By now the novel coronavirus pandemic has affected every corner of the globe. If it has not brought disease, it has at least brought the fear of infection. Cities, and indeed entire countries, are in lockdown. Fortress Europe has raised its walls higher. Airlines are grounded. Nepal has banned trunk international routes from Friday night. Even countries with excellent public health facilities and emergency preparedness plans are overwhelmed.
Nepal is now so closely intertwined with globalisation through migration, tourism and trade that its already-fragile economy has been badly hit even before a full-blown health emergency hits. Ironically, less-developed countries seem to have a built-in resilience that comes from being crisis-prone — since they are lower down in the economic ladder, they have a shorter distance to fall.
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Despite Nepal’s surprisingly dramatic improvements in mother-child survival over the past two decades, the public health system here is in crisis. State-of-the-art modern hospitals in the city, while reducing the need for Nepalis to go abroad for treatment, are out of reach of a majority of the population. Government health facilities are more affordable, but for the most part medical care there is not up to mark.
Nepalis are still afflicted by easily preventable water-borne diseases like typhoid and diarrhoea, vector-borne infections like malaria, encephalitis or dengue, and illnesses like tuberculosis and acute respiratory infections that spread through breathing. Great inroads have been made in reducing the impact of communicable diseases in the past decades through awareness programs, vaccinations and safer drinking water, but children in remoter parts of Nepal are still dying of simple infections.
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On top of this, urbanising Nepal now also has the added burden of non-communicable afflictions like diabetes, cardio-vascular ailments and renal disease. As families move from the districts to the cities, changes in diet and more sedentary habits have given rise to an epidemic of lifestyle-related diseases. This is compounded by genetic susceptibility among South Asians for diabetes and heart disease.
For example, a study by the BPKIHS in Dharan showed that while the national average for Type 2 diabetes prevalence is 8.1% of the population, the incidence in Dharan was 14%, while it was only 1% in Taplejung. The prime minister’s own second kidney transplant this month showed that ignoring risk factors and not diagnosing non-communicable diseases can lead to a huge health burden for families and the state. A small percentage of Nepalis have health insurance, so many middle income families fall below the poverty line due to medical expenses. Many Nepali migrant workers have been forced to seek jobs abroad to pay back debts incurred during hospitalisation of family members.
Last summer’s explosion of dengue in Kathmandu Valley was blamed on climate change. But it was actually a perfect storm of crowded and squalid living conditions, poor drainage, greater mobility of people, and a particularly wet monsoon. None of these factors have been addressed, so we are staring at a recurrence of dengue this year even while we cope with a possible COVID-19 outbreak.
Public health has not been a national priority for successive governments in Nepal. Even if it has, it is only in paper and has not really been translated into accessible and affordable healthcare for the general public. Governance failure has contributed to this state of affairs, but there is also the virus of corruption that has afflicted the entire government healthcare system. A politico-business nexus has also infected medical education, putting it out of reach of deserving poorer students.
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Into this mix, we now have the coronavirus scare. Officially, Nepal has just one case in which the patient recovered and has been discharged. The government has tested about 500 people, and all have been negative. Experts have confirmed that the tests are credible, and proper protocols are in place. But not enough tests have been done to determine if there are more people out there with the virus.
At $75 per test, the kits are expensive. This is where international help would be needed, and if the case rate rises the country will also need help with containment and mitigation. Nepal has been lucky so far that there is no indication of community transmission yet. But our luck could turn any day.