Donated ventilators gather dust in Nepal

When the second wave of the Delta variant ravaged Nepal in April-May this year, hospitals ran out of oxygen and ICU beds. The international community rushed oxygen plants and ventilators, but many of the critical life-saving machines are lying idle in government hospitals around the country.  

Besides the hundreds of donated ventilators, the government also bought the machines, but state-run hospitals do not have the anaesthesiologists trained to run it nor the critical care wards to put them in.  

The district hospital in Sandhikharka of Arghakhanchi bought a ventilator six months ago, it has never been turned on even though there were critically-ill Covid-19 patients who needed respiratory support.  

Even though the second wave appears to have subsided, the positivity rate among those being tested is still hovering at 10%, and there is a weekly rolling average of 320 patients in ICU and 120 in ventilators in government and private hospitals around the country. 

“Only two days ago, we had a Covid patient who had to be put on a ventilator. But we had to send them to Butwal since we didn’t have anyone who knew how to use it,” says Rajendra GC, medical superintendent of the hospital. 

The Seti Provincial Hospital in Nepalganj has 11 ventilators, but not all of them can be used at the same time because of the lack of dedicated space and trained personnel.

“If the ventilators stop working, we won’t be able to treat the patients until a technician from Kathmandu comes to fix them,” says hospital manager Ved Prakash Joshi.

In the district hospital in remote Bajhang district, a medical officer was the only person with some level of training in critical care. He was transferred recently, and it is hospital chief Sandip Okheda who has had to handle emergency cases based on only a few days of training to operate ventilators.

Ventilators are essential for patients needing critical care and are used for breathing problems that can accompany various health conditions. In severe Covid patients, the virus damages the lungs, causing the oxygen level to drop and making it harder for the person to breathe. Ventilator tubes are intubated to push air into the lungs, and the procedure is regarded as the last resort for many patients.

Before the pandemic, government hospitals across the country had only 500 ventilators, which meant there was a critical shortage during the second wave when many of the patients admitted to the ICU needed life support. At the height of the pandemic in April-May, there were 11,000 new confirmed cases daily and up to 240 people were dying every day, hospitals were overwhelmed.  

The public health emergency led national and international aid agencies as well as Nepali migrant workers in the Gulf to rush in with the help. The government reportedly added 1,000 ventilators after the pandemic, and some government hospitals ordered their own, although there is no count of the exact number. 

There are currently 329 Covid patients getting treatment in ICUs across the country and an additional 112 in ventilator support, many of them referral patients from outside Kathmandu Valley. 

Each patient on a breathing machine requires multiple doctors and nurses to care for them and operate it properly. In many district hospitals, that is not the case and as a result, patients needing ventilator support have lost their lives.

“My own relatives died because the hospitals did not have ventilators and intensive care units,” says epidemiologist Anup Subedi. “Having ventilators alone is not enough, hospitals must be equipped, and the staff trained in intensive care.”

According to critical care specialist Manoj Kumar Yadav, operating a ventilator requires a pulmonologist, anaesthesiologist and intensive care specialist. Professionals with 3-4 years of training through fellowship or a graduate of internal medicine or anaesthesia are considered proficient. Meanwhile, doctors with an MD in anaesthesia and medicine as well as nurses can be trained in critical care to fill the gap.

A recent study conducted at Teaching Hospital in Kathmandu has shown that of all the diseases, Covid patients require ventilators the most. It also found that 84% of the 95 Covid-19 patients in the hospital who were on ventilator support have died.

“The same study also points out that although the lack of skilled manpower is not directly responsible for the death of patients on ventilators, round-the-clock care is required for those on breathing support or complications may arise,” adds Yadav.

Officials at the Health Ministry admit that the inability of the government to recruit permanent doctors and specialists has adversely affected the healthcare services across the country. This is a critical gap, and leaves Nepal at high risk in case there is a third wave.

The Ministry of Health spokesperson Krishna Prasad Paudel has the usual vague promise, without mentioning actual actions taken: “We will train our human resource and make sure that at least the ventilators in storage are up and running soon."