A 25-year-old female nurse employed at a private hospital in Nepal has been experiencing back pain and shooting aches. She is exposed to viruses, fungi, and organic dust at work, and has developed allergies and <a href="https://www.nepalitimes.com/latest/like-a-sunburn-on-your-lungs-how-does-the-climate-crisis-impact-health">skin disease</a> due to exposure.
She is also at risk of radiation exposure as the hospital, has not implemented adequate safety measures to <a href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-covid">protect the workers </a>except for the use of shielding walls. This is now affecting her mental health, causing sleep and eating disorders.
<a href="https://www.nepalitimes.com/here-now/nepal-s-doctors-are-like-soldiers-fighting-a-war">Job risk for health workers increased</a> during the Covid-19 pandemic, but their burden of work-related accidents and illnesses around Nepal is still significant.
Nurses, doctors and other medical workers face a unique set of <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma">occupational hazards</a> compared to other professions due to the nature of their work, which often involves direct contact with patients and exposure to various types of health and safety risks.
Some have back injuries from frequently having to lift patients, biological and chemical hazards and <a href="https://www.nepalitimes.com/opinion/diary-of-a-covid-frontline-worker-in-nepal">mental stress and burnout</a>.
<a href="https://www.ijcmph.com/index.php/ijcmph/article/view/10680/6477">A recent study</a> published in the International Journal of Community Medicine and Public Health found that back pain was the most common injury experienced by healthcare professionals around the world, with 64.8% of the 247 respondents reporting this condition. Over half of them were also afflicted by needle prick, a sensation of uncomfortable tingling or prickling in arms, legs, hands, or feet.
The study also highlighted the prevalence of workplace hazards with over 80% of the participants viewing them as a potential cause of injury or adverse health effects. While many workers were aware of the hazards in the hospital environment and recognised the importance of protecting themselves a significant number had not received any training to do so.
Over half of the respondents cited biological hazards as the biggest threat, with 87% of healthcare professionals reporting exposure to chemicals, 88% to biological risk, and 66% to viral dangers. 
The study also found that work experience, employment status, and job type can impact the likelihood of facing hazards, with radiologists being a particularly high-risk group.
Although the measurement of radiation exposure among healthcare professionals can be challenging, almost half of the respondents reported constant exposure to radiation. 
In Nepal, after the earthquake of 2015, radiation was found to have leaked from 18 hospitals in Kathmandu Valley. A joint study by NAST, the National Academy of Medical Sciences (NAMS), and Teaching Hospital found that this leakage posed a risk to public and medical professionals' health. 
In December 2022, the Nepal Institute of Science and Technology (NAST), stopped the Thermos Luminescent Dosimeter (TLD) service, which is used to measure the cumulative exposure to radiation among health workers in X-ray and CT scan rooms, putting them at a greater risk. 
Most hospitals do not meet the radiation safety standards and there are no procedures for monitoring the use of radioactive equipment. The situation outside of Kathmandu Valley is even more dismal.
According to the World Health Organisation (WHO), 59 million people globally work in healthcare facilities, accounting for 12% of the working population. 
The <a href="https://www.ilo.org/global/lang--en/index.htm">International Labor Organisation</a> (ILO) reports that millions of healthcare workers suffer from work-related diseases and accidents, and many succumb to occupational hazards. This highlights the need to address the occupational health and safety concerns faced by healthcare professionals also in Nepal. 
Occupational Health and Safety (OHS) is a crucial aspect of any workplace, especially in the healthcare industry where workers are constantly exposed to various types of dangers. 
The primary focus of OHS is to ensure the well-being of the workers, protect them from potential harm, and promote a safe and healthy work environment. 
Despite the efforts made by scholars and practitioners to raise awareness about <a href="http://archive.nepalitimes.com/news.php?id=4747">workplace health and safety</a>, Nepal lacks legal support for OHS concerns. Apart from a few provisions in the Labour Act of 1992, Nepal's workers remain without adequate legal support for occupational safety and health concerns.
The Ministry of Health and Population has conveniently turned a blind eye to the situation. There are also no health programs in Nepal that address the prevention and control of occupational diseases and conditions.
To address these issues, hospitals in Nepal need to provide training and workshops about occupational health and safety. The government should also take steps to update policies and regulations to better protect healthcare workers. 
It is essential to ensure the well-being of healthcare workers and prevent workplace hazards to create a safe and healthy working environment.
Marasini is a public health professional and correspondence author of the research report: <a href="https://www.ijcmph.com/index.php/ijcmph/article/view/10680/6477">Occupational health and safety hazards faced by health care professionals in Kathmandu based hospital</a>.

