Poverty – the real pandemic

At time of writing at noon on 21 March there were 785,855 confirmed cases of COVID-19 around the world, and 37,826 fatalities in just three months.

The speed of spread and the size of population and geography affected is unprecedented in human history, after it spread from Wuhan in December.

Nepal was actually only the fifth country to report its first case of COVID-19 in a student who came from Wuhan. Even though only five positive cases have been found in Nepal so far with one of them recovered, Nepal was the first country in South Asia to declare a lockdown on 17 March.

There are surely more infected people out there, but for some reason there has not been a major outbreak with large numbers of elderly and vulnerable people crowding our hospitals, as has happened elsewhere.

However, for us working in a community hospital here in remote Accham district the COVID-19 pandemic and need to break its transmission chain comes on top of pre-existing public health crises. For Nepal, there are multiple competing priorities – the foremost of which is poverty.

Returnees maybe taking coronavirus to rural Nepal, Mukesh Pokhrel and Sonia Awale

Although the percentage of Nepalis in absolute poverty has decreased from 59.3% in 2006 to about 20% today, there are large parts of the country with such grinding poverty that it forces families to ignore serious ailments because they cannot afford travelling to a hospital.

At Bayalpata, we treat patients who have walked or have been carried for days because they either do not have access to medical care, or cannot afford it. Having a sick person drives even some better off families into poverty, and men have to migrate to earn enough to pay off loans they took for treatment. For Nepal, the real pandemic is poverty.

A 42-year-old woman was admitted to Bayalpata Hospital last week after fracturing both bones on her left leg after a fall while travelling to a school where her daughter was about to give her secondary school examination. The tests were postponed at the last moment because of COVID-19.

A 14-year-old boy was admitted with a fractured femur after falling from a tree. Despite the lockdown fodder and firewood must still be collected, the maize needs to be planted, livestock have to be tended.

Bayalpata Hospital has set up an emergency department and fever clinic as per government directives. We have trained healthcare workers to deal with coronavirus patients. But all we are encountering so far are the chronic poverty-related diseases that have always been endemic in western Nepal.

Enlisting female health volunteers to fight COVID-19, Ramu Sapkota and Mukesh Pokhrel

The Lancet Global Health Commission says 8 million people every year die around the world from treatable conditions in low and middle income countries. Yet, that does not qualify as a global pandemic.

More than 1,200 women die in childbirth every year in Nepal, that is three fatalities evry single day. Tuberculosis kills 6,000 people in Nepal every year. There were 2,736 fatalities in road traffic accidents in Nepal last year. All of these deaths were in one way other linked to deprivation and inequities.

Every day at Bayalpata Hospital we manage cases of children who are stunted or wasted due to malnutrition, exposing them to opportunisitic infections. Some of their families are too poor to provide enough food. There are also cases of fractures, neglected infections like abcess and bone infections every day – mainly among children because parents are forced to be busy at work in the farm, or had gone abroad to earn.

COVID-19 is a dangerous, easily spread viral infection. Yet, when the pandemic does spread to western Nepal it will just be another disease burden on top of the pyramid of poverty we have to deal with here every day.

Bikash Gauchan is the Healthcare Director for Nyaya Health Nepal in Achham based at Bayalpata Hospital.