As the COVID-19 pandemic sweeps the globe, hospitals have been overwhelmed. <a href="https://www.nepalitimes.com/banner/why-nepal-must-watch-about-coronavirus-but-not-panic/" target="_blank" rel="noopener">Nepal is ahead of the curve, but if the case load is to rise steeply </a>as it has done in Italy or Spain, the government needs to start preparing ICUs, ventilators, and protective gear for hospital staff.At present, nurses, doctors, interns and resident doctors and other medical personnel in Nepal’s hospitals lack personal protective equipment (PPE), and they fear for their own lives while <a href="https://www.nepalitimes.com/editorial/this-is-a-test/" target="_blank" rel="noopener">treating patients with suspected coronavirus</a>.Patients can be carriers and spreaders of the virus without showing any symptoms. Thousands have been visiting hospitals to get tested, have chest x-rays done, and could be unknowingly infecting medical staff.“If we find issues with the patient’s lungs after the chest x-ray, we monitor them closely for infection,” says a doctor at a medical college in Kathmandu. “By the time we confirm whether they have been infected, the virus could infect many others in the hospital treating them, like myself.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a029c7e80680e064735jpeg.jpg" alt="" width="714" height="960"/><figcaption>A doctor wearing makeshift protective gear while treating a patient in Karnali hospital.</figcaption></figure>Many doctors and even interns do not have a choice, and treat patients without PPE. “If you don’t go to work, the medical college won’t give a certificate,” the doctor complains.Staff at the Sukraraj Tropical and Infectious Diseases Hospital in Kathmandu which gets most of the referrals of suspected coronavirus cases are most at risk. Sagar Kumar Rajbhandary works 12 hour shifts at the Teku hospital, and says PPE are must-have given the number of patients coming in for checkups every day.“We need at least a 100 PPE units right away, but we have not got it yet,” says Rajbhandry. The anti-biohazard equipment include respirator masks, sterile hoods, gowns, and goggles.For the past month, hospitals across Nepal have been treating patients coronavirus symptoms without proper PPE, and the medical system is ill-prepared for a major outbreak.Read also: <a href="https://www.nepalitimes.com/opinion/nepal-locked-down-now-what/" target="_blank" rel="noopener">Nepal locked down, now what?</a>, Marty Logan <figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a049c7e80680e064736jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>“Since a few units of PPE are not going to be enough, and because they are so expensive we have no choice but to start making them locally,” says Paras Pandey at Bheri Hospital in Nepalganj who is not waiting for help from Kathmandu, and has already made 200 PPE at a local garment factory.The PPE gown is improvised from thin plastic, and the goggles have been made from transparent stationery, while the helmet is fashioned out of elastic apparel material. Pandey says other hospitals in the region have also copied the design.Protective gear are being manufactured at four other sites, including by the Innovation Centre of Mahabir Pun (see box), the Karnali Health Science Institute, the Dharan-based BP Koirala Health Science Institute.Although these Nepal-made PPE are not as high quality as imported ones, they at least offer some protection to medical staff. One imported PPE can cost anywhere up to Rs20,000, but a locally manufactured one costs only Rs250.“We got local tailors to make 50 PPEs on the first day itself, they are cheap but effective, and serve the purpose for now,” said Mangal Rawal of the Karnali Health Science Institute.https://youtu.be/c_57ssQF8Ywhttps://youtu.be/mGo7TuZu61ghttps://youtu.be/EVX4SlY28IUTourism entrepreneur Suman Pandey says if the government only gave him permission, her could get workers with experience in making trekking gear to start assembly line manufacture of PPEs. He has already made two prototypes which could be also worn by ambulance drivers and helicopter pilots transporting infected people.The PPE also needs to be disposed of properly after use in the medical wards, the ICU or even in front of a patient getting tested for COVID-19. One doctor or nurse needs at least eight units of PPE every day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a079c7e80680e064737jpeg.jpg" alt="" width="720" height="960"><figcaption> </figcaption></figure>Bhogendra Raj Dotel at the Ministry of Health, is currently working to procure more PPEs, but there is a shortage in the world market. In case, all flights have stopped, so there is no way to bring them here quickly.“It is not possible for donor countries to respond because they are dealing with shortages themselves,” Dotel explains. Suppliers who used to source PPEs from Singapore, Thailand, China and India are not getting new units because they have stopped exports.Nepal’s hospitals also have a chronic lack of oxygen cylinders and ventilators even at the best of times. If the pandemic hits Nepal with full force, medical facilities just do not have the equipment to treat critically ill patients.Read also: <a href="https://www.nepalitimes.com/opinion/nepal-locked-down-now-what/" target="_blank" rel="noopener">Protecting Nepal's elderly from COVID-19</a>, Alisha SijapatiBesides this, the government procurement process is cumbersome, and although a tender was issued for PPE, gloves, boots, digital thermometers and other essential items on 15 March, delivery is uncertain.The department had requested bids to supply materials for a 1,000 bed isolation ward and 235 ventilators. But even these would not be enough if the infection rate rises.The Nepal office of <a href="http://www.nsi.edu.np/en" target="_blank" rel="noopener">Nick Simons Institute (NSI) </a>flew in 11 portable ventilators from the United States and they arrived on 16 March. NSI is also committed to supply 1,000 locally-made PPE to the government.China has also committed to help with medical supplies including PPE, but Mahendra Shrestha of Department of Health Services said they had not yet arrived.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a099c7e80680e064738jpeg.jpg" alt="" width="640" height="853"><h2>How Facebook came to the rescue</h2>Ma<a href="https://www.nepalitimes.com/banner/drones-to-the-rescue/" target="_blank" rel="noopener">habir Pun</a>, the Magsaysay Award winning Nepali activist, knew that Nepal’s health system would not be able to function unless nurses, doctors and technicians had protective gear for treatment of patients.Since imports were impossible because of flights being cancelled, Pun decided that his centre would start churning out PPEs. He even brought 2,500 metres of fabric, but could not find a single tailor shop open in Kathmandu Valley.So on 23 March, he <a href="https://www.facebook.com/mahabir.pun">posted a message on his Facebook page</a> asking for tailors. He has nearly 100,000 followers, and the word spread quickly. Soon Pun started getting inundated with phone calls from tailors and garment shops all over the city.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101156/636b7a0b9c7e80680e064739jpeg.jpg" alt="" width="600" height="400"><figcaption> </figcaption></figure>Garment factories in Balaju and Putali Sadak offered to stitch prototypes, which are now ready. “We will now show them to doctors, and if they approve we will start mass producing protective gear and distribute them to hospitals all over the country,” Pun told Nepali Times.

