<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ab9c7e80680e06f104jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91ad9c7e80680e06f105jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b09c7e80680e06f106jpeg.jpg" alt="" width="768" height="513"><figcaption>Crowded Covid ward at Teku Hospital. Photo: AMIT MACHAMASI</figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b39c7e80680e06f107jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121140/636b91b69c7e80680e06f108jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

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Nepal’s doctors are like soldiers fighting a war

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2839c7e80680e09d913jpeg.jpg" alt="" width="960" height="640"/><figcaption>Photo: BIKRAM RAI/NEPALI TIMES ARCHIVES</figcaption></figure>Prashuma Malla had never felt so helpless as a physician. Her patient, a man in his 40s, was suffocating, incapable of drawing in breath.But the hospital ventilators were all occupied, and the central supply of oxygen was very low. She pronated her patient while his wife sobbed near him.“With no oxygen, we can do nothing,” said the 28-year-old second year medical resident specialising in anaesthesia at Bir Hospital in Kathmandu. “It is scary. It is non-stop. I try to tell myself everything is OK. But what can we do? Eight people have already died on my watch.”Malla and her colleagues are on the <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEZnm1Wh-lIyg9tsnCRr9-mgD_R4Q">Covid frontlines in Nepal</a>. Her world is a haze of 36-hour intense, and often terrifying shifts, at Nepal’s oldest and best-known public hospital.As in many <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNELCBtyZv7D1U8LDXT-i7HJPRZbeQ">government hospitals in Nepal</a>, relatives follow patients in the wards, providing food and running to pharmacies to purchase medicine. <a href="https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/nepals-frontline-workers-brave-it-out/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGmvFGTkOC_M_eTcOYyHWYTMLFBJw">Bir Hospital is overwhelmed</a>. People are sleeping in hallways, stairways, curled up on patients’ beds, pacing from room to room.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2869c7e80680e09d914jpeg.jpg" alt="" width="1500" height="850"><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf2899c7e80680e09d915jpeg.jpg" alt="" width="768" height="513"><figcaption> </figcaption></figure>Doctors believe many relatives are sick as well, but the hospital does not have enough PPEs for them, and there is a serious shortage of oxygen.“We are exposed to the virus all the time,” Malla said of her shifts with the sickest of patients. “Everywhere you go is a Covid ward.”Malla and her colleagues have also become counsellors. But with every patient, her job gets harder because most are in their 30s and 40s, and increasingly some in their 20s are being brought in.In the chaos, it calms her to explain every detail to relatives. What does it mean to be intubated? Why once intubated it is hard to take patients off, and they usually die if they are taken out. No, they cannot take the body to be cremated: only police or soldiers can remove it from the hospital.“They are confused, they have never seen someone come off an intubator. I remind them: there is no guarantee,” Malla said.Every move Malla makes, every decision she takes, she reports to her superior. And every day at the shift handover, she has to be careful with the safety precautions.At the end of her shift that lasts more than 24 hours, Malla heads home on her scooter through light traffic because of the lockdown. She lives in a tiny two-room apartment with her two brothers, and is terrified of infecting them.She washes immediately, including her mask and face shield. Masks are always on, they cook together. Briefly unmasked, she eats alone on a miniature terrace. She talks on Viber with her parents in central Nepal.Every day, sometimes every hour, they remind each other to stay safe. She tries to focus on her online medical classes. She doesn’t want to fall behind. But always that nagging fear. Death is lurking. Near her. Floating and invisible.Although Nepal’s second wave appears to have peaked, and the official number of Covid-19 cases and mortality is down, there are <a href="https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-covid-19-impact-worse-than-official-figures/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGD_zw--sdgKNcbkUD2EUdjZg82Lw">doubts about how accurate the figures are</a>.The number of daily recoveries is now higher than new infections, and the official death toll is hovering around 100 every day, which is half what it was three weeks ago. The number of active cases fell below 100,000 for the first time in more than one month on Saturday. But there are still more than 1,500 <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHxZUs6NeKiFHYbFIJkkSZzx7D9vg">patients in ICUs</a> nationwide, with 450 of them needing ventilator support.More and more cases in city and <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNFpAtg51hSoSi41jBs4YjPKQ9MsVA">district hospitals</a> now are from the hinterland, and there are indications that the <a href="https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/editorial/nepals-humanitarian-emergency/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGRytlb8jAYJB_hKJQNVCuwiFBmEQ">virus has spread to the remotest communities </a>in the mountains where there is no hospital care. And no <a href="https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/life-hangs-by-an-oxygen-tube-in-nepal/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNF2Eis06JvGsCzy_McEPymUP-h5sw">supplemental oxygen</a>.