I’ve been reading about social determinants of health for some years now, but I had to see this phenomenon in practice before I truly ‘got it’.
It’s one thing to understand an issue or fact intellectually, another to experience it first-hand. That’s been made clear to me twice recently concerning health care here in Nepal and what are sometimes called ‘social determinants of health.’
One of my current projects is reporting about malnutrition during Covid-19. I contacted the Nutrition Home close to Kathmandu hoping to speak to the guardian of a child who had been admitted because they were malnourished.
There is no way to sugarcoat this – Nepal is being hammered by Covid-19. Just as in its giant neighbour, places such as the capital Kathmandu and cities bordering India have run out of intensive-care hospital beds and oxygen, extra cremation sites have been set up on the banks of rivers and fewer than 5% of people have been vaccinated, with no new jabs in sight.
A report published online in the journal The Lancet Global Health this week revealed that the COVID-19 pandemic has caused 50% fewer women in Nepal than usual to give birth in hospitals, resulting in higher risks for premature births, stillborn deliveries and newborn deaths.
The study, conducted in nine hospitals across Nepal found that the stillbirth rate at hospitals and birthing centres increased from 14 per 1,000 before the lockdown to 21, and the neonatal mortality increased from 13 per 1,000 livebirths to 40.
As many as 7,500 people are now crossing into Nepal daily. Since Monday, 283 new cases have been confirmed country-wide, including 114 on Wednesday, the highest one-day tally to date. The returnees are some of the roughly 2 million Nepalis forced to migrate to India because they can’t earn livelihoods at home.
The wait-and-see is over. Many of us living in Kathmandu have speculated during the past four months about where and when multiple cases of Covid-19 would finally appear after Nepal confirmed its first infection on 23 January, a student from from the disease’s epicentre in Wuhan. Small numbers of infected people have been sneaking across the Indian border despite it being closed since 24 March, but this week the trickle became a surge.
As many as 7,500 people are now crossing into Nepal daily, according to media reports. Some are not being screened for the coronavirus or put into quarantine, and of those who are being confined, some say conditions are not safe or comfortable and that they are not being provided food.
The returnees are some of the roughly 2 million Nepalis forced to migrate to India for months and even years at a time because they can’t earn livelihoods at home. Many are daily wage earners, whose work dried up soon after India went into lockdown on 24 March and have been making their way homeward ever since. Some have been forced to wait for weeks at the Indian border.
It was startling to learn that Nepal Prime Minister KP Oli admitted in Parliament on Tuesday that Nepal’s two coronavirus deaths to date represent a failure of his government. This raises the question: when will a leader apologise for the more than 1,200 women who die every year giving birth?
When will a Nepali leader apologise for the 1,200-plus women who die giving birth yearly?
The headline of this story refers to Nepal Prime Minister KP Oli, who a couple of weeks ago admitted in Parliament that his government had failed to prevent COVID-19 deaths. (As I write this Nepal has four COVID deaths). When the article was published on the Nepali Times website the headline was changed, removing that point. Regardless, too many women, and other Nepalis, continue dying because of the broken health system.
It shouldn’t be surprising that Nepal’s first COVID-19 death was that of a new mother. It was startling to learn that Prime Minister Oli admitted in Parliament on Tuesday that Nepal’s two coronavirus deaths to date represent a failure of his government. This raises the question: when will a leader apologise for the more than 1,200 women who die every year giving birth? Continue reading “‘We have failed’ new mothers”
This article was published on nepalitimes.com on 24 April as Helping the helpless during lockdown. It features six organisations that are providing food and other essential items, mainly to the poorest of the poor. I’m sure there are hundreds, if not thousands, more groups in Nepal also contributing in this way. It is a bright spot in a gloomy situation as the country is far from prepared for a major outbreak of the Coronavirus.