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

Protecting those who protect us from the epidemic

https://www.youtube.com/watch?v=bWTvesQmPVAR aharman Tamang was using a circular saw to cut a steel rod at a metal shop in Bhaktapur when a section of the rod snapped off and pierced his head.The rod entered through his left forehead just above his eyebrow, crossed the brain in the midline, and exited from behind the brain on the right side. (See CT scan, below) While doing so, it damaged the basal ganglia and internal capsule, the conglomerate of neurons controlling the movement of the left half of his body. Half of his body became paralysed immediately. Tamang, 20, lost consciousness and went limp.Relatives rushed him to a nearby hospital in Bhaktapur, which said it was not possible to treat him. They then took him to TU Teaching Hospital at Maharjganj, where he was turned away because there were no beds in the ICU.By the time they got to the emergency ward of Upendra Devkota Memorial National Institute of Neurological and Allied Sciences in Bansbari it had been four hours since the accident.Doctors were shocked — they had never seen a case like this. They were doubtful at first that the patient would live. Quickly the team reviewed literature to guide the patient’s care and management. Neurosurgeon Pratyush Shrestha found an article in Pubmed about a similar case in a hospital in Mumbai.Read also: <a href="http://archive.nepalitimes.com/news.php?id=7376#.XYNT_i4zbIU">Two out of 200,000</a><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58749c7e80680e054837jpeg.jpg" alt="" width="1400" height="933"/>“We did not have much time: the dirty rod could lead to brain infection,” Shrestha recalls.Any foreign object that enters a head has to be  taken out from the direction opposite to its entry, since removing it from the same side could inflict additional damage on vital nerves.An 11-member team, including resident doctors Suvas Lohani, Ranjan Lamichhane, Madhav Gautam and neurosurgeon Shikhar Shrestha took part in the operation. They also consulted Professor Laxmi Pati and Terence Hope. First, they performed a craniotomy and carefully pulled out the rod to prevent infection and bleeding.Read also: <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/book-review-Admissions-Henry-Marsh-Neurosurgeon,4055">The English Surgeon</a>, Niraj Shrestha<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58789c7e80680e054838jpeg.jpg" alt="" width="434" height="500">The only reason Tamang survived the delicate operation was because the rod miraculously missed by arteries that supply blood to the brain by millimetres. It also did not touch the brain stem and the vital organs regulating respiration and cardiac activity.Three weeks after his treatment, Tamang’s health is improving and he has been shifted to the general ward of the hospital (picture, below). He can talk, and is not suffering any major side effects, but needs to take his medication to avoid infection, and do physiotherapy. The doctors involved are working on a paper to be published in a peer-reviewed journal so the experience can help in treating other patients. “Just like we were guided by a paper, we hope our experience will also be useful to others,” says Shrestha.Tamang’s accident is an example of the sorry state of industrial safety in the country. He would not have been as severely injured if he was wearing a helmet.Sunil Kumar Joshi, a physician at Kathmandu Medical College, says that though the government has rules about safety in the workplace, they are not enforced.“Workers do not know that they can ask their employers to ensure safety and security,” he says.Read also: <a href="https://www.nepalitimes.com/here-now/upendra-devkotas-lives/">Upendra Devkota’s lives,</a> Kunda Dixit