<a href="https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/in-nepal-virus-climbs-from-plains-to-mountains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEsKzdZRZejQF0SGnV4lSHoAk0EHQ">In rural Nepal</a>, there is now hope from ground-breaking tele-health that is transforming medical care.Hari Neupane is fighting Covid-19 with his cell phone. He is simultaneously a doctor, nurse and mental health expert, and works with <a href="https://www.healthfoundationnepal.org/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.healthfoundationnepal.org&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGdGiTiG90TCoPVsSwtrWug2LqVYA">Health Foundation Nepal</a>, a Kathmandu-based volunteer-staffed telemedicine service that reaches out to patients across 35 districts in Nepal via its Kathmandu hotline.Neupane leads a team of seven doctors in Dang Valley in mid-western Nepal. Because of the large numbers of workers returning from India and its rudimentary medical facilities, Dang bore the brunt of the pandemic in both the first and second waves.As the monsoon approaches, it is soon rice planting season but a national lockdown has left fields, streets and roads empty, void of the everyday crowds and cacophony of passing trucks.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28c9c7e80680e09d916jpeg.jpg" alt="" width="1500" height="1000"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131144/636cf28f9c7e80680e09d917jpeg.jpg" alt="" width="1500" height="1000">In Dang in western Nepal, the highways are empty because of the lockdown, while farmers are busy preparing for rice-planting. Photos: HARI NEUPANE<a href="https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/article/nation/long-distance-medicine-in-nepal,3521&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNGKSSvGC8yUXhCQ9FP5G-0uZmJjng">Telemedicine is new in Nepal</a>, and medical teams in the field in Nepal are supervised by Ashok Devkota, a doctor of internal medicine in Providence, Rhode Island, in the United States The organisation’s seven full-time workers and 50 part-time physicians are all volunteers.Most of Neupane’s patients across Nepal have Covid symptoms, but most have not been tested. Working closely with local health posts, Neupane’s team identifies symptoms, using cell phones – voice, photos and videos – as medical communicators.They connect patients via cell phone with pharmacies and if necessary source portable oxygen. The very sick are referred to the hospital.“We focus on people in home isolation and counsel them on the medicines they need and how to get them. We prescribe steroids and do follow-ups and notify local government officials,” Neupane explained.In Dang, cell phones have become transformative lifelines at many levels. They are a critical means of money transfers from relatives working abroad, so that families can pay school fees, medical bills and food.This year’s lockdown has made day-long walks to access medical care virtually impossible. Even if patients can get to a hospital, chances of a bed are slim. In Dang, there are only 155 intensive care beds and 15 ventilators, most of them occupied.Health Foundation Nepal advertises its telemedicine counselling through social media and newspapers. It cannot take blood tests, but with the help of local health workers can monitor oxygen saturation, blood pressure and temperature and can gauge the condition of the patients to recommend a solution.“Telemedicine existed in Nepal before but before Covid people did not accept it much, but now it is helping save lives,” said Ashok Devkota, the Nepali doctor in the US who supervises medical staff like Neupane half-way around the world Nepal. And as long as Neupane’s cell phone stays charged, he is on duty.The pandemic and political crisis in Nepal have increased the risk of Nepal becoming an imploding catastrophe. The country was just beginning to recover from the 2015 earthquake, and was struggling with pre-existing health challenges, and earlier this year was beginning to think the worst was over when the second Covid-19 wave struck.The health and economic crises <a href="https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/latest/covid-19-to-reverse-child-survival-gains/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNHA2oJKTj8wDzac2WJdbkvphDJODQ">threaten the gains Nepal has made</a> in the past years in fighting malnutrition, immunisation against other infectious diseases, child labour, early marriage and women’s rights.But if Nepal is a petri dish of disasters, it is also one of innovation and individual dedication. This pandemic once again is a place where despair is often met by individual and community fortitude by medical workers like Prashuma Malla and Hari Neupane.Donatella Lorch is a former New York Times foreign correspondent who lived three years in Nepal. She blogs at: <a href="https://tangledjourneys.com/about/" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://tangledjourneys.com/about/&amp;source=gmail&amp;ust=1623050870892000&amp;usg=AFQjCNEHm4HaaRyE_KrqKL6VlN7zbgNjlQ">tangledjourneys</a>

