Lockdown in Nepal: Creative Thinking Required
As the lockdown Nepal continues into its fifth week (it is currently extended to 27 April), inevitably those with precarious livelihoods, such as daily laborers and itinerant street sellers, are struggling. Provincial and local governments are endeavoring to respond the immediate needs of such people through food distribution, although doing so without attracting crowds poses logistical challenges. Some laborers who originally stayed at urban construction sites are now walking back to their villages – posing another challenge to authorities enforcing the lockdown.
Along the Southern and Western borders of the country, Nepalese who were working in India have been arriving and are being placed in hastily erected quarantine camps. Testing for COVID-19, initially only possible in one laboratory in Kathmandu, has been ramped up by the federal government to 14 sites across the country. Nevertheless, as of now just over 9,000 tests have been conducted (this in a country of some 30 million people). Only 32 have shown positive; reassuringly, no deaths due to the virus have been reported.
Ensuring the safety and security of our own staff was of course our priority at the onset of lockdown, but now that this has been arranged as far as possible, regular online meeting fora established, operational plans adjusted and donors duly updated, what, realistically, can we do? Local governments in the rural areas in which we work are increasingly approaching Helvetas and other INGOs for support. “Distant support” is the only way in which we can currently respond; this requires creative thinking as well as good coordination with government authorities and other agencies such as those of the UN.
The dilemma of protective clothing
The big demand everywhere is for PPEs, personal protective equipment, which the federal government is trying to procure on the international market. This has apparently proved difficult due to the limited global supply and high demand from other countries.
So, what about locally manufactured PPEs? This idea has been promoted by the National Innovation Centre (NIC) in the person of Dr Mahabir Pun. Having sourced appropriate fabric and come up with a design, Dr Pun called for tailors – so Helvetas staff linked him to tailors trained under a former Swiss Agency for Cooperation and Development, SDC, Project - the Employment Fund, in which Helvetas was responsible for technical assistance. As a pilot exercise, the tailors produced 400 garments. Unfortunately, though, special machines were required for stitching the fabric, and the tailors were unable to obtain official passes allowing them daily travel between their homes and the workshop housing the machines. There is still a possibility of resuming this work once lockdown is lifted – but there is a dilemma. These locally manufactured PPEs are not as fully protective as top grade imported PPEs. Is less than full protection better than nothing, or do such PPEs give a false sense of security? Clearly the risks and benefits need to be fully evaluated by those who wear them.
Face masks
There is a simpler form of protective equipment that trained tailors can make, which is cotton fabric face masks. There are also differing views on the use of masks, but expert opinion suggests that if well manufactured and properly used (see here for a link to the manual), they can reduce virus transmission by nose and mouth by about 70%. They also have the advantage of being reusable if heat washed (in a pressure cooker – a normal kitchen item in most Nepalese households). Such cotton masks are of course not recommended for front line health workers but are helpful for anyone required to interact with other persons without being regularly exposed to COVID-19 patients. People making quick shopping trips during lockdown have already taken to wearing whatever masks are available, and in the assumption that protective measures will be needed after lockdown ends, our tailor contacts are now focusing on quality mask making.
Simple medical equipment
Municipalities are particularly anxious to receive reliable thermo-guns, thermometers and medical masks (N59). In province 2, which borders India, many quarantine centers are being established and there is a high need for these basic items. By telephone, we are coordinating with our local and Kathmandu networks to procure and dispatch good quality materials as quickly as possible.
WASH – Water, Sanitation and Hygiene
WASH interventions are a core competence of Helvetas – focused, in Nepal, in Karnali province. Here the equipment that we already had in stock – such as pipes, water tanks, and buckets – has been dispatched to municipalities (via their own vehicles) along with supplies of sanitizers and soap. These are being used at health clinics and for the establishment of quarantine centers. Having good contacts with reliable suppliers, we are also procuring more equipment of this nature, which should be available soon.
There is no shortage of public messaging in Nepal about COVID-19 and the importance of hand-washing and social distancing. However, few of the messages explain why hand washing is important, or how often it should be done. We are therefore working with local radio stations to produce short messages in “jingle” form that answer the question “why?”; that take listeners by surprise, making the message more likely to be remembered; and that change regularly, to avoid “listener fatigue”. In remote parts of Karnali where belief in malevolent spirits and local deities is far stronger than knowledge or understanding of unseen germs, such messaging remains crucial in curbing virus spread.
Once lockdown is lifted, there will be far more than we can do. For now, we are fortunate that our funding partners are supporting changed project plans and the diversion of some funds to a COVID-19 response. Chief amongst these are SDC, and charity: water.