1250x600

1084x550

Man survives steel rod piercing his head

Devprakash Tripathi in Ghatana ra Bichar, 29 JanuaryNCP Co-chair Pushpa Kamal Dahal recently expressed strong support for the sovereignty of Venezuela’s elected communist government, and denounced foreign intervention, particularly that of the United States. This is ironic because his own political trajectory has depended on foreign intervention and support. As a rebel, Dahal sought shelter abroad while perpetrating violence in his home country. His signing of national agreements while in foreign land was already an open invitation for interference. Even when he was in power, Dahal pursued the agendas of foreign powers to support his own power.Historically, Dahal has shown no respect for Nepal’s sovereignty. He was involved in demolishing statues of Prithvi Narayan Shah, was irreverent of poet Bhanubhakta Acharya and other figures regarded as Nepal’s national heroes. Yet, Dahal is in effusive admiration of Marx, Lenin, Stalin and Mao who in no way contributed to Nepal’s development. Dahal’s statements are hypocritical, and inconsistent with his own past.There is speculation that Dahal issued the statement to regain China’s diminishing trust in him after his India visit. This was evident in the way the Chinese snubbed him on a recent trip to China. This latest statement calling for international support of Venezuela’s communist government may be intended to convince China that his communist stance is still intact.

A conflicting stance

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108101144/636a252e9c7e80680e0439b4jpeg.jpg" alt="" width="1000" height="507"/><figcaption>Photo: YOYOKHABAR</figcaption></figure>Nagarik, 31 JanuaryDoctors across the country have taken to the streets to protest the government’s inaction on Govinda KC’s demands and his deteriorating health. The House of Representatives passed the Medical Education bill on 25 January, amidst opposition, without addressing KC’s demands of reforms in medical education. Doctors, united under the leadership of Nepal Medical Association, have begun a relay hunger strike to pressurise the government.KC is on his 16th fast-unto-death at the TU Teaching Hospital at Maharajganj. His health is said to be critical after not eating for more than three weeks and he has difficulty breathing due to chest pains. Decreasing white blood cell count has put his life at grave danger. The amount of oxygen, glucose, and potassium in KC’s body has also decreased, he has trouble sleeping and is vulnerable to infections. KC needs to be treated in an Intensive Care Unit (ICU) but has refused to go to there.KC has been fasting since 10 January, asking the government to implement the agreement made with him after his 15th fast. But after the government prepared the Medical Education bill in contradiction of the agreement, KC began his current fast. The government claims that the bill fulfills KC’s demands.Nepal Medical Association says that doctors in major cities like Biratnagar, Dharan, Janakpur, Chitwan, Birgunj, Butwal, Pokhara, Nepalganj, Dhangadi and others have carried out protests in support of KC, and medical professionals working in Primary Health Care Centers have joined them.On Wednesday, former Chief Justice Sushila Karki visited KC and expressed her solidarity with his movement. “Not fulfilling Dr. KC’s demands would be a loss to the entire nation, and his victory is the victory of 30 million Nepalis,” she said as she asked the government to fulfill his demands.

Doctors solidarity with Govinda KC

mainNavigation

footerNavigation

opinionSubnav