<figure><img width="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec639c7e80680e09ad61jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec669c7e80680e09ad62jpeg.jpg" alt=""><figcaption>Bayalpata Hospital in Achham run by the non-profit Nyaya Health Nepal is treating a flood of Covid-19 cases.</figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec699c7e80680e09ad63jpeg.jpg" alt=""><figcaption>Achham District made this urgent plea for equipment last week.</figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cec6c9c7e80680e09ad64jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

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At the Covid-19 frontlines in rural Nepal

<figure><img width="1641" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84419c7e80680e067784jpeg.jpg" alt=""/><figcaption>Services provided from outside of OPD due to Covid cases. Photos: NYAYA HEALTH NEPAL</figcaption></figure>Nepal’s rural health system, already underfunded, understaffed and overstretched, is struggling with the enormous added burden of the Covid-19 pandemic.  Having barely coped with the first wave last year, hospitals in the remote mountains of Far-Western Province have found that the variants in the second wave are much more lethal, there are many more patients than before, and more of them require hospitalisation.  In Achham district the administration declared a lockdown on 3 May, but by then the virus was already spreading within families and house-to-house. Till the day before the lockdown, people were still arriving by the busloads from India, Kathmandu and other cities. Testing and tracing were lax, and they were mingling in the markets.  On Sunday, Nepal added 8,850 new confirmed infections, bringing total active cases to 88,160. There were 52 fatalities but 26 more died at home. Kathmandu reported 4,198 cases in the last 24 hours. There are 832 people in ICU across the country, and 267 patients on ventilator support. In the village of Jaygad of Achham, for example, an annual fair with large crowds was being held even as 13 out of 15 sample antigen tests came out positive. The virus was spreading into the remotest villages. “We have increased awareness programs and testing, and local governments have become more active in the recent days and taken more ownership of testing and information dissemination,” says Janakraj Dhungana at Achham’s District Health Office.  But many wonder whether it is too late to be disseminating information through loudspeakers on masking and distancing, when patients and families throng ill-equipped hospitals. Dhungana himself admits that there was not enough testing and isolation because of a shortage of kits.  Like other districts of Far-Western Province, the caseload in Achham is increasing, with 2,183 positive cases and 17 deaths so far. Of this, 511 positive cases and 6 deaths are during this second wave.  The vaccination drive was also suspended after 3,000 medical personnel and community health workers were inoculated. But 15,000 senior citizens in Achham alone still have not got their second doses yet.  <figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84449c7e80680e067785jpeg.jpg" alt=""><figcaption> </figcaption></figure>The government has now asked all hospitals to also treat Covid-19 patients. Bayalpata Hospital in Achham, which is run by the non-profit Nyaya Health Nepal in partnership with the local government, was not a designated Covid-19 hospital during the first wave. This year, it is treating a flood of Covid-19 cases.“We had set aside an entire wing for coronavirus cases, but there has been such a surge in the past week that we have turned the emergency room into a Covid ward,” says Mandeep Pathak, medical director at Bayalpata Hospital. “We converted five rooms set aside for drug-resistant tuberculosis treatment for Covid patients.”Bayalpata is currently treating 26 patients with Covid-19, all of them with low oxygen saturation levels, but new cases are being admitted every day. The hospital has also had to reassign eight rooms for Covid-19 patients, including for 14 of its own staff who have tested positive. In Dadeldhura Hospital a four-hour drive to the west, all 31 beds are full with Covid-19 patients, and although there are only five ICU beds, 13 patients are receiving intensive care. In the neighbouring district of Doti, it is the same story.“Even if we have beds, we have no oxygen, it is a vicious cycle,” says Jagdish Bista, Medical Superintendent at Dadeldhura District Hospital. “The most urgent need now is oxygen, and we are also running out of PPEs.” But what worries the doctor more is the 50-70% positivity rate of testing, and what this means for the next two weeks.For the time being, the nursing staff shortage has been alleviated with new transfers. But Dadeldhura Hospital’s oxygen plant cannot cope with demand, and there are difficulties to get cylinders refilled in Nepalganj and Dhangadi. Covid-19 has taken precedence over other cases, apart from emergencies and deliveries. Most patients are in the 30-year-old range, and those turned away seek help in Dhangadi’s Seti Hospital, which is also inundated.Patients who can get to hospital and get admitted in this remote region are the lucky ones. Local municipalities have built isolation centres, but most are empty because there is no oxygen and no medical personnel, says Devraj Devkota of Panchadeval Binayak municipality. <figure><img width="1753" height="2409" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b84479c7e80680e067786jpeg.jpg" alt=""><figcaption> </figcaption></figure>“Our people prefer to either isolate at home or try to get to a hospital if their condition deteriorates,” he adds. “We have had no help from Kathmandu.”But Nepal’s cities, including in the capital, are also out of hospital beds and oxygen, so there is little hope for outside help. In fact, a reverse flow is starting: critical Covid-19 patients in Kathmandu are being helicoptered to Jhapa or Kaski where there are still hospital beds with oxygen.The need in every municipality in the far west is the same: oxygen cylinders, pulse oximeters and testing kits, and additional hospital beds for serious cases.Says Achham’s District Health Officer Dhungana: “Oxygen is a problem. We depend on Dhangadi and Nepalganj to refill cylinders. They get used up fast, which has made it a logistical challenge.” There is also a critical shortage of staff. Despite vacancy notices, there were few applicants for specialised medical personnel even pre-pandemic. For example, although the District Hospital in Mangalsen has ventilators, there is no one to run them, and there isn’t enough oxygen.Patient referrals to city hospitals offering critical care, or just beds with oxygen, are also complicated. They are also overwhelmed, and there are few ambulances with oxygen for the 8-12 hour journey across mountain highways. Ambulances are expensive, and helicopter air lifts are even more costly. Despite this, desperate families have taken loans to try to save family members in critical conditions by air lifting them to city hospitals—often too late. Then there are all the other non-Covid trauma patients needing urgent surgery, or maternity cases. With its free treatment, Bayalpata Hospital has served more than 1 million patients from Achham and six surrounding districts of Karnali and Far-West Provinces in the past 12 years. Separating Covid-19 and other cases is a challenge for doctors like Mandeep Pathak (pictured right) who do not like to turn patients away. Even though the height of the pandemic this week, the orthopaedic surgeon has performed 15 operations, including on a 13-year-old boy from Kalikot with a fractured leg. In the past month, Bayalpata Hospital has performed 77 deliveries, of which eight were caesarean sections. “The staff adjust, innovate, accommodate, reallocate, adapt and have kept working right through the pandemic,” Pathak says. <img width="1906" height="1398" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b844b9c7e80680e067787jpeg.jpg" alt="">New health protocols have been adapted to minimise disruptions, and Bayalpata is seeking resources to help with the crisis. There is fear that regular services will be increasingly impacted as the pandemic peaks.  The lockdown also means that families may wait till the very last moment to take patients to hospitals, by when it is usually too late. Bayalpata Hospital has therefore modified some of its regular services to remote care via phone calls. Bayalpata Hospital’s community health program, for example, that provides regular group antenatal care to pregnant women has been severely impacted. While the program was offered throughout the first wave, it has been interrupted during the second wave, and staff have had to resort to phone-based counselling and follow-up unless in case of emergencies.  The fear is that far-flung and traditionally neglected districts like Achham will be the last to get test kits, PPEs, oxygen, hospital beds and eventually vaccines. The progress Nepal has made over decades in rural healthcare is being undone by the pandemic.  For offers of assistance to hospitals in Far-Western Nepal, contact: Bayalpata Hospital: <a target="_blank" rel="noopener noreferrer">srijana.devkota@nyayahealthnepal.org</a> +977 9851093920   Dadeldhura Hospital: +977 9858753201 (Dr Jagadish Bista) <a href="https://give2asia.org/covid-19-pandemic-response-nepal/" target="_blank" rel="noopener noreferrer">https://give2asia.org/covid-19-pandemic-response-nepal/</a>

