COVID-19: Impact on Nepal and UMN


UMN Hospitals

Situation in Nepal
 
How has the Government of Nepal responded?

In a country with 28 million people, only 700 ICU beds, and little capacity for high levels of Covid-19 testing there was no option but enforce a lockdown. Any outbreak would have had a very high likelihood of getting out of control, overwhelming the health system resulting in a high death rate.
  • 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 on 24th March after the second confirmed case.
  • Food support to informal sector workers (i.e. low paid people with little job security) and destitute people has sometimes been provided through local Government.* On many occasions this has been with the additional help and generosity of local community groups.
  • The lockdown lasted for 17 weeks between 24 March and 21 July. In some areas it was more strictly observed and enforced than others – however it is widely accepted that the restriction has curbed the rise of infections seen in many other countries.
  • One of the most commonly expressed concerns in the media has been about the lack of stringent testing and tracing which is regarded as the most effective way of keeping control.
     
Increasing Concern

In the seven days before lockdown ended on 21 July the daily average of new infections was 129. In the third week after lockdown that daily average over seven days had risen dramatically to 419.
 
Two Noticeable Trends
  • Right along the districts of the Terai which borders India the number of infections and deaths has been significantly greater than in the hilly areas.
  • Since the ending of lockdown and large numbers of people moving around and returning to Kathmandu the infection rate in the Kathmandu Valley has been rising rapidly.
 
How has this affected 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.
  • Many families who took on debt to send a member to work in Korea, Malaysia, or Gulf countries now can't pay off their loans.
  • Lockdowns have already caused job losses and business failures. This has been especially hard for many who rely on a daily income in order to feed their families. There are no unemployment benefits or government furlough schemes.
  • Thousands of Nepali migrant workers have been returning daily, especially from India. They are overwhelming quarantine and testing facilities (with great risk of transmission). 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.
  • Many people needing hospital treatment have not received it due to fear about going to a hospital or lack of transport to get there due to lockdown. For example there has been a huge rise in deaths of mothers in labour who could not reach a hospital.
  • Many families who took on debt to send a member to work in Korea, Malaysia, or Gulf countries now can't pay off their loans.
  • Mental health has been strained by people's losses, the fear of the virus and the affects of months of confinement. An increased number of suicides have been reported.
  • Gender based violence has increased as many women and children have been trapped in their homes with their abusers.
  • We expect reduced uptake of girls’ education and increased risks for child marriage and human trafficking.

These severe effects are likely to impact Nepal for several years - the hard truth is that in addition to the illness and hardship caused by the Coronavirus, there is an unfolding economic disaster hitting every district in Nepal.This is because:
  • Until vaccines or medicines become available, for at least the next year or two we can expect the Government to impose localised lockdowns in any area where there is a spike in infections.
  • 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 continue to be completely disrupted by border closures, travel restrictions, and the collapse of tourism.
  • Many are now in debt they cannot repay.

UMN Hospitals
 
What about PPE?
At the outset of coronavirus lockdown our hospitals experienced the global problem of insufficient PPE (Personal Protective Equipment) including N95 masks for frontline health workers. For a period, our staff were busy making their own PPE. Fortunately, using emergency funds we have been able to get enough supplies for the time being. ****
 
A Revenue Shock
As lockdown began, fear of coronavirus was increasing, and travel became nearly impossible, with the result that the normally bustling hospital outpatient departments were close to empty. At one point the reduction was down to between 10-20% of normal. Since 80% of hospital income comes from patient fees for outpatient services and elective surgeries this was of great concern. The initial severe shortfall in income was in the region of $300,000 (USD) per month. A shortfall of USD 1.5m is estimated for a one-year period. We are very thankful that in July the numbers of people coming to hospital began increasing significantly (though not fully recovering), and that the worldwide appeal to our friends for financial support is receiving a generous response which we pray will carry us through the crisis.
 

Will income quickly return to normal?
  • 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.

What other responses have the hospitals made?
  • 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 care for patients with Covid-19 around the clock.
  • Both hospitals are on their district task forces working to combat coronavirus. Covid-19 has fostered a closer relationship with local authorities.
  • 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)?
  • Both hospitals have had a number of Covid-19 patients to care for. The frontline staff have been fantastic in their willingness to care for these people. We are deeply thankful that none of these staff have been infected.
  • The nursing schools in both hospitals have closed, and so has the lab technician training school in Tansen. More than 300 students are affected. It is uncertain when these training centres will re-open.
  • Expatriate volunteers (long term and short term) have been affected. Three appointees had to leave, one new doctor and one annually visiting surgeon were unable to arrive, 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.
  •  

Tell me more about the hospitals!
UMN has been treating patients in Nepal for over 65 years. Learn more about our two hospitals serving rural districts from Tansen Mission Hospital website and Okhaldhunga Community Hospital page.
 

Clusters
 
UMN works through local partners in six remote and poor districts across Nepal.
 
How are clusters affected now?
As soon as the government announced the closing of offices, cluster staff were asked to leave and return to their families (often one or two days' travel away) rather than be separated for months of lockdown. Ever since cluster staff have been working online from home where possible. For Dhading and Sunsari clusters which were due to finish in July 2020, sadly they had to close early because of the budget crunch as a result of the global pandemic (see June 2020 UMNews).
 
Looking ahead, how will clusters be affected?
  • The pandemic is having a severe impact on millions of families across Nepal, and this is likely to be protracted. Livelihoods and income, education, food security, access to services, mental health etc. are profoundly affected. We currently work in all these aspects of development with the most marginalised. Sadly, we are seeing thousands becoming poorer and needing more help.
  • Intermittent lockdowns are expected for months. As much of our cluster work normally 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. For some time all travel has been suspended, and even with more freedom in the country, UMN has decided that only the most essential travel will be attempted under very carefully regulated safety instructions.
  • We recognise that funding sources may be restricted as supporting partners and countries are themselves suffering badly during the pandemic. This raises a major concern about how we can continue our service.

In light of all the above, UMN has made a major decision to re-orientate our work for the next one to two years to respond to the immediate impact of Coronavirus. This involves 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 between lockdowns when we have access to visit and support. In the lockdown periods staff will seek to support and guide partners remotely as best they can.
 
How are the clusters responding?
Cluster teams have been revising their planned work in light of this new approach. The clusters will and have started to 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.
  • Promoting good mental health.
  • 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.

Where possible, our clusters have been responding to relief needs for quarantine centres, isolation centres, health centres and also sometimes with food supplies and livelihood support as well as Covid-awareness messages. See our latest news, the separate UMN Covid-19 relief page (coming soon) and also our recent issues of the UMNews magazine.

 


 

*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