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 Health Minister Dhakal: We are in better position in regard to COVID-19 prevention in South Asia  



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Kathmandu, April 10 : Coronavirus has been an issue of prime global health concerns as the contagious disease has so far spread to almost across the world and the World Health Organisation has already declared the outbreak a pandemic.    
Even the world powerful countries are finding it so hard to cope with the disease which was first emerged in Wuhan of China late last year. Bearing the heightened risk of the viral disease, the government of Nepal has enforced a nationwide lockdown since March 24 to stem the spread of virus following the second confirmed case (imported) in the country. Works are going on with much priority for the prevention, containment and treatment of the virus. Boarders have been sealed.    
Air service has remained closed. Health/medical workers and security personnel are on the frontlines in the fight against the virus. Though the human cost caused by the virus continues to surge, posing further challenges in the containment efforts, Nepal is among a few countries where the virus has so far caused no death.    
The Ministry of Health and Population has taken a lead in the workforce mobilisations, in the development of health infrastructure required in these hours and management of hospitals, in the management and supplies of required materials, and in the dissemination of messages and information of public awareness and other health related information.    
 A team from the Rastriya Samachar Samiti (RSS) comprising reporters Prakash Silwal and Sharad Sharma on Thursday reached the office of Minister of Health and Population Bhanu Bhakta Dhakal to interview him about the government's overall efforts and measures taken for the prevention, control and treatment of the virus, for the operation and management of health sector during this crisis and future strategies to combat the virus.    
The edited excerpts from the same interview are as follows:    
Q: The emergence of virus in China has complete 100 days. In Nepal also, it has entered the second phase or it has been confirmed to have transmitted to the local level. In your views, what is the present situation of its infection at home?    
A: In the beginning, our efforts were concentrated on preventing the virus from entering the country. We had appealed to those returned from outer world to stay in quarantine and home quarantine. In case of the detection of suspected case(s), we had a plan to take the suspect to hospital for a lab test and treatment and simultaneously we were doing our best to minimise the risk. Till today, we have been successful in limiting the cases just to nine. One already has been cured while remaining eight are under treatment and they are orienting to normal health conditions. The matter of concern is that the virus has seen at the family level as one who had not exposed to outer world has tested positive and our understanding is that the virus has already crossed one level. We have realised that further plans and measures are essential as it could not be controlled being based on yesterday's plans and measures.    
Two weeks have passed since lockdown against the virus was implemented. At the moment, lockdown seems as a key weapon to secure a win over the virus worldwide. It was the Teku-based National Public Health Laboratory that first started the test for coronavirus. The test facility has now been available at 10 places and we are preparing to extend it to 15 places. The test coverage has been expanded. Though the risk of imported case through air route has been averted, the infection risk seems high among those entering the country via the southern border points. We have launched the testing facility by sending a Nepal Army helicopter to collect the throat swab samples from settlements sharing border with the southern neighbour. We are in more right track today than yesterday. We are working to ensure the smooth supplies of medical equipment and medicines in the days to come.    
Q: There is a complaint that the test rate is a little even in the aftermath of the entry of virus to the second phase. Are we planning to change the strategy?    
 A: Expression of frustration and dissatisfaction is generally a global trend and here in the country too, some people are doing the same for self-satisfaction when the country is going through a crisis. We have yet to rise above the mentality of pulling other's leg instead of lending hands so as to find a way out of the crisis. But again, we have a huge support of people. Medical workforces are doing their jobs amazingly. Political parties have expressed solidarity with the government efforts for the control of the situation. Criticisms are expected and obvious. Some of them are genuine or some are baseless and time will define them well in the future.    
In the past, the government had appeal to all those returned home from abroad to stay in self quarantine and visit the hospital in case of falling sick. The appeal for self-quarantine was unnecessarily criticized and taken it as an irresponsible remark as though it was crime. But I don't mind and always adhere to my duty and responsibility and spoke whatever I see as necessary with clearly and honestly. The Prime Minister is there to find out a way out to this as the head of the government. The high-level coordination committee headed by the Deputy Prime Minister is there to respond the COVID-19 crisis. The entire Health and Population Ministry under my leadership is working for the same. It means we all are contributing from our respective sides to control the virus.    
We have started testing people visiting Nepal from foreign countries and the people who have come in contact with them. We will test those Nepalis returning home from foreign countries and those who have come in contact with them and those who have been quarantined at Nepal's borders sharing with neighbouring countries after their return to home country.    
All health workers attending to infected people and deployed at quarantine areas, security personnel, ambulance drivers and representatives of local levels would get a test. Approximately 500 suspected people have got a test on a daily basis through rapid diagnostic test kits and polymerase chain reaction. The density of tests would be increased.    
