COVID-19: Impact on Nepal and UMN


UMN Hospitals

Situation in Nepal
 
How many cases are there in Nepal?  See https://kathmandupost.com/covid19 for the latest numbers.
 
How has the Government of Nepal responded?
  • The government gradually banned flights from badly affected countries.  
  • Long distance buses, international flights and office working were banned from 22nd/ 23rd March, 
  • A nationwide lockdown was declared after the second confirmed case 
  • Food support to destitute people and those working in the informal sector has been announced.* 

Lockdown was probably a wise decision, in a country with 28 million people, only 700 ICU beds, and next to no capacity (at present) for COVID-19 testing.  Any outbreak would have a very high likelihood of getting out of control, overwhelming the health system, and costing hundreds of thousands of lives.
 
How will it affect ordinary people and the economy?
  • Over one-third of the Nepali economy relies on either tourism** or remittances*** from overseas workers; both have collapsed, and may not recover for many years.
  • The many families who took on debt to send a member to work in Korea, Malaysia, or Qatar now can't pay off their loans.  
  • Lockdowns are already causing job losses and business failures here as they do elsewhere, and hitting especially hard the many Nepalis who rely on a daily income in order to eat.
  • Thousands of Nepali migrant workers are returning daily, especially from India. They are overwhelming quarantine facilities (with great risk of transmission) and testing facilities. Others are being flown back from the Gulf and Malaysia and placed in quarantine in Kathmandu. For the first two months of lockdown they were trapped in other countries, unable to work, often unable to pay rent and have money for food.

These severe effects are likely to impact Nepal for several years - the hard truth is that we are at the beginning of a disaster that will hit every district in Nepal, even if the virus is kept out, because:
  • Until vaccines or medicines become available, for at least the next year or two we can expect governments to continue to use frequent lockdowns, especially in countries that don’t have the systems in place to test their citizens on a mass scale. 
  • We cannot expect labour migration to return to normal for many years, meaning that the remittances on which so many families depend will stop.  
  • Many people’s livelihoods will be completely disrupted by border closures, travel restrictions, and the collapse of tourism.  
  • Many will be in debt they cannot repay. 
  • Mental health will be strained by people's losses and by fear of the virus

UMN Hospitals
 
What about PPE?
Our hospitals also share the widespread global problem of not being able to get enough PPE (personal protective equipment) or N95 masks for frontline health workers.  For this need, UMN already has the necessary funding (from emergency funds)****, but is scouring Asia for a supplier willing and able to take our money.  Meanwhile our staff have been busy making their own PPE.
 
What other preparations are hospitals making?
  • Both Okhaldhunga and Tansen are running separate fever clinics where people with possible COVID-19 symptoms can be checked apart from other patients and staff.
  • Both Okhaldhunga and Tansen have prepared isolation wards, where dedicated nursing staff can care for patients with COVID-19 around the clock.
  • Both hospitals are on their district task forces to prepare for coronavirus.  They are advising local governments on infection control and quarantine planning.   
  • Both have been training staff and ensuring all are familiar with the coronavirus contingency plan.  

How are the hospitals affected now (apart from the revenue shock)?
  • All training schools have had to close until the lockdown and risk are over – nursing in both hospitals, also the lab technician training school in Tansen – at least 300 students are affected.
  • For Tansen expat volunteers - three appointees had to leave, one new doctor and one annually visiting surgeon were unable to arrive, and two medical elective students were called back early and all others due to come in 2020 have cancelled.  Others in the application process are also delayed.

Will the income return to normal after this lockdown?
  • No, not for months or even years. The future is likely to bring more lockdowns and many months in which most people avoid hospitals whenever possible.  

Tell me more about the hospitals!
  • Both are in rural districts of Nepal, Tansen in the west and Okhaldhunga in the east. 
  • Both offer free treatment to patients who can’t afford to pay.
  • Medical needs in Tansen inspired the start of UMN – we’ve been there for over 65 years.  It’s a 169 bed hospital, serving thousands a year and has over 350 students a year training in medical professions.  You can learn more from Tansen Mission Hospital website
  • Okhaldhunga is an 85-bed hospital with a maternity waiting home and a nursing school in a more remote location – you can learn more from Okhaldhunga Community Hospital page.

Clusters
 
(UMN works through local partners in 8+ remote and/or poor districts across Nepal)
 
How are clusters affected now?
As soon as the government announced closing offices for 2 weeks, Cluster staff were asked to leave and return to their families (often one or two days' travel away) rather than be separated during the closures. Cluster staff are working from home where possible.
 
We have asked our Cluster teams to rethink their planned work in light of this prospect—lots of disruptions to everyone’s life and work, with windows within which we can reach communities and do whatever is possible to help them, and also long stretches where we can expect to be working from home on lockdown.
 
How will clusters be affected in the near future?
  • We expect the pandemic to have a severe and long-lasting impact on millions of families across Nepal – their livelihoods and income, education, food security, access to services, mental health etc. We currently work in all these areas with the most marginalised.  We will see thousands becoming poorer and needing more help.
  • Intermittent lockdowns are expected for months.  As much of our cluster work involves travel for hours in remote locations, and some central support staff travelling out to clusters from Kathmandu for one or more weeks at a time, our regular work and projects will be severely disrupted.  
  • If there is a COVID-19 epidemic in Nepal, tens of thousands of households may lose members to the illness (or to other diseases, when local health systems are overwhelmed).  All non-medical work in the affected area of the country is likely to be suspended.
  • We also recognise that funding sources may be restricted as supporting partners and countries are themselves suffering badly during the coronavirus pandemic.  

In the light of all these, UMN has made the big decision to re-orientate our work for the next one to two years to respond to the immediate impact of Coronavirus.  This will involve putting our existing projects and five-year plans on hold while we use the same skills and experience to support communities impacted by COVID-19, in the windows of opportunity when we have access to visit and support, in between lockdowns.
 
How will the clusters respond?
The clusters will address the most urgent local needs of people affected by this pandemic, including:
  • Preparing health systems to prevent/cope with an outbreak
  • Helping people whose livelihoods have been severely disrupted by coronavirus lockdowns and border closures
  • Helping children whose access to education has been severely disrupted by coronavirus response
  • Supporting people in the highest-risk groups, including people living with HIV, the elderly, and people with disability
  • Helping communities reverse an expected increase in domestic violence and risk of human trafficking
  • Strengthening local governance systems for coronavirus response
  • Encouraging local faith networks to reduce coronavirus risk and reach out to help those badly affected

 


 

*https://kathmandupost.com/national/2020/04/01/rice-pulses-salt-oil-soap-and-sugar-to-be-distributed-to-informal-sector-workers-and-destitutes
**Tourism contributes at least 5% of GDP - https://thehimalayantimes.com/opinion/tourism-industry-in-nepal-make-it-backbone-of-economy/
***Remittances contribute around 28% of GDP - https://kathmandupost.com/money/2019/04/10/nepal-is-19th-largest-receiver-of-remittances-with-81-billion
****PPE represents a large cost – around USD 90,000 – but it is dwarfed by the revenue loss of income to the hospitals, of over USD 300,000 a month.
 

 

Developed by the Communications Team, UMN