Dr Sanjeeb Sapkota is a Medical Epidemiologist who has been working in the public health sector for the past 20 years. After graduating from Tribhuvan University as a medical doctor, he worked in the World Health Organization (WHO) and with a number of other public health agencies for several years. He has served as a consultant to Ministries of Health of several countries in Europe, Africa and Asia. He has published several books including on pandemic. Dr Sapkota, who lives in Atlanta, the US with his family, currently leads the Health Committee of Non-Resident Nepali Association (NRNA). Nepal Live Today spoke to him to discuss the impact of the pandemic and Nepal’s health system. Excerpts:
As we speak, Nepal’s health system is badly struggling to treat the Covid patients and the system itself seems to be collapsing. In your view what areas require immediate improvement, and what can be done in the medium and long term?
Nepal immediately needs to map out all the resources available both in the public and the private sectors. Those resources include health care workers (doctors, nurses, and paramedics), medical care facilities, hospital beds, medical equipment, laboratory services, equipment, and supplies including oxygen plants, cylinders, concentrators and ventilators. It needs to utilize all of them. There needs to be sufficient training and safety of health workers, and there needs to be centralized data systems like the dashboard of where resources are (doctors, beds, oxygen) and how to access them. It also needs to procure 100,000 oxygen concentrators and establish 20-100 oxygen plants in each province of Nepal.
Daily situational updates by the Health Ministry should be broadcast nationally via radio and TV stations. This helps in assuaging the fear and panic of the people.
In the medium and long term, each province should have its own laboratory facilities, a 1000 bed hospital to treat infectious diseases including Covid and 1000 plus trained doctors and nurses. Patients need to be made feel reassured. Each person should have access to easy and hassle-free testing facilities.
I also urge each individual to do her or his part in mitigating the pandemic. Each person has a role in stopping the infection from being transmitted to them and their loved ones. They need to cover their nose and mouth in public, wash hands thoroughly using soap and water before touching nose and mouth, and keep a physical distance of two meters from strangers. Avoid being crowded indoors, limit talking directly to each other.
These help a lot. This helps a lot in preventing virus transmission and infection. Not getting infected means less risks to the health care workers, not going to hospital and giving less stress to the limited supply of hospital beds.
As the focal health person at NRNA, you are also actively involved in supporting Nepalis during the pandemic. What types of support has NRNA provided so far? What is in the line?
We worked as a proxy Health Ministry for the Nepalis who are outside of Nepal. We did everything possible that a Health Ministry of a country does. We prepared statistics on the status of Nepalis, prepared technical guidance to health professionals and the public on topics related to preventing and managing the infection, we established a tele-health system whereby any Nepali can contact any specialist and seek health guidance and so on. Besides, we provided equipment and technical support to the Nepal government such as 500,000 USD worth of PPE and testing supplies, and procuring 200,000 USD worth of oxygen concentrators. These concentrators are being procured from China and will be handed to the government once they arrive. Similarly, we organized over 500 webinars in each country around the world on topics covering preventing and breaking the chain of viral transmission.
Nepal immediately needs to map out all the resources available both in the public and the private sectors.
Over eight million Nepalis reside outside of Nepal in over 80 countries. Of them, an estimated 90 thousand have been infected so far since the pandemic began in early 2020. But the good news is that 90 percent of them or over 85 thousand have recovered. Around 5000 Nepalis are actively infected and the majority of them are in India, some in the Middle East. The weekly statistics we prepare on the status of Nepalis have helped the government, international agencies, and Nepali diaspora in identifying where the needs are and where the scarce resources can be mobilized.
Over 300 doctors of Nepali origin around the world have been providing telehealth and guidance to Nepalis worldwide. We focused on preventing uninfected persons from being infected. This helps tremendously. If we prevent one person from being infected then we lessen the exposure to health care and lessen the burden on health care services.
You have seen the health services of many countries of the world. What is your assessment of Nepal’s health facilities?
Nepal has made important improvements in its health indices over the past decades. Both maternal mortality and infant mortality have been reduced remarkably. Nepal’s life expectancy has gone up to the current 71 years, the literacy rate has risen to 63 percent. Sill Nepal ranks 142 among 189 countries in the human development index (HDI). It accounts for life expectancy, education, and decent living standard. Living standards have improved noticeably but not as much to move people from the lower-income to middle income.