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebe19c7e80680e09ad30jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Ever since he was a child, Ramesh* knew he wanted to be a doctor to serve society and "do something good for others". Even now, as an MBBS student at B P Koirala Institute of Health Sciences (BPKIHS) in Dharan, his zeal is intact. As a part of his curriculum, he is required not just to attend lectures but also complete clinical postings. And that is what he was doing till a few days ago when he tested positive for Covid-19."I started feeling unwell during the exams, and took a PCR test. The result came out positive. I have been isolating since," Ramesh told us on the phone from Dharan.In January, when the government announced the priority list for the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first round of Covid-19 vaccines</a>, medical interns and doctors were on it. Many admin staff working in the hospitals also qualified for the jab. However, missing from the list were medical students who work in close proximity with the patients as a part of the curriculum. BDS and MBBS students have to do ward and clinical postings in their third, fourth and fifth years. Nursing students too have hands-on training as part of their course work."We all know that wearing a mask is one of the best precautions we can take against Covid. But as dental students, we need to treat patients when they are not wearing masks. The risk of exposure is the same for us as the interns, yet we did not get the vaccine," says a dentistry student from BPKIHS, whose friend recently tested positive as well.<a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">Masks and vaccines to stop Nepal’s 2nd wave</a>, Sushil KoiralaAfter the first lockdown, BPKIHS like many others <a href="https://www.nepalitimes.com/latest/face-to-face-classes-online/" target="_blank" rel="noopener noreferrer">conducted classes online</a>. However, as the country opened up slowly, clinical postings for fourth year students started from 1 December. While they conducted PCR tests for those seeking admission in wards, those coming to the Out Patient Department (OPD) could not be monitored. "Even in wards, although patients were tested the same was not true for the visitors," says a final year medical student at BPKIHS. According to the students as many as 25 of these colleagues have tested positive over the past few months. Students say they have talked with the school administration, but were told there was no government protocol to get them the vaccine. Medical students from other schools that Nepali Times spoke to shared similar stories. "We would be a little more confident if we were vaccinated," says a medical student from Birat Medical College in Biratnagar. "It is not just about us being exposed or working, we have lost a lot of valuable time in terms of our course work.” After the first lockdown, classes here went online and the practical classes were conducted without hospital exposure. "But after the third year finals, we were called for clinical postings," says the student. "Maybe they could have given us the vaccine and we could continue with our classes."It is not just the students, new interns who recently graduated, have entered, or are soon entering the workforce were also left out.<a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/"> Nepal fights infodemic to push vaccine</a>, Sonia AwaleGita* is a medical student at Kathmandu University's medical school recently passed her final exams, and is starting her internship. Even though she and friends were omitted from the priority list last year, she was planning to get the <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer">Vero Cell jab</a> this time around. Poor planning and overcrowding prevented her from getting vaccinated, then she had to return to school to start her internship. "New interns who just started last Saturday were left out from the list," says an intern coordinator at a medical school in Biratnagar. "Students don't get the same level of protection as the faculty. We have talked to interns about safety measures and precautions. And we are also looking into simulation-based teaching for practical classes.”It is not just for the safety of students but the patients as well that the students and new interns need to be vaccinated. When they are vaccinated, they can ensure that the patients are not going to get infected through the ones who are treating them, say the students."While the vaccines may not work against the new variants and there are chances of being infected even when you are vaccinated, the severity of symptoms is less," says an intern doctor who tested positive after the second jab.With the lockdown on 28 April, medical schools have also now suspended classes. Trainee doctors in India are being pulled from the exams to work on the frontline, and Nepal’s medical students may have to do the same. "Maybe keeping this in mind, they could still give this a serious consideration and vaccinate the students and new interns," says a final year student at BPKIHS.Spokesperson for Ministry of Health Jageshwor Gautam, however, says that young people are still not a priority. "We are aware of the situation,  the reason medical students didn't get vaccines is because there are just not enough doses." Asked if medical students will be given priority once new vaccines arrive, Gautam replied flatly: "People above 60 years are still a priority. Everyone else comes after that."*Some names have been changed or withheld for privacy reasons.

