State of Nepal’s health: The poor sell their land and properties for treatment while powerful politicians drain millions from the state coffers

Most kidney and cancer patients from the poor and low income background in Nepal have to sell their lands and properties to receive treatment. Reports show out-of-pocket expenditure on health is pushing over 74000 Nepalis into the poverty line.

Rita Lamsal

  • Read Time 5 min.

Shyam Narayan Shrestha, a 43-year-old resident of Saptari, was lying on the bed of the Dialysis Ward at Shahid Dharma Bhakta National Transplant Center in Bhaktapur. He had been undergoing dialysis for several months due to kidney failure.

He shared the pain he had been suffering from and the expenses incurred for his treatment for the past nine years while shedding tears of sadness. Due to the financial burden, he had to sell his ancestral land in Saptari to pay for dialysis services.

He said with teary eyes, “I had to sell all the ancestral land in Saptari to cover the expenses. This disease has made me helpless, neither can I do anything nor can I die.”

He did not want to live on dialysis for nine years. But due to the inability to find a kidney donor, he had to.

“I got my father’s health check-up done to donate his kidney, but he passed away,” Shrestha said. “I got my wife’s health checked to see if her kidney could be transplanted in me. I could only get her blood cross-matched three-four times, and the final test showed it was not possible.”

He is looking for someone who could donate kidney after death. To that effect, he got his name registered in hospital as well but to no avail.

Shrestha lives in Surya Binayak of Bhaktapur in a rented room, with his wife and an eight year old son. He goes to the hospital three times a week for dialysis. His health is poor, he cannot work.

He said, “I have to come to the hospital for three days every week. Dialysis weakens me, and I can’t work. My wife takes care of the household chores. That’s how our household runs. Without money, we cannot buy medicines.”

Although the government provides free dialysis services to kidney patients, Shrestha says that additional expenses for other medications and blood transfusions are too high.

“Dialysis may be free, but we still have to buy paracetamol, increase the blood count, and the needle for blood transfusion costs around 13-14 hundred rupees. We need two to three needles per week. The first packet of blood used to cost 400 rupees, but now it costs 800 rupees,” he said. “Dialysis is free, but the rest of things are quite expensive.”

He also shared that he spent around 15,000 rupees per month on other medications such as sugar tests, blood pressure, calcium among others.

“The government used to provide a monthly allowance of 5,000 rupees to patients like us, but we haven’t received it,” he shared.

Having been on a regular dialysis for nine years, Shrestha came to know that he was fortunate to receive dialysis and organ transplant services compared to other new patients. He said, “I have already crossed the hurdle for dialysis as an old patient. But the new patients cannot even get a turn. There are no beds or space for them.”

Next to Shrestha was Lal Bahadur Rana Magar, 34, the resident of Dadeldhura’s Aalital Rural Municipality, who had been undergoing regular dialysis for six years.

Like Shrestha, he had also sold his land to pay for treatment expenses. In six years, said Rana Magar, he spent around 2.5 million rupees for the treatment of his kidney disease. “I had to take a loan. I had to sell all my land.” “Dialysis is free, but you have to buy blood. It is difficult to afford the expenses.”

Rana Magar spends around 30,000 rupees on medication and treatment every month. Rana Magar and his wife manage household expenses by doing odd jobs.

Six years ago, he started feeling exhausted and experienced shortness of breath. After that, he underwent a health check-up at a Dadeldhura-based hospital and when his hemoglobin levels were found to be low, he was referred to Seti Zonal Hospital in Dhangadhi. After undergoing a health check-up there, both of his kidneys were found to be dysfunctional. “When they found at Seti Hospital that both of my kidneys had failed, they referred me to this center,” he said.

Initially, he had to undergo dialysis at the center after being admitted in the ward. After some time, he was informed that he could undergo dialysis at Seti Hospital itself. However, when Rana Magar’s mother offered to donate a kidney, he decided to go through transplant procedure in Bhaktapur.

He mentioned that he had already spent around 1.5 million rupees on his mother’s health check-up, but the examination showed that she also had kidney problems.

“I spent 1.5 million rupees on my mother’s treatment, all in vain,” he said.

Since there was no one available to donate a kidney for the transplant, he couldn’t undergo regular dialysis either.

Getting dialysis service, when it was available, was not easy either.  He had to wait for his turn in the cold December night, sleeping on the cold floor all night. “I slept in this hospital like this for one and a half years,” he said. His son and wife, who attended him, also had to endure the cold nights.

“My son was one and half years old when I was bedridden. I had to struggle a lot and spend a lot of money for dialysis. Once, it cost me 35,000 rupees. The doctor provided free dialysis only after one and half years,” Rana Magar told his story of woe.

Now Rana Magar receives regular dialysis service three times a week. But the new patients with kidney problems cannot receive free dialysis in government hospitals.

“I have received treatment as an old patient. The new patients cannot receive such treatment,” he explained.

Rana Magar has heard about the expansion of dialysis services in Dadeldhura’s regional hospital. But it takes seven hours form him to travel to the hospital from his home, which is too far and too difficult for the patient like him.

“I have to take blood transfusion up to three times a month. At least Blood Center is near in Bhaktapur. In Dadeldhura, it’s hard to get blood. It’s not even near my home,” he said.

As Shrestha and Rana Magar were discussing their health issues, news reports were circulating on social media that politicians had taken millions of rupees for their own treatments. Top leaders of political parties and those in power such as former president Dr. Ram BaranYadav, former PMs K.P Sharma Oli and Jhalanath Khanal and others with political connections were receiving millions of rupees from the state coffers for the purpose of health treatment.

The data of Ministry of Finance shows that Oli received 12.6 million rupees, Yadav 12.5 million rupees and Khanal 11 million rupees from the state coffers for their treatment. Notably, they are the leaders who are capable of spending for their health treatment from their own sources.

Like the kidney patients, most of the cancer patients from the poor and low income background have to sell their lands and properties to receive treatments against these diseases in Nepal.

The equal access to health for all citizens, which has been enshrined in the constitution as a fundamental right, does not seem to apply in case of the patients like Shrestha and Rana Magar and cancer patients, who are poor and who have to sell the little land and property they may have to pay for the health treatment.

The state of Nepal’s health, especially those of the poor, is alarming.  World Health Organization’s ‘Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region 2022’ shows that out of pocket expenditure on health is pushing over 74000 Nepalis into the poverty line.