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Nepal health workers at risk of workplace hazards

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161148/636d1db19c7e80680e0af3d0jpeg.jpg" alt="" width="767" height="575"/><figcaption>Security personnel and relatives of the deceased attend a mourning at the premise of infectious disease hospital in Pokhara. Photos: BARSHA KAFLE</figcaption></figure>A 79-year-old woman lay on the emergency bed, diagnosed with pneumonia due to Covid-19. Even as she was gasping for breath she had a smile on her face, handing over an invitation card to the attending doctor who was also her relative.Her grandson’s wedding was four days later. Family members from across the world had flown into Pokhara for the ceremony. She died of severe acute respiratory distress syndrome with multiple organ failure a day before the wedding, and it had to be cancelled.As her physician, I had sleepless nights when her condition worsened. We <a href="https://www.nepalitimes.com/here-now/nepal-health-workers-battle-covid-19-but-also-stigma/" target="_blank" rel="noopener noreferrer">health-care workers are also human beings</a>. When we lose near and dear ones it takes a toll on our physical and mental health, we grieve when our patients die. We may hide our emotions but we suffer all the same.The woman was just one of many relatives I have lost during this pandemic. As I grieved with family members gathered at the hospital, we were once again reminded of the Buddhist teachings about impermanence. Yet none of us is ever ready.“But it must be easier for you to face death as a doctor,” one of the mourners said to me. No, it is just as difficult. If not more, because as a physician I had the added responsibility of saving her life.Army men dressed in PPE from head to toe had arrived to take her body for safe disposal. Relatives from across the world who had come to celebrate a wedding ended up attending a funeral.The Gandaki Province government established Nepal’s first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1,300 Covid-19 cases at a cost of Rs500 million.Tha Gandaki Province government established Nepal's first provincial infectious disease hospital in July 2020. Since then, it has managed nearly 1, 300 Covid-19 cases saving Rs500 million out of pocket expenditure of common people.We have lost 52 people to the coronavirus in the same period. The Covid-19 mortality rate in this provincial hospital is 4.1%, relatively high compared to the total number of people who were hospitalised.The global death rate now stands at 1.97% with a total of 5,318,277 fatalities. This figure is exceptionally high given it has only been two years. Even then, this figure does not include <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">the social, mental and economic consequences</a> to family and friends of the deceased.But each Covid death is also a lesson for us to learn from. Most of these deaths could have been prevented if only Nepal had a robust primary health care system, and if preventive measures were more strictly enforced.With the <a href="https://www.nepalitimes.com/here-now/omicron-may-not-be-as-risky-but-take-care/" target="_blank" rel="noopener noreferrer">rise of new variants like Omicron</a>, it is also advisable to up our vaccination drive and we should also start administering boosters to vulnerable populations given our stock of doses and those that are on the pipeline.A man in his late thirties was isolating at home in Pokhara after getting infected. He just had a common cold but I requested him to undergo hospital-based isolation as he was symptomatic. But just a few days after getting admitted, his symptoms worsened and his condition deteriorated. He was then transferred to another hospital, and died soon after.This was not a case that should have been fatal. Even after 12 years of clinical experience, some of the Covid-19 outcomes I have encountered in the past year have been unexpected and shocking. It must have been devastating for the young man’s family and friends.Earier this year, when a 86-year-old mukhiya from Mustang died at our hospital of Covid complications, hundreds of Thakalis travelled to Pokhara to show their respect to the deceased despite the coronavirus surge at the time. Young or old, the virus was indiscriminate.In November 2020, I myself had to self-isolate with an upper respiratory infection due to a coronavirus infection. I thought I would not survive the excruciating body ache, sleepless nights and high anxiety level. During those horrific 10 days at <a href="https://www.nepalitimes.com/here-now/at-the-covid-19-frontlines-in-rural-nepal/" target="_blank" rel="noopener noreferrer">Bayalpata Hospital in Achham</a> I was battling an infection that I was treating my patients for.An elderly couple had been admitted to our hospital with Covid, both of them had severe symptoms. The husband died within a few hours of admission, but his wife was not aware of his passing until she became critically ill herself, and the family decided to tell her the truth. She passed away a week after her spouse. Medical staff usually have seen it all, but so moved with sorrow they mourned too.Holistic <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">health care</a> is the central core of modern medicine. But the caregivers can provide only acute biomedical care to alleviate the suffering of Covid patients. Their psycho-social wellbeing and that of their family members are often ignored. And we have not even begun to think about the mental health and trauma of the frontline workers.Over 800,000 Nepalis have been infected with the coronavirus and 12,852 have died of the disease. It is time we study this data, in particular the common causes of Covid-19 deaths in Nepal. Is it heart attack, blockage of vessels in the lungs, multiple organ failure or acute respiratory distress syndrome?We must reshape our health policies based on these facts and evidence. We must ensure adequate preparation with ICU beds, oxygen supply, <a href="https://www.nepalitimes.com/latest/donated-ventilators-gather-dust-in-nepal/" target="_blank" rel="noopener noreferrer">ventilators</a> and other equipment that were in short supply earlier this year.Only then can we design a robust and customised care system to protect our population from future surges.Bikash Gauchan is the Executive Director of the Infectious and Communicable Disease Hospital in Gandaki Province.

Diary of a Covid frontline worker in Nepal

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