Sahina Shrestha

Medical students deprived of Covid-19 vaccines

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83bd9c7e80680e067753jpeg.jpg" alt=""/><figcaption>Photo: MONIKA DEUPALA</figcaption></figure>Ever since he was a child, Ramesh* knew he wanted to be a doctor to serve society and "do something good for others". Even now, as an MBBS student at B P Koirala Institute of Health Sciences (BPKIHS) in Dharan, his zeal is intact. As a part of his curriculum, he is required not just to attend lectures but also complete clinical postings. And that is what he was doing till a few days ago when he tested positive for Covid-19."I started feeling unwell during the exams, and took a PCR test. The result came out positive. I have been isolating since," Ramesh told us on the phone from Dharan.In January, when the government announced the priority list for the <a href="https://www.nepalitimes.com/banner/nepal-begins-covid-19-vaccination-drive/" target="_blank" rel="noopener noreferrer">first round of Covid-19 vaccines</a>, medical interns and doctors were on it. Many admin staff working in the hospitals also qualified for the jab. However, missing from the list were medical students who work in close proximity with the patients as a part of the curriculum. BDS and MBBS students have to do ward and clinical postings in their third, fourth and fifth years. Nursing students too have hands-on training as part of their course work."We all know that wearing a mask is one of the best precautions we can take against Covid. But as dental students, we need to treat patients when they are not wearing masks. The risk of exposure is the same for us as the interns, yet we did not get the vaccine," says a dentistry student from BPKIHS, whose friend recently tested positive as well.<a href="https://www.nepalitimes.com/opinion/masks-and-vaccines-to-stop-nepals-2nd-wave/">Masks and vaccines to stop Nepal’s 2nd wave</a>, Sushil KoiralaAfter the first lockdown, BPKIHS like many others <a href="https://www.nepalitimes.com/latest/face-to-face-classes-online/" target="_blank" rel="noopener noreferrer">conducted classes online</a>. However, as the country opened up slowly, clinical postings for fourth year students started from 1 December. While they conducted PCR tests for those seeking admission in wards, those coming to the Out Patient Department (OPD) could not be monitored. "Even in wards, although patients were tested the same was not true for the visitors," says a final year medical student at BPKIHS. According to the students as many as 25 of these colleagues have tested positive over the past few months. Students say they have talked with the school administration, but were told there was no government protocol to get them the vaccine. Medical students from other schools that Nepali Times spoke to shared similar stories. "We would be a little more confident if we were vaccinated," says a medical student from Birat Medical College in Biratnagar. "It is not just about us being exposed or working, we have lost a lot of valuable time in terms of our course work.” After the first lockdown, classes here went online and the practical classes were conducted without hospital exposure. "But after the third year finals, we were called for clinical postings," says the student. "Maybe they could have given us the vaccine and we could continue with our classes."It is not just the students, new interns who recently graduated, have entered, or are soon entering the workforce were also left out.<a href="https://www.nepalitimes.com/banner/nepal-fights-infodemic-to-push-vaccine/"> Nepal fights infodemic to push vaccine</a>, Sonia AwaleGita* is a medical student at Kathmandu University's medical school recently passed her final exams, and is starting her internship. Even though she and friends were omitted from the priority list last year, she was planning to get the <a href="https://www.nepalitimes.com/latest/the-gift-of-the-jab/" target="_blank" rel="noopener noreferrer">Vero Cell jab</a> this time around. Poor planning and overcrowding prevented her from getting vaccinated, then she had to return to school to start her internship. "New interns who just started last Saturday were left out from the list," says an intern coordinator at a medical school in Biratnagar. "Students don't get the same level of protection as the faculty. We have talked to interns about safety measures and precautions. And we are also looking into simulation-based teaching for practical classes.”It is not just for the safety of students but the patients as well that the students and new interns need to be vaccinated. When they are vaccinated, they can ensure that the patients are not going to get infected through the ones who are treating them, say the students."While the vaccines may not work against the new variants and there are chances of being infected even when you are vaccinated, the severity of symptoms is less," says an intern doctor who tested positive after the second jab.With the lockdown on 28 April, medical schools have also now suspended classes. Trainee doctors in India are being pulled from the exams to work on the frontline, and Nepal’s medical students may have to do the same. "Maybe keeping this in mind, they could still give this a serious consideration and vaccinate the students and new interns," says a final year student at BPKIHS.Spokesperson for Ministry of Health Jageshwor Gautam, however, says that young people are still not a priority. "We are aware of the situation,  the reason medical students didn't get vaccines is because there are just not enough doses." Asked if medical students will be given priority once new vaccines arrive, Gautam replied flatly: "People above 60 years are still a priority. Everyone else comes after that."*Some names have been changed or withheld for privacy reasons.

