Rural Nepal fights back Covid-19

Setting the example for the rest of the country that is at a breaking point due to the lack of hospital beds, oxygen and ventilators for Covid-19 patients, local governments in parts of Nepal are going door-to-door to test and control community spread.

Epidemiologists say that lockdowns alone are not the answer to the pandemic, they just buy time and the closure should be used to trace, test and isolate infected people. 

Doing just that is Helambu in Sindhupalchok district 45km northeast of Kathmandu. So far, 31 people have tested positive in Helambu but only half of them are active. Once they were isolated, no new cases have been reported in the last six days, and not a single person has died of the disease.

What this little village in the mountains is doing to control the spread of the disease could be an example for other parts of rural Nepal, and also for the cities which have run out of hospital beds and oxygen. The idea is to test people before they become seriously sick and over-burden the health system.

Helambu village chair Nima Galgen Sherpa is himself in isolation after contracting the virus. He explains the process: “First we identify people who are infectious, and manage them separately. This has helped stop the spread of the infection in the community, and most do not need hospitalisation.”

Helambu has formed teams in each ward consisting of health workers who go house-to-house looking for people with symptoms, and then testing them on the spot. After their swab collection, they are told to isolate. If the PCR test result comes back negative, infected individuals are quarantined to be managed separately until they recover. Only if their symptoms get more serious are they taken to hospital.

For Sherpa, the door-to-door campaign is just a continuation of what Helambu did when the contagion first spread last year. The second wave is more virulent, and the village learnt lessons from last year to make testing even more systematic. 

“This strategy is effective because people don’t come forward for the test due to lack of awareness, or fear of being ostracised in the community,” he adds.

Learning from Helambu, Indrawati Rural Municipality down the valley has also started conducting community-level house-to-house testing. "We have found that proactive testing and isolating those infected from others helps break the chain of transmission, so this has been our priority," says municipality chair Bansalal Tamang.

Its house-to-house tests are being conducted in coordination with the local representatives, ward health post and community people. The village with a population of 28,000 has collected 183 pharyngeal-nasal swabs so far. Of the 51 people infected, 27 are still active, while three patients who had to be hospitalised died.

A team in the ward is also monitoring the compliance of the lockdown and safety practices. “We can bring the pandemic under control faster with the help of people being more careful, and testing during the lockdown,” adds Tamang.

Nearby Jugal Rural Municipality in Sindhupalchok has also been conducting RT PCR tests under the recommendation of the local health post. Of those 86 tested so far, 35 people are positive, and the rate is high because only those with Covid-19 symptoms were tested. Two have recovered.

"We are working in coordination with other municipalities in the district to control the infection in our area," says vice-chair of Jugal municipality Sirjana Tamang, who is confident that a coordinated local effort can help defeat the virus.

Jugal has also collaborated with neighbouring Balephi Municipality started construction of a 70-bed isolation centre in addition to a 20-bed medical ward with the oxygen.

Despite having inadequate influence and resources, these local governments appear to be more accountable and effective in tackling the pandemic than provincial or federal governments. And these villages in Sindhupalchok also seemed to know exactly what to do during the second wave, and they were prepared with tracing, testing, quarantine and isolation centres, and relief distribution.

Not all local governments have been as effective. Many districts in western Nepal, for example, have been overwhelmed by the sheer ferocity of the second wave. The virus is spreading uncontrollably in the community and over-stretched hospitals in the cities are not taking any more patients. 

Here in Sindhupalchok, local representatives say they have done what they can, but they need a helping hand from the provincial government in Hetauda or from the national capital in Kathmandu for oxygen, equipment at the quarantine centres and isolation wards. 

“If we had more oxygen, medicines and testing kits we can save lives right here, but there is no one listening to us, so we are doing the best we can by ourselves,” adds Indrawati chair Bansalal Tamang.

Jugal vice-chair Sirjana Tamang agrees: “We did not expect any help from Kathmandu, and we did not get any, so we decided to do what we could on our own.”