Updated: Jun 28, 2020
By Christina Min
Nepal, a small country wedged between India and China, is still stuck in the hardships of its past. Its mountainous terrain and geographic divisions mean rural populations are often isolated; this, in conjunction with topographical factors, poor sanitation, and air pollution, means that epidemics of infectious diseases, malnutrition, and other health-related issues commonly occur. Consequently, Nepal is rife with both communicable and non-communicable diseases.
The United Nations Development Programme (UNDP) indicated in its 2009 Nepal Human Development Report that a quarter of Nepal’s population is still below the poverty line. With political and economic unrest woven directly into the fabric of everyday life, Nepal has faced many developmental challenges over the years. In comparison to a more modernized country like New Zealand, an individual in Nepal is 8.8 times more likely to die in infancy and has an average life expectancy that is 13.74 years lower. A Nepalese is also three times more likely to contract HIV/AIDS.
Challenge 1: Understaffing
These statistics can be attributed towards a fundamental difference between New Zealand and Nepal: healthcare. New Zealand has around 40 public hospitals, and treatment is free for any eligible citizen. In contrast, Humla, a rural region in Nepal, has only one under-equipped and understaffed hospital to cater for a population of over 50,000. According to nurse Basta Limbu at Humla District Hospital, a small staff-to-patient ratio means that “it is sometimes impossible to give proper care.”
I can personally attest to this statement from my experience volunteering at the ER department of Humla District Hospital. I remember one instance when fifteen patients flooded in at one-minute intervals, despite there being only two doctors and three nurses on call at that time (much lower than the recommended staff-to-patient ratio of 1:4).
In the minutes that followed, absolute chaos ensued. Patients lay on trolleys in corridors, shrieking and crying out in pain. Staff frantically ran around, assessing vitals and attending to whomever they could. Some were left unattended for hours simply because the hospital was understaffed. A patient who came in for treatment of a small wound was neglected to the point where infection occurred.
Even in a developed country such as New Zealand, nine in ten healthcare workers report that they feel as if hospitals are understaffed and under-resourced. Many have also expressed discomfort at prioritizing patients.
Understaffing seems to be an issue on both sides of the spectrum.
Challenge 2: Lack of Services for the Rural Community
Due to an inhospitable geographical terrain, the Nepalese also face difficulty in reaching hospitals. Consequently, rural communities have fewer choices in healthcare services, resulting in rural patients showing lower levels of health service utilisation and being forced to seek help in the later stages of a disease’s development.
Challenge 3: Lack of Sufficient Infrastructure
Lack of healthcare in Nepal is exacerbated by a lack of sufficient infrastructure at rural facilities.
Challenge 4: Traditional Belief
Cultural factors such as personal beliefs, religious practices, and local traditions can dictate perspectives on and may affect usage of healthcare.
For example, some Nepalese people believe diseases are caused by evil spirits and that they can be cured by astrologers, priests, monks, or prayer. They believe that treatment comes through chanting mantras to force bad spirits out of the body. Certain diseases like HIV/AIDS are perceived as consequences for some wrongdoing committed in a past life.
These cultural barriers mean that people are less likely to go for regular check-ups at medical practitioners. Moving forward, Nepalese healthcare officials must address the cultural constraints that prevent the use of healthcare services.
There are, however, some aspects of Nepalese healthcare that are admirable. The Nepalese government has begun organising health insurance programs in a few districts with the long-term vision of offering locals services such as nutrition, family planning, vaccinations, medication, and preventive services. The government plans to provide “easy access to acquire quality health services” and extend “services by augmenting and managing involvement.”
The holistic approach of Nepal’s developmental policy will benefit its healthcare system, and we, as a nation, can learn from the factors that have led to a subpar healthcare system and ensure these factors are well-maintained and recognised in our own society. Only vigilance can ensure that Nepal’s healthcare challenges do not become our own.