<img width="1366" height="871" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111140/636b83b69c7e80680e067751jpeg.jpg" alt=""/>Nepal’s first wave of the coronavirus last year now looks like a ripple, and what the country is now witnessing is the main eruption. 
A lot of the attention is on Kathmandu Valley because more than half the daily new Covid-19 cases are here. But it is the Tarai districts bordering India that have been ravaged first, <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">just like last year</a>, but on a much vaster scale. 
Epidemiologists say what happens in India arrives in Nepal four weeks later, and the border cities precede Kathmandu by two weeks. Banke district, for example, which is the gateway to Nepal for most returnees from India, is the second most affected after Kathmandu, with 4,811 <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">active cases</a>. 
Banke’s positivity rate is shocking: <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">210 of the 299 PCR tests</a> at Nepalganj Medical College (NMC) in Kohalpur in 24 hours on Tuesday were positive -- 19 times higher than the rate a month earlier.
The doubling time for the infection at Bheri Hospital in Nepalganj is only eight days. The hospital did 1.6% of all the tests nationwide in the past two months, but had 5.35% of the new cases in that time. 
One would have thought that the first wave would have prepared Banke and indeed Nepal for this one. But what is happening now is a <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">tsunami</a>.
Last year, when we caught up with <a href="https://www.nepalitimes.com/latest/quarantine-guidelines-impossible-to-meet-local-governments/" target="_blank" rel="noopener noreferrer">Deputy Mayor Uma Thapa Magar of Nepalganj</a>, she was trying to enforce mandatory quarantine on returnees from India, and trying to make sense of a virus that no one knew much about. The mixed directives or inadequate resources from the federal government did not help. Municipalities were left to fend for themselves. 
“We were learning as we went along, this time we are dealing with a completely different virus," says Deputy Mayor Magar. "Last year the patient numbers were manageable, even with home isolation. This year, a high share of those who test positive need hospital beds with oxygen. If we cannot provide oxygen, we lose them. There is enough oxygen, but not enough cylinders." 
The first wave was a dress rehearsal for the <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">second one</a>. Local leaders have learnt that <a href="https://www.nepalitimes.com/latest/the-india-connection-in-nepals-covid-19-status/" target="_blank" rel="noopener noreferrer">the border is the chokepoint</a>, and 70% of cases initially were among those with travel history. At the Indian border, health personnel are working in three shifts to screen inbound Nepalis with antigen tests. Those testing negative are kept in holding centres, then transported to home districts by local governments. Positive patients are kept in isolation in Nepalganj, or taken to their domiciles with the support of the Red Cross. These pre-established networks from the first wave have made the work smoother, but the sheer numbers have overwhelmed local capacity. 
Bheri Hospital had 140 beds and NMC had 50, which had been expanded to 220 and 300 during the first wave. As our report this week shows, <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">Nepalganj has also added isolation centres</a>, including with oxygen supply, to reduce the pressure on the hospitals. But even with all this, it is not enough.
“We are operating beyond capacity,” says Prakash Bahadur Thapa, the physician who heads Bheri Hospital, sounding fatigued on the phone. “Of the 277 patients now, 180 need oxygen and 9 are on ventilator support, 77 in ICU beds. We are using up to 400 oxygen cylinders daily, before Covid we needed only 10-20 per day.”
More than 100 staff at Bheri Hospital have tested positive. More support has been added, but even doctors and nurses with mild symptoms are caring for patients in the Covid-19 wards. A bed is available only when a patient recovers or dies. Says Thapa, “There is no comparison between the first and the second wave, and the next two months will be difficult.”  
The number of deaths is also higher during the current spread, and even the Nepal Army is overwhelmed in <a href="https://www.nepalitimes.com/banner/kathmandu-electric-crematorium-running-non-stop/" target="_blank" rel="noopener noreferrer">management of bodies</a>. We asked Thapa what is most urgently needed. His reply: <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">more hospitals need to be included as Covid-19 facilities</a>. Just two hospitals with limited beds are already inadequate. 
Nepalganj shows that local governments are best placed to react urgently to the ground situation. But Deputy Mayor Thapa Magar says the scale of this crisis means that they need help with medical supplies, oxygen, cylinders, setting up more isolation centres. Voluntary organisations can also help by mobilising awareness about using masks and avoiding crowds. The only way to stay alive in the pandemic is not to fall sick in the first place. 
Physician Thapa at Bheri Hospital puts it bluntly: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” 
An exasperated Sunil Singh, chair of Ward 2, says Nepalganj must declare a health emergency. “Imagine if this was an earthquake or a flood disaster, what would our response be? More medical supplies, more health staff, temporary health centres, food rations for the needy. Kathmandu and Karnali Province have not done enough. This is a war. We are hanging by a thread, how much longer before it breaks? 
Read also: <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/">“Our health system can’t contain the pandemic”</a>, Nepali Times

This is war

<img width="1366" height="871" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110131116/636cebda9c7e80680e09ad2ejpeg.jpg" alt=""/>Nepal’s first wave of the coronavirus last year now looks like a ripple, and what the country is now witnessing is the main eruption. 
