Hospitals in mountainous districts struggle to cope with rising dengue

Critically ill patients at Sankhuwasabha District Hospital are crammed into every available space besides beds – corridors, the floor, chairs and even the storeroom and outside the hospital premises.

Faced with an increase in new cases of waterborne viral fever and vector-borne diseases, mainly dengue, the hospital is struggling to cope.

“Every day, around two dozen critically ill patients end up sleeping on the floor of the corridor and in other areas,” Dr. Pranam Jayaru, medical superintendent of the district hospital, told The Post over the phone from Khandbari, the district headquarters. “Our health workers have been working overtime to provide care, but we lack even the most basic supplies, such as IV poles. Visitors to the patients have to hold the IV bags or we have to improvise by tying them to the windows.”

This situation is becoming increasingly common in hospitals in many districts, which are experiencing a surge in patient numbers amid a massive dengue outbreak.

The virus has spread to 75 of the country’s 77 districts, killing at least three people and infecting 5,119 others since January.

Two hill districts, Humla and Mustang, have not yet recorded any dengue cases this year.

“For the past three years we have witnessed a dengue epidemic during the monsoon season,” said Jayaru. “We can only ask our staff to work overtime, but we cannot provide equipment or increase the number of beds.”

Doctors say most patients do not want to be referred elsewhere as it takes more than six hours to reach Dharan, the nearest town, by ambulance. Keeping seriously ill patients in ill-equipped hospitals is risky as they lack specialist doctors, blood transfusion services and high-tech laboratories, among other things.

Experts say the deadly outbreak of the virus in most and all hill districts shows the impact of climate change on Nepal’s healthcare system. Despite these challenges, no effective mitigation measures have been taken.

Many hospitals are overwhelmed by the influx of patients and health workers are forced to place critically ill patients in hallways and other makeshift spaces, compromising patient safety.

“Our health facilities are not prepared to withstand the climate crisis,” said Dr. Meghnath Dhimal, a senior researcher at the Nepal Health Research Council. “Many of them are built on hilltops or river banks, two areas vulnerable to climate impacts. Moreover, these health facilities are not prepared to deal with emerging challenges and increased patient influx.”

Of the 5,119 reported cases of dengue, only 77 cases are from Madhesh province, which is traditionally an endemic area.

Health Ministry officials admit that the disease is shifting to mountainous and hilly regions due to climate change. They say other factors, such as increased mobility and improved transportation, are also contributing to the spread of the disease to new areas.

“Yes, new challenges have emerged in areas that were previously considered less risky, but we have not strengthened our health facilities to meet the emerging challenges accordingly,” said Dr. Gokarna Dahal, head of the Vector Control Section of the Division of Epidemiology and Disease Control. “Our health system is not designed to address these ever-evolving risks.”

Dengue is a viral disease transmitted by females. Aedes aegypti and Aedes albopictus Mosquitoes. According to the World Health Organization, the same vector also transmits chikungunya, yellow fever and the Zika virus.

In 2023, at least 20 people died and more than 52,000 were infected by the virus across the country.

In 2022, a total of 88 people died and more than 54,000 were infected with the virus. During that period, hospitals in the Kathmandu Valley were overwhelmed by dengue patients and pharmacies ran out of paracetamol, the most commonly used drug to treat fever.

In 2019, dengue killed at least six people and hospitalized more than 16,000 across the country. The virus had spread to 68 districts by then.

Dengue has become an annual threat in Nepal over the past few years and cases are steadily increasing every year.

Epidemiologists and virologists consider the dengue virus to be a major public health problem in Nepal. They also say that despite thousands of people being infected and dozens dying from the disease, the authorities have not taken the situation seriously. They believe that the lackadaisical attitude is contributing to the spread of the virus. They call for measures such as search and destroy campaigns and awareness campaigns to be implemented to control dengue vectors.

A United Nations report titled “Climate Change 2022: Impacts, Adaptation and Vulnerability” states that at least six major vector-borne diseases have recently emerged in Nepal and are now considered endemic, with climate change being the main driver.

The report also showed growing evidence that climate change has extended the altitudinal distribution of virus-transmitting Anopheles, Culex and Aedes mosquitoes to above 2,000 metres in Nepal.

Mosquitoes that transmit dengue breed in clean water and bite people during the day. Uncovered water tanks and other discarded objects, such as plastic cups and bottles, could be breeding grounds for mosquitoes that transmit dengue.

Symptoms of dengue include mild to high fever, severe muscle pain, rashes, severe headache and eye pain, doctors say. Patients with these symptoms are advised to seek immediate treatment. While there is no specific cure for the disease, early detection and access to proper medical care can prevent death.