Even though its government has announced an all-out effort to stop the spread of Covid-19, the Karnali Province is facing an acute shortage of doctors and medicines. People in the province are going back to villages from urban centers, hoping to save themselves from infection. But they get more worried when they get to the villages and find that even basic medical facilities are missing.

Historically, even a simple disease routinely becomes an epidemic in far-flung regions of Nepal. In 2014, almost 200 people died from diarrhea in Jajarkot of western Nepal as its villages lacked even basic medicines and health workers. Last year, flu killed 12 in two weeks in Humla district.

Forget specialist doctors, even general practitioners are not available in the remote mountainous districts of Karnali. While the district headquarters has some medicinal supplies, remote villages are without even basic drugs such as paracetamol. The provincial government has centered its anti-coronavirus efforts in the provincial capital Birendranagar. Although there are plenty of awareness programs, both the provincial and local governments have failed in arranging medicines and doctors. 

Even the district hospitals—the biggest in the districts—don’t have doctors to fill the vacant positions. Dolpa District Hospital has positions for four specialist doctors and five nurses. But only one doctor (under temporary contract) and two nurses are currently serving there. 

Such is also the case of Mugu District Hospital where 10 doctors including four specialists have been provisioned. But all four specialist positions are vacant. “There are some medicines in the drugstore, but we don’t have a single specialist doctor. What little medicines we have will not be enough if the pandemic spreads here,” says Dr. Nirmal Nagarkoti, chief of the District Public Health Office. 

The situation in Kalikot and Jajarkot is no better. People in remote areas of these districts do not get paracetamol if they get a fever. “As many as 200 people come for treatment for seasonal ailments every day. But treating them is a single doctor, instead of the eight provided on paper,” says Dr. Bhisma Pokharel, chief of Kalikot District Hospital. Jajarkot, which has time and again hit by epidemics, also lacks doctors. Most health institutions in the province are run by employees under temporary contracts. 

The Provincial Hospital in Birendranagar is no better. “Of the 50 positions for specialist doctors, only seven have been filled,” says Binod Adhikari, information officer of the hospital. “Of the 25 positions for resident doctors, there is only one.” 

Likewise, Dailekh District Hospital employs one doctor while there are seven positions for specialist doctors. All five resident doctors’ positions lay vacant. 

Although the district hospitals have set aside isolation rooms, they lack basic equipment to identify and treat Covid-19 patients. However, the provincial government keeps promising it will arrange for necessary drugs and doctors. “We are serious about sending medicines and doctors to rural areas. We have asked for medicines from Kathmandu also,” says Rita Bhandari, chief of the Provincial Health Directorate.