A lot of the attention is on Kathmandu Valley because more than half the daily new Covid-19 cases are here. But it is the Tarai districts bordering India that have been ravaged first, <a href="https://www.nepalitimes.com/banner/as-india-peaks-covid-19-spreads-rapidly-in-nepal/" target="_blank" rel="noopener noreferrer">just like last year</a>, but on a much vaster scale. 
Epidemiologists say what happens in India arrives in Nepal four weeks later, and the border cities precede Kathmandu by two weeks. Banke district, for example, which is the gateway to Nepal for most returnees from India, is the second most affected after Kathmandu, with 4,811 <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">active cases</a>. 
Banke’s positivity rate is shocking: <a href="https://covid19.mohp.gov.np/covid/englishSituationReport/6091313e5e4ad_SitRep450_COVID-19_4-05-2021_EN.pdf" target="_blank" rel="noopener noreferrer">210 of the 299 PCR tests</a> at Nepalganj Medical College (NMC) in Kohalpur in 24 hours on Tuesday were positive -- 19 times higher than the rate a month earlier.
The doubling time for the infection at Bheri Hospital in Nepalganj is only eight days. The hospital did 1.6% of all the tests nationwide in the past two months, but had 5.35% of the new cases in that time. 
One would have thought that the first wave would have prepared Banke and indeed Nepal for this one. But what is happening now is a <a href="https://www.nepalitimes.com/editorial/the-covid-tsunami/" target="_blank" rel="noopener noreferrer">tsunami</a>.
Last year, when we caught up with <a href="https://www.nepalitimes.com/latest/quarantine-guidelines-impossible-to-meet-local-governments/" target="_blank" rel="noopener noreferrer">Deputy Mayor Uma Thapa Magar of Nepalganj</a>, she was trying to enforce mandatory quarantine on returnees from India, and trying to make sense of a virus that no one knew much about. The mixed directives or inadequate resources from the federal government did not help. Municipalities were left to fend for themselves. 
“We were learning as we went along, this time we are dealing with a completely different virus," says Deputy Mayor Magar. "Last year the patient numbers were manageable, even with home isolation. This year, a high share of those who test positive need hospital beds with oxygen. If we cannot provide oxygen, we lose them. There is enough oxygen, but not enough cylinders." 
The first wave was a dress rehearsal for the <a href="https://www.nepalitimes.com/banner/unmasking-the-second-wave/" target="_blank" rel="noopener noreferrer">second one</a>. Local leaders have learnt that <a href="https://www.nepalitimes.com/latest/the-india-connection-in-nepals-covid-19-status/" target="_blank" rel="noopener noreferrer">the border is the chokepoint</a>, and 70% of cases initially were among those with travel history. At the Indian border, health personnel are working in three shifts to screen inbound Nepalis with antigen tests. Those testing negative are kept in holding centres, then transported to home districts by local governments. Positive patients are kept in isolation in Nepalganj, or taken to their domiciles with the support of the Red Cross. These pre-established networks from the first wave have made the work smoother, but the sheer numbers have overwhelmed local capacity. 
Bheri Hospital had 140 beds and NMC had 50, which had been expanded to 220 and 300 during the first wave. As our report this week shows, <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">Nepalganj has also added isolation centres</a>, including with oxygen supply, to reduce the pressure on the hospitals. But even with all this, it is not enough.
“We are operating beyond capacity,” says Prakash Bahadur Thapa, the physician who heads Bheri Hospital, sounding fatigued on the phone. “Of the 277 patients now, 180 need oxygen and 9 are on ventilator support, 77 in ICU beds. We are using up to 400 oxygen cylinders daily, before Covid we needed only 10-20 per day.”
More than 100 staff at Bheri Hospital have tested positive. More support has been added, but even doctors and nurses with mild symptoms are caring for patients in the Covid-19 wards. A bed is available only when a patient recovers or dies. Says Thapa, “There is no comparison between the first and the second wave, and the next two months will be difficult.”  
The number of deaths is also higher during the current spread, and even the Nepal Army is overwhelmed in <a href="https://www.nepalitimes.com/banner/kathmandu-electric-crematorium-running-non-stop/" target="_blank" rel="noopener noreferrer">management of bodies</a>. We asked Thapa what is most urgently needed. His reply: <a href="https://www.nepalitimes.com/latest/nepal-designates-more-hospitals-for-covid-19-treatment/" target="_blank" rel="noopener noreferrer">more hospitals need to be included as Covid-19 facilities</a>. Just two hospitals with limited beds are already inadequate. 
Nepalganj shows that local governments are best placed to react urgently to the ground situation. But Deputy Mayor Thapa Magar says the scale of this crisis means that they need help with medical supplies, oxygen, cylinders, setting up more isolation centres. Voluntary organisations can also help by mobilising awareness about using masks and avoiding crowds. The only way to stay alive in the pandemic is not to fall sick in the first place. 
Physician Thapa at Bheri Hospital puts it bluntly: “In the coming days, it will be the availability of oxygen that will determine how many live and how many die.” 
An exasperated Sunil Singh, chair of Ward 2, says Nepalganj must declare a health emergency. “Imagine if this was an earthquake or a flood disaster, what would our response be? More medical supplies, more health staff, temporary health centres, food rations for the needy. Kathmandu and Karnali Province have not done enough. This is a war. We are hanging by a thread, how much longer before it breaks? 
Read also: <a href="https://www.nepalitimes.com/latest/our-health-system-cant-contain-the-pandemic/">“Our health system can’t contain the pandemic”</a>, Nepali Times

