Protecting those who protect us from the epidemic
As the COVID-19 pandemic sweeps the globe, hospitals have been overwhelmed. Nepal is ahead of the curve, but if the case load is to rise steeply as it has done in Italy or Spain, the government needs to start preparing ICUs, ventilators, and protective gear for hospital staff.
At present, nurses, doctors, interns and resident doctors and other medical personnel in Nepal’s hospitals lack personal protective equipment (PPE), and they fear for their own lives while treating patients with suspected coronavirus.
Patients can be carriers and spreaders of the virus without showing any symptoms. Thousands have been visiting hospitals to get tested, have chest x-rays done, and could be unknowingly infecting medical staff.
“If we find issues with the patient’s lungs after the chest x-ray, we monitor them closely for infection,” says a doctor at a medical college in Kathmandu. “By the time we confirm whether they have been infected, the virus could infect many others in the hospital treating them, like myself.”
Many doctors and even interns do not have a choice, and treat patients without PPE. “If you don’t go to work, the medical college won’t give a certificate,” the doctor complains.
Staff at the Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu which gets most of the referrals of suspected coronavirus cases are most at risk. Sagar Kumar Rajbhandary works 12 hour shifts at the Teku hospital, and says PPE are must-have given the number of patients coming in for checkups every day.
“We need at least a 100 PPE units right away, but we have not got it yet,” says Rajbhandry. The anti-biohazard equipment include respirator masks, sterile hoods, gowns, and goggles.
For the past month, hospitals across Nepal have been treating patients coronavirus symptoms without proper PPE, and the medical system is ill-prepared for a major outbreak.
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“Since a few units of PPE are not going to be enough, and because they are so expensive we have no choice but to start making them locally,” says Paras Pandey at Bheri Hospital in Nepalganj who is not waiting for help from Kathmandu, and has already made 200 PPE at a local garment factory.
The PPE gown is improvised from thin plastic, and the goggles have been made from transparent stationery, while the helmet is fashioned out of elastic apparel material. Pandey says other hospitals in the region have also copied the design.
Protective gear are being manufactured at four other sites, including by the Innovation Centre of Mahabir Pun (see box), the Karnali Health Science Institute, the Dharan-based BP Koirala Health Science Institute.
Although these Nepal-made PPE are not as high quality as imported ones, they at least offer some protection to medical staff. One imported PPE can cost anywhere up to Rs20,000, but a locally manufactured one costs only Rs250.
“We got local tailors to make 50 PPEs on the first day itself, they are cheap but effective, and serve the purpose for now,” said Mangal Rawal of the Karnali Health Science Institute.
Tourism entrepreneur Suman Pandey says if the government only gave him permission, her could get workers with experience in making trekking gear to start assembly line manufacture of PPEs. He has already made two prototypes which could be also worn by ambulance drivers and helicopter pilots transporting infected people.
The PPE also needs to be disposed of properly after use in the medical wards, the ICU or even in front of a patient getting tested for COVID-19. One doctor or nurse needs at least eight units of PPE every day.
Bhogendra Raj Dotel at the Ministry of Health, is currently working to procure more PPEs, but there is a shortage in the world market. In case, all flights have stopped, so there is no way to bring them here quickly.
“It is not possible for donor countries to respond because they are dealing with shortages themselves,” Dotel explains. Suppliers who used to source PPEs from Singapore, Thailand, China and India are not getting new units because they have stopped exports.
Nepal’s hospitals also have a chronic lack of oxygen cylinders and ventilators even at the best of times. If the pandemic hits Nepal with full force, medical facilities just do not have the equipment to treat critically ill patients.
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Besides this, the government procurement process is cumbersome, and although a tender was issued for PPE, gloves, boots, digital thermometers and other essential items on 15 March, delivery is uncertain.
The department had requested bids to supply materials for a 1,000 bed isolation ward and 235 ventilators. But even these would not be enough if the infection rate rises.
The Nepal office of Nick Simons Institute (NSI) flew in 11 portable ventilators from the United States and they arrived on 16 March. NSI is also committed to supply 1,000 locally-made PPE to the government.
China has also committed to help with medical supplies including PPE, but Mahendra Shrestha of Department of Health Services said they had not yet arrived.
How Facebook came to the rescue
Mahabir Pun, the Magsaysay Award winning Nepali activist, knew that Nepal’s health system would not be able to function unless nurses, doctors and technicians had protective gear for treatment of patients.
Since imports were impossible because of flights being cancelled, Pun decided that his centre would start churning out PPEs. He even brought 2,500 metres of fabric, but could not find a single tailor shop open in Kathmandu Valley.
So on 23 March, he posted a message on his Facebook page asking for tailors. He has nearly 100,000 followers, and the word spread quickly. Soon Pun started getting inundated with phone calls from tailors and garment shops all over the city.
Garment factories in Balaju and Putali Sadak offered to stitch prototypes, which are now ready. “We will now show them to doctors, and if they approve we will start mass producing protective gear and distribute them to hospitals all over the country,” Pun told Nepali Times.