Raj Kumar Mahato launched the Covid-19 relief campaign of BHORE with Rs200,000 from his own pocket but doesn’t know where the NGO will find money to continue providing essential items for the ultra-poor, Nita Raut has spent all but Rs4,500 of the Rs78,000 she raised and says she will donate her own salary if necessary to provide food to Kathmandu’s poorest and Sano Paila, an NGO, is dipping into its savings to continue relief work in the eastern Terai.
Budgets of small organisations providing relief to needy people in Nepal are being squeezed dry as the lockdown continues but all of them say they are determined to keep working.
Finally in the past two weeks Nepal has started testing larger numbers of people, using so-called ‘rapid diagnostic tests’, although the total is still less than 20,000. That is one of the few bright spots in the government’s response to the pandemic since the first case was confirmed here on 24 Jan. So far the country has been very lucky but it’s time to stop taking the good fortune for granted and get serious about the ongoing lockdown.
The following was published on the Nepali Times website on 17 April:
Shape up the lockdown in Nepal
Going through the motions to quarantine people or wearing masks haphazardly will not help to prevent a devastating outbreak
When I read a few days ago that China and India were willing to provide medical equipment and medicine to Nepal I did a double-take. Surely, this isn’t news, I thought — I’m certain that the giant neighbours would have responded positively to such a request a month, or even two months ago, when it was blatantly obvious that Nepal lacked masks, Covid-19 tests and other materials needed to prevent an outbreak. Of course, what did make it headline-worthy was that the recent inquiry had come from the Nepal Army.
I have no medical training, but given the utter failure of the government to react to the shortage in a timely manner, and to get the big things right more broadly, I think that the smaller ways in which we all react to the threat are going to take on a larger dimension. Yet what I’m seeing in my neighbourhood, and in the media, does not give me confidence.
With only 16 cases detected since January, how seriously are Nepalis preparing for the pandemic?
Nepal’s long land border with India (1,800 kilometres) is usually open, so that citizens of both countries can come and go easily without visas and usually with little notice from the police posted at entry points. On March 24 India closed that border, along with all other access to the country of 1.4 billion people. The same day Nepal also declared a ‘lockdown’ and barred all entries. But it’s been estimated that there are 500 official and unofficial entry points along the imaginary line between the two countries and in the days before and after the lockdowns as close to half a million Nepalis living in India crossed home, according to the Nepali Times newspaper.
Since Nepal’s first case of COVID-19 was detected in January the country has tested just over 6,000 people. Yet only 15 other cases have been detected, and no one has died of the coronavirus. How can that be? is the question that everyone is asking, including officials in the ministry of health.
If the current trend doesn’t change it will take the poorest Nepali families 50 years longer than the wealthiest ones to reach the target for the number of newborn deaths per capita. As the Covid-19 pandemic is leading to discussion about what kind of societies we want to live in, Nepal’s growing inequality should also be on the table. Read my latest article for Nepali Times.
The overall trend in neo-natal deaths is positive, but the poorest families will lag behind further as inequality grows
According to a recent journal article, it will be 2067 before newborn deaths among the poorest Nepalis have fallen enough to reach the global target set for 2030. That target, of 12 or fewer deaths per 1,000 live births, was attained by the wealthiest in Nepal four years ago, but the impact of COVID-19 may increase inequality and make it even more difficult for the country to reduce infant mortality.
If the pandemic shutdown is an opportunity to reimagine our societies, what should Nepal make of the widening gap in newborn deaths? Yes, overall trends are improving — both maternal and newborn health have made major gains in recent decades — but the poorest families are still lagging behind.
India — Hit By Coronavirus Lockdown, 90-Year-old Kajodi Trudges Home, 400 Km Away
Thousands of migrant workers are leaving cities after the central government announced a three-week nationwide lockdown to prevent the spread of Coronavirus. — Outlook India
Nepal Supreme Court refuses to order government to repatriate migrant workers
The Supreme Court refused to issue interim order sought by advocates Madhav Kumar Basnet and Mina Khadka Basent to allow Nepali citizens stranded in foreign countries, including India, to return home. — The Himalayan Times
No exceptions with COVID-19: “Everyone has the right to life-saving interventions” – UN experts say