Responding to the COVID Surge in Nepal

Q&A with CHRHS Affiliated Fellow, Dr. Ramu Kharel

As you are in Nepal at the moment, can you please tell us a little about the current COVID situation?

The COVID 19 situation is dire in Nepal, and the country is in humanitarian crises. Nepal has a very weak health infrastructure and it has collapsed during this second wave of the pandemic. With the rise of cases in India, Nepal shortly followed, and crossed India in per capita cases. Currently, the country is seeing as high as 80% positivity rate in some districts, especially those bordering India. There has been a major lack of oxygen supply. Testing has not been adequate to date, which has helped propagate community spread. While the international focus is currently in India, Nepal, a country with nearly 30 million people, is drowning in the pandemic.

You recently led a training on COVID-19 clinical management and vaccines for health providers in the country. How has that training been received and what impact do you think it will have?

As part of the larger CHRHS / Project HOPE COVID-19 Training of Trainers project, I led a 4 hour training with a focus on clinical management of COVID-19 in Nepal, and it was attended by 300 doctors, nurses, health workers around the country. 300 was the max number allowed on my Zoom. The feedback from this training has been tremendous. It is very clear that we do not have enough to equip health care workers working in the frontline to fight this pandemic, and one of the gaps is basic clinical management knowledge. We also conducted another 2 hour training a few days ago with max capacity with a focus on isolation/surge center staff. This has also been well received. There is a high need in Nepal to train and equip frontline HCWs with COVID 19 clinical knowledge.

What is the current level of vaccine access in Nepal and how has the roll out been thus far?

Though available data is varying, Nepal has vaccinated about 7% of its population with atleast 1 dose. This is one of the lowest numbers in the world. Nepal has a really good vaccine delivery infrastructure from years of vaccine campaign experiences, but Nepal just has not gotten the vaccines. Due to the crises in India, one of the major sources of vaccines is now not available. Currently, so vaccines have been coming from China, but Nepal needs more vaccines. There are many who got the first dose of Astrazeneca (COVIShield), and have no way to get the second dose due to the crises in India.

In addition to these training courses, can you tell us a bit about the research assessment you are currently conducting on Hospital emergency care in Kathmandu, Nepal?

There is a big gap in emergency care research in the country. We understand how important emergency care is to save lives around the world, during a disaster and in normal times. Current COVID-19 pandemic and the 2015 earthquake exposed the necessity to work towards strengthening emergency care in Nepal. I came to Nepal to conduct a pilot research study to assess hospital facility emergency care at 7 tertiary hospitals. Our study focuses on gathering information on the current state of emergency care services at these hospitals including human resources and service delivery. This study will give us a baseline information on the current state of emergency care at tertiary levels, and also pave the way to conduct a country wide assessment. This study is supported by a CHRHS grant, and I am highly appreciative.

What types of advocacy efforts can individuals get involved with to help not only spread awareness but also assist with getting more vaccines into the country?

Nepal's crisis needs our attention. I am Nepali born American citizen, and fought in the pandemic's frontlines in the United States. Like myself, many other Nepali healthcare workers in America fought in the pandemic as well. Now, our families need help in Nepal, and we hope the US steps up. Currently, the United States is sitting on millions of extra vaccines. While the new focus is in India, we can't have the US forget Nepal while allocating vaccines. President Biden has already announced they will be sending vaccine aids, but the countries have not been decided. We are working on advocacy on many fronts. Brown University has a large Nepali community and they have been affected by the pandemic. We have sent a letter through Dean Ashish Jha to President Paxon asking her to make a public statement on the Nepal crises, and to personally call upon the Biden administration to send vaccines to Nepal. Different universities are taking this same initiative. People can help us with advocacy effort by doing multiple things: Call your local representatives and describe this Nepal's situation to the, post of your social media, write op-eds and talk to people about the Nepal crises. People can also donate to different grassroots organizations in the country. My NGO, HAPSA, is currently helping people stay home by giving home isolation kits. If you are interested in learning more or donating to this effort, you can go here.