Frontline struggles

In early June, Prakriti Bhattarai, a physician at the Siluchaur Primary Health Centre in Rolpa, far-west Nepal, went into quarantine. She is one of the two doctors in charge of 30,000 people in the village. A day earlier, Bhattarai and four others had taken samples from recent returnees, whose polymerase chain reaction (PCR) tests came back positive from the lab. 

“I got myself and my team tested immediately, and those of us who were exposed went into quarantine and are waiting for our results to come back.” 

She sounded anxious and worried about what would happen to her patients, to the samples that need to be collected, and the people who need her help if she would test positive.

Born and brought up in Kathmandu, Bhattarai trained as a medical doctor in the capital. As a Nepal government scholarship student she was sent to work in Rolpa for two years. A few months before Nepal went into the Covid19 lockdown, Bhattarai had finished her two-year contract at the district’s health facility, packed her bags and left to come home. She was in Kathmandu preparing for the MD entrance examination when she joined the government’s Covid19 response team. 

“I can help save lives, there was no question in my mind that I would not be a part of the response team,” she said.

Until late last month, Bhattarai’s schedule was pretty much the same. She and the other doctor at the health facility divided their tasks between the outpatient department and Covid19 response. 

“We were testing, treating, counselling — the days were long and tough,” she said. 

However, their strategy took a dramatic turn when locals who had returned from India started filling up in quarantines. Late last month, the Nepali and Indian governments decided to open the sealed borders and repatriate their citizens. According to the home ministry, so far, some 200,000 Nepalis have made their way back. 

The government had sent big consignments of rapid diagnostic test (RDT) kits to health centres all over the country, and Siluchaur health facility was using the RDT technique to test for the Covid19 virus. RDT was easy and swift — but Bhattarai started noticing inconsistencies in the results. 

“I had read that RDT shows false positives and negatives, and when I experienced that first hand here in our health facility, I knew I could not use RDT to diagnose,” said Bhattarai. 

She lobbied to the district health coordinator to switch completely to PCR tests, which is what Siluchaur has been doing for the last three weeks. 

“I was lucky — the health coordinator was extremely responsive, and she was able to promptly get me more PCR kits.” 

Epidemiologists, doctors, and public health experts have criticised the Nepali government for continuing to use RDT kits to test for Covid19. RDT has proven ineffective in the diagnosis stage because it does not detect the virus early on. Even on day 11 of a person acquiring the virus, only a few people will test positive. This means that those with negative RDT results may still have the virus and will continue to transmit the highly contagious disease. This is especially dangerous in quarantine centres where people are being housed in large numbers. There is a widespread fear that the quarantine facilities will turn into incubation centres for the coronavirus.

Every additional day that Bhattarai remains in quarantine, workload on the already-stretched manpower at the health centre increases. But she has found a work-around. “I may be in self-quarantine, and I may not be able to help in the quarantine centres or at the health facility,  but I can still talk, I still have a phone, I can still coordinate Covid19 sample collections,” said Bhattarai excitedly. It was 8pm when she was finally free for this interview, and she had already been working for 14 hours. 

According to Bhattarai, the decision to switch completely to PCR was the best decision, but that still meant that those samples had to be sent to the labs to be tested. She had been on the phone all day trying to coordinate the samples they collected so that they could be safely transferred to the right lab and be tested. At present, only 22 labs have been given permission to test for the Covid19 virus. Samples from Rolpa have to travel to Butwal, a five-hour journey by car.

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Meanwhile, the health centre is also serving out-patients while continuing to deal with the lack of resources. 

“Just because there is a pandemic doesn’t mean accidents have stopped happening, or that people have stopped getting ill. We have to deal with the regular patients too,” Bhattarai explained. 

Recently, villagers brought in a 14-year-old who had fallen from a tree while gathering feed for cattle. She was found, injured, hours later. Bhattarai and her team tried their best to do what they could — they were finally able to put the 14-year-old in an ambulance to take her to the hospital in Butwal, but she died on the way.

Bhattarai confessed that working away from family during the pandemic has taken an emotional toll on her. She misses her family and her loved ones. But every day Bhattarai and her team of doctors, nurses, paramedics, lab technicians wake up and continue to work. They continue to push, they continue to lobby, they continue to test, and they continue to save lives. 

“This is a long haul. As long as there’s need, I am here,” she said.

 A few days after this conversation, Bhattarai tested negative for Covid19.  

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