always weak,” said Dr Marasini, further adding that the government had a whole year to prepare to fight the second wave of pandemic, which the Health Ministry had already predicted.