If the WHO is to truly represent the low and middle-income countries it needs to garner adequate funds to purchase vaccines that are sufficient for the entire population of the country like Nepal.
Nepal’s medical system is provided by taxpayers’ public sector and the private sectors. Health is not only about going to the hospital and getting treated and getting prescriptions. It is also about being prevented from illnesses, applying preventive measures, and getting access to ways and means to stay healthy.
But that sounds like a far cry for Nepal at the moment. In fact, the Covid pandemic has exposed the fragility of Nepal’s health system.
No country was sufficiently prepared for the pandemic and no system was able to control the infection and the mortality it suffered. The pandemic has laid bare the limitations of the health systems of every country globally. Nepal is no exception. The pandemic rode on the vulnerability of each nation. Mitigation of the pandemic is not only the concern of the health sector. Transportation, aviation, law enforcement, border management all play a role in its mitigation. Nepal is close to India from where the large majority of the infection entered the country. Nepal saw its limitations in testing, providing adequate communications, treatment, providing adequate oxygen supply and vaccine.
The blunder Nepal made was not getting adequate vaccines for Nepali people. Nepal could just immunize nine percent of its population. If 50 percent or more people had been immunized, the majority of the people would be protected and there would be no oxygen shortage as we are witnessing now. Nepal did not come up with adequate money to buy vaccines directly from the manufacturing companies. Canada, the UK, Finland and Norway did that. It decided to stay with the Covax facility that has committed to vaccinating just 20 percent of the population and not even half has been achieved so far.
What should Nepal do to get the global community’s attention to help the people in crisis?
Nepal should have asked for funds from the global community to buy vaccines from the manufacturing companies. It should have done that much earlier. Nepal needs to make a clear outline of where the needs and gaps are, make the list of donors and foundations, and approach them frequently until adequate funds are obtained.
NRNA’s Health Committee worked as a proxy Health Ministry for the Nepalis who are outside of Nepal. We did everything possible that a Health Ministry of a country does.
You have been serving the Nepali community during the pandemic. How taxing or fulfilling has that been?
Serving as the health lead of NRNA, I get the opportunity to speak to all levels: from the very ground level where front-line workers are fighting the battle against the pandemic to the high-ranking government officials who make policies and give directions. When I pick up the phone and provide guidance to the family on how to be safe from corona infection I feel tremendous satisfaction. It gives me a sense of pride and a feeling that I helped save lives.
What is the most challenging aspect in providing humanitarian aid?
Obtaining approval from the authority to provide service where the aid is needed is not easy. It needs multiple talking and negotiations as well as patience. We cannot avoid government while providing humanitarian support. We need to work in collaboration.
What type of health system do you want to see in Nepal, where many impoverished people are dying due to lack of quality health care?
A health system that provides each person in Nepal free health care including preventive services, screening for diseases like diabetes, medicine for common and chronic diseases, free emergency services, and free surgery for life-saving purposes. A health system that is scalable to meet the demand of the nation at the time of crisis like the pandemic. I wish it were so in Nepal.
What do you think the WHO should do to ensure that the vaccines reach countries like Nepal on a priority basis?
If the WHO is to truly represent the low and middle-income countries it needs to garner adequate funds to purchase vaccines that are sufficient for the entire population of the country like Nepal.
How could the rich and developed countries in the West help Nepal at the moment?
High-income countries could help Nepal by establishing manufacturing capacity to produce vaccines that are sufficient for each person in Nepal. These countries should help Nepal make its drugs that mitigate pandemics like antivirals.
Over 300 doctors of Nepali origin around the world have been providing telehealth and guidance to Nepalis worldwide.
At the end, what is your message to Nepalis regarding their health?
Like I said earlier, health is not only about going to a clinic or hospital and being seen by a doctor and getting medicine. Health is not only about being ill and sick. It includes but is not limited to good nutrition, physical activity, pollution-free environment, clean drinking water, getting adequate health education and so on.
A large number of Nepalis have coronary heart disease and diabetes. Many smoke cigarettes and consume alcohol. Corona infection impacts them more. They need to control their heart disease and diabetes with adequate medicine. They need to quit smoking and drinking, or least cut them down, so that they do not become vulnerable to corona infection.
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