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9aa9c7e80680e0878d2jpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181152/636be9ae9c7e80680e0878d3jpeg.jpg" alt="" width="686" height="915"><figcaption>Binaya Raman Dahal, a hospitalist in North Carolina, getting his vaccination. He says it is a “big relief” for health workers like him as the pandemic rages across the US.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b09c7e80680e0878d4jpeg.jpg" alt="" width="686" height="915"><figcaption>Srijana Panta Rokka has been a nurse in the UK for 15 years, and says she is fortunate as a frontline worker to be one of the first in the UK to be vaccinated against Covid-19.</figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b39c7e80680e0878d5jpeg.jpg" alt="" width="859" height="915"><figcaption>Khagendra Dahal, a clinician in Nebraska, was overwhelmed when he got an email regarding his first vaccination dose.</figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b69c7e80680e0878d6jpeg.jpg" alt="" width="720" height="960"><figcaption>Notice in a UAE newspaper announcing free Covid-19 vaccinations for citizens and residents.</figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109181156/636be9b89c7e80680e0878d7jpeg.jpg" alt="" width="720" height="960"><figcaption>And a UAE Covid-19 vaccination card.</figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

Nepalis overseas get first vaccinations

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0914b0ad905ca02f01bjpeg.jpg" alt="" width="1350" height="1565"/><figcaption>Nischal Shrestha, a caregiver in Israel, getting vaccinated last week.</figcaption></figure>Long before Nepalis in Nepal will be vaccinated against the coronavirus, <a href="https://www.nepalitimes.com/here-now/overseas-nepalis-on-the-covid-19-frontlines/" target="_blank" rel="noopener noreferrer">Nepali frontline workers around the world</a> are already receiving their first jabs.The most optimistic prediction for a vaccine to arrive in Nepal is mid-2021, but with countries around the world prioritising medical workers, many Nepalis who work in the healthcare sector overseas are starting to get vaccinated.The globalisation of the Nepali workforce became even more apparent during the pandemic: a Nepali doctor in the UK could be using medical gloves <a href="https://www.nepalitimes.com/latest/global-glove-makers-compensate-nepali-workers/" target="_blank" rel="noopener noreferrer">made by Nepali workers in a Malaysian glove factory</a> while vaccinating a Nepali nurse.“We always knew healthcare workers would be in the priority group, but the general understanding was it would still be a few months into 2021 that the vaccines would reach us,” said Binaya Raman Dahal, a Nepali hospitalist in North Carolina who got his first injection last week, and said it was like taking any other flu shot.Dahal recalls how his colleagues would fall ill, and hospital staff had to step in even during off days. The first couple of months into the pandemic, <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener noreferrer">personal protective equipment</a> ran out, and there was a rush of patients following the July 4 and Labour Day weekends.“There is a big sense of relief that the vaccines are here,” Dahal said over the phone, adding that he will still have to careful because of the risk to family.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0944b0ad905ca02f01cjpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0964b0ad905ca02f01djpeg.jpg" alt="" width="686" height="915"><figcaption> </figcaption></figure>Srijana Panta Rokka, has been a nurse in the UK since 2004, and considers herself fortunate for being one of the first recipients of the vaccine. “It was like taking a flu-shot. Others report sore arms, temperature and headache as side effects, but for me I just felt tired and my eyes ached that day,” she recalls.Her General Practice has largely avoided in-contact patients since March, and has moved to tele-medicine, while only taking emergency in-person patients. But from 1 January, she will be serving as a vaccinator, after being trained in administering the Pfizer vaccine.“I was one of the nine nurses in my practice who got vaccinated so we could vaccinate others,” Rokka said in a phone interview. Most patients eligible for vaccination will be above 80 years.There are fears about side-effects and long-term implications of the vaccine, and Rokka has had to counsel fellow Nepalis working in elderly homes in the UK who are eligible for the vaccine, but are reluctant to take it. She thinks information campaigns to assuage people’s fears will have to be a part of vaccination drives.Another Nepali clinician in the United States, Yagya Raj Bhattarai, says the past year has shown that Covid-19 spared no one. “I had a 20-year-old patient who suffered the worst outcomes, including heart failure and anoxic brain injury. Then, I had a 100-year-old who was positive but completely asymptomatic,” said Bhattarai, who self-isolated in a room throughout the period to keep his family safe.Bhattarai’s hospital in North Carolina participated in vaccine trials, and says the efficacy of the first dose is 52%, and it is 95% after the second shot. He experienced mild local pain in his left arm and no other side effects.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf0984b0ad905ca02f01ejpeg.jpg" alt="" width="859" height="915"><figcaption> </figcaption></figure>Across the United States in Nebraska, cardiologist Khagendra Dahal recalls long periods of self-isolation and the difficulty explaining to his young children why he was staying separately.“Even after being vaccinated, we will still need to continue to wear our protective gear because it is not known whether we are transmitters of the virus even if we ourselves are safe,” Dahal says.Another country with a sizeable <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/nepali-caregivers-in-israel,3809" target="_blank" rel="noopener noreferrer">Nepali caregiver population is Israel</a>, and it has started a massive vaccine campaign for health workers, those over 60 and at high risk. Nepali caregivers are considered frontline workers.Nischal Shrestha (pictured above) has been living in Israel for the last 11 years, and takes care of a 91-year-old woman who she took to the hospital to vaccinate last week.“I was not expecting to be given the shot because we were told that the priority would be health workers and the elderly. But my employer got the hospital to also get me immunised,” says Shrestha, who says her arm and body ached for a day or two, but she is fine now.Deepika Bhusal also works as <a href="https://www.nepalitimes.com/here-now/demand-grows-for-nepali-caregivers-in-israel/">a live-in caregiver</a> for an elderly couple in Israel. Her employers got their first doses of the vaccine on 25 December, and there was much celebration in the house.“I trust the health system here. Even the Prime Minister went on live television to take his first shot publicly,” says Bhusal, who is getting her own shot on new year’s day.“We live in the same house so compared to elderly care institutes or live-out care workers, we were in a much safer position,” Bhusal explains. “But we had to go outdoors often for therapy or exercise, or to shop, so there was always a risk,” she adds.The UAE is another popular destination for Nepali workers, and the first country to approve the Chinese Sinopharm vaccine which is said to be 86% effective after trials around the world. The UAE is providing the vaccines free to residents and citizens.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09b4b0ad905ca02f01fjpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109191124/636bf09e4b0ad905ca02f020jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>Kisan Magar works in a car showroom whose employer got him and his European and Filipino colleagues vaccinated recently. He says he has been getting lots of congratulatory messages from family in Nepal, while compatriots in the UAE have been querying him about how to enrol for the vaccine.Navaraj Ghimire, another UAE-based Nepali who got his first jab says: “We work in security and are exposed to risk, and 33 people in my company have been infected so far." Some of his colleagues, however, refused to be vaccinated because they did not trust it.Back in Nepal, the <a href="https://www.nepalitimes.com/here-now/when-will-nepals-covid-vaccine-turn-come/" target="_blank" rel="noopener noreferrer">best-case scenario is for the first vaccinations</a> to start in mid-2021. Health experts say Nepal was late in the game to start ‘vaccine diplomacy’, and there is a fear that even when the vaccines do arrive the poor in remote areas will be the last in the queue.The vaccines that Nepal will acquire will have to be the ones that require less sophisticated cold storage systems which are currently in Phase 3 trials in India and China. Till then and even after being vaccinated, Nepalis have to keep wearing masks, avoid crowds and wash hands.According to Ministry of Health and Population, the Government plans to vaccinate 72% of the country's population, as 28% are below 15 and therefore excluded. An estimated 20% are expected to be vaccinated through the <a href="https://www.nepalitimes.com/opinion/glimmers-of-hope-for-nepal-on-vaccine/">WHO-initiated COVAX facility</a>, while the remaining 52% will be through government-to-government mechanisms.

frontline-health-workers

Nepal’s doctors are like soldiers fighting a war

Nepal’s doctors are like soldiers fighting a war

At the Covid-19 frontlines in rural Nepal

At the Covid-19 frontlines in rural Nepal

Medical students deprived of Covid-19 vaccines

Medical students deprived of Covid-19 vaccines

This is war

This is war

Nepalis overseas get first vaccinations

Nepalis overseas get first vaccinations