Shambhu Rishidev lost his son during the Covid-19 pandemic. The resident of Biratnagar could not get an oxygen cylinder in time for his son who was admitted at a government hospital.
“My son was given oxygen at first,” he says, “but there was none left when he needed it again.” The 14-year-old passed away a few days after he was admitted to the hospital.
Rishidev’s story echoes that of many people in different parts of the country. They all lost their loved ones because they could not arrange for oxygen cylinders on time.
Dr Sher Bahadur Kamar, senior consultant physician, Seti Provincial Hospital, Dhangadi, says the hospital didn’t have enough oxygen cylinders for their patients, especially after the second wave of the covid.
“There were patients lined up in every corner of the hospital, from corridors to the entrance of the emergency ward,” he says. Many of these patients were suffering from low oxygen levels. “We didn’t have enough oxygen at the time.”
Nepal’s 30m population had access to 840 ventilators at the start of the pandemic, according to the government’s Health Sector Emergency Response Plan dated May 2020.
As the pandemic escalated, the Ministry of Health and Population (MoPH) received bulks of equipment from several countries, UN bodies, and NGOs as donations. Besides, the government also bought medical resources to outfit the hospitals and health facilities across the country.
While the government claims that the available medical equipment and resources were distributed to hospitals all over Nepal, their numbers do not match what the hospitals received, according to ApEx analysis of the datasets from 2 Feb 2020 to 18 Oct 2022. The data were provided by the Logistics Management Section of the Department of Health Services (DoHS) and the government hospitals.
For instance, the number of oxygen cylinders received by Seti Provincial Hospital is 50, when according to the government’s data, the hospital should have received 79 cylinders. This sort of discrepancy was discovered in almost every government hospital around Nepal. And it was not just limited to oxygen cylinders, but also oxygen concentrators and ventilators, all of which were distributed by the Logistics Management Section during the covid pandemic period.
Responding to our queries, Dr Dipendra Raman Singh, director general, DoHS, says such discrepancies are bound to happen when large numbers of equipment and medical resources are being delivered. “It does not necessarily mean that the equipment went missing,” he says.
Rana Bahadur Gharti Magar, chief of Logistics Management Information Resource Center, DoHS, completely denies that there were any inconsistencies. When presented with the gaps in the records, he had no explanation.
Other officials ApEx spoke to refused to comment on the issue.
The discrepancies in the distribution of medical equipment affected everyone, but minorities suffered the most.
“Most people from minority communities live in poverty and can only afford government hospitals because of their lower economic status,” says Sundar Purkuti, member and spokesperson of the National Dalit Commission.
Since government hospitals lacked the medical resources and equipment, the repercussions were largely felt by the people from minority communities.
Several individuals from minority groups that ApEx spoke to were unable to get their family members admitted to hospitals due to lack of beds.
Dr Baijnath Sah, former coordinator (till April 2022), Koshi Hospital, Biratnagar, says that it was difficult to manage the patient numbers that grew exponentially.
Purkuti says that minorities have always been left behind in every sector. “One reason is the discrimination that still lingers in our society. Minorities have little to no opportunities to uplift their socio-economic status.”
The Asian Development Bank’s analysis of the national census data say that poverty incidences by caste and ethnicity are highest amongst the hill and Tarai Dalits. A significant 57.8 percent and 45.5 percent of the total hill and Tarai Dalit population were poor in 1996 and 2004, respectively. The hill and Tarai Dalits were still the poorest during the 2010-2011 Nepal Living Standards Survey, with 43.6 percent of poor amongst the hill Dalit population and 38.16 percent poor amongst the Tarai Dalit population. Following the Dalits, poverty incidences in 2011 were highest amongst other caste groups in the Tarai, then the hill Janajatis at 28.25 percent. Conversely, poverty incidence was at a lower proportion for Newars and hill Brahmins at 10.25 percent and 10.34 percent, respectively.
The latest Nepal Multidimensional Poverty Index Analysis (2021) shows that Karnali Province has by far the biggest percentage of residents living in poverty (39.9 percent), followed by Sudurpashchim Province (25.3 percent) and Madhes Province (24.2 percent).
Only seven percent of individuals live in multidimensional poverty in Bagmati Province, compared to 9.6 percent in Gandaki Province. Madhes Province is the most poverty-stricken, followed by Lumbini Province and Province One, in terms of population.
During the covid pandemic, privileged communities were better able to afford equipment and medications as compared to lower-income and minority groups, according to Hari Mainali, secretary of Forum for Protection of Consumer Rights – Nepal.
Rishidev’s experience attests this situation. “It was already difficult to receive free medications distributed by the government and we were in no position to afford medicines that cost money,” he says. “Private hospitals are more expensive than the government ones. It was not an option for us.”
According to Mainali, a lot of equipment may have ended up being illegally traded. “A good deal of equipment was being sold in the black market at higher price, which people of lower economic status were not able to afford.”
Minority communities in Nepal have always fallen victim because of the government’s lack of interest in strengthening the health infrastructure of state-run health facilities.
“From minor medications to major health services, the minority communities have never gotten the right treatment,” adds Mainali.
Concerns regarding discrepancies related to the procurement and distribution of medical resources to fight covid were raised by the public in April 2020, but the matter was brushed aside by the then prime minister, KP Sharma Oli.
After continuous public pressure, the government formed the Covid-19 Crisis Management Center (CCMC), under the Ministry of Defense, replacing the High-level Coordination Committee for the Prevention and Control of Covid-19. The CCMC was mainly staffed by several high-ranking politicians for proper implementation and coordination of policies, as well as the Chief of Army Staff. The matter of securing and distributing equipment, such as oxygen cylinders, was under the jurisdiction of the CCMC.
Binoj Basnyat, a retired Nepal Army major general and security analyst, believes the CCMC is the government’s way of shielding itself from controversies.
“CCMC ensures massive army participation, which means the budget allocation, usage, as well as several other data would not be easily accessible to the public,” he says. “This gives politicians and civil servants leeway not to get caught in case any of them were to commit forgery.”
None of these brings any comfort to the families who lost loved ones during the pandemic.
“It is still hard to accept that I lost my son because there weren’t enough oxygen cylinders,” says Rishidev. “We felt hopeless. There was nothing we could do and nowhere we could go and ask for help.”
Annapurna Media Network’s district’s reporters Rakesh Karn, Ganga Khadka, and Rajendra Bahadur Karki contributed reporting
Thankful to Thomson Reuters Foundation, and Emmy Abdul Alim for providing their support and guidance with this article