Now the world's powerful countries are battling the infection. The situation is heading to risks and dangerous situation more than the situation caused by the World War II. The situation is not like a joke. So this time is not for criticism, but unity and cooperation. So our efforts at this time would be to save lives by containing the crisis through help and participation from all and by engaging all power of the state. We are engaging all-out efforts to do so. We are devising a plan to reduce losses in case the situation goes out of control. Our efforts in this regard were satisfactory during a video conferencing among ministers of 10 Asian countries recently. Our works are being praised across the globe.    
Q. What preparations are in place for control and treatment when the infection turns epidemic?    
A. We have made additional arrangements in the recent days based on the situation of the world and our topographical condition. We have announced hospitals dedicated to treat infected people across the country. We have planed everything in view of increasing possible risks. The virus is our all enemy. We all should join the force against the infection and there is out achievement when it is contained.    
Q. You have talked a bit about security of health workers and availability of medical appliances. But the issue is being raised extensively. The matter may involve motivations. What the Ministry is doing on this matter?    
A. Firstly, commanders of this battle are health workers. We are at work determined to get a win in this battle under the leadership of heath workers. They have engaged in this battle with high willpower and big courage. We have made them feel that the state is their guardian and their security is its responsibility. We have ensured up to 100 percent facilities and insurance worth Rs 2.5 million for them. Likewise, necessary decisions have been taken through the Cabinet to end hindrances and other untoward activities at health institutions and health camps. We will soon publish a book relating to the decisions and a protocol in this regard. We have got a committee involving concerned authorities with the Ministry and experts. We the government and private sector are fighting the infection together acting on suggestions from the committee. For the formulation of daily action plan and review relating to the infection, we have been holding a meeting of a high command comprising minister, sectary and experts since April 8. A situation would be created wherein we would be proud when we together fight the virus and get a triumph despite hardships we are going through at this moment. I am sure we will win this battle.    
Q. There are reports that there lacks enough coordination between private sector, drug producers in particular?    
A. It is not relevant to approach the Ministry for general things. There are our concerned sectors. I do not prefer to encourage the tendency to seek minister's decisions in all maters and get all works done through minister. Works are done through a system. We can facilitate in difficult situation or on special occasion. But I do not encourage works done by breaching the due process. Problems will be sorted out if any in the mechanism or system. Another talk, it is not appropriate to demarcate a line between private sector and government at his situation. Hospitals designed to treat corona patients would not admit patients with other diseases. Now, Shukraraj Tropical and Infectious Disease Hospital, Teku is treating infected people. Other hospitals like Patan Hospital, Armed Police Force hospital, Bir Hospital or TU Teaching Hospital, Grande International Hospital or Mediciti Hospital maybe designated to treatment infected people when the Teku hospital is overcrowded.    
We will determine whether private hospitals would provide treatment to the infected free of cost or how much discount they offer. The reports about private sectors not fulfilling their responsibility at this time of crisis are only baseless. They are also responsible and cooperative at this time.    
Q. Some disputes surfaced in course of bringing health equipment. The ministry is bringing more equipments and the government has given this responsibility to the Nepal Army, make clear about this?    
A. There is nothing to be confused. There is lack of health equipment. We started process immediately to bring the equipments after High-Level Coordination Committee directed the ministry to bring the equipments within March 28. The ministry facilitated the Health Service Department in this process thinking our presence and encouragement is needed in this difficult situation. We signed an agreement with a company bearing in mind that price of equipments could not be compared with the value of people's lives and imported the first-phase equipment. We have started procuring the equipments through another process after the Department terminated the contract with the company after its failure to supply all the medical appliances and gear as agreed. The Directive Committee (CCMG) under the High-Level Coordination Committee will import the equipments through government to government (G2G) process.    
Q. Whom do you hint are trying to carry out unscrupulous activities to serve their petty interest by using ministry’s network?    
A. It is almost clear. Those who had made rapport with ministry were reaping more benefits in the past and their ways to continue making more benefits have now come to a halt. Now, such people are in painful situation. I cannot make compromise whatever pain it has inflicted to those.    
Q. Is it not the responsibility of the government or bodies concerned to carry out investigation on past irregularities?    
A. I have been trying my best to break the past wrong trends after my appointment as the minister. Problems and weaknesses taking place in institutional manner should be improved in institutional way.    
Q. Do you see any political or inter-party struggle behind accusation against you?    
A. I do not want to give any political or inter-party colour behind the scene. I heard that the opposition political party is trying to defame me by mobilizing its cadres.    
Q. What is the strategy in mobilizing health related human resources at hospitals and labs?    
A. We are making preparation to request retired health workers to provide service to the nation for three months. One can lend help without taking remuneration or in a volunteer manner. Medical colleges have been producing skilled human resources and we have set a plan to request such human resources as well as other volunteers to help the nation in this difficult situation and depute them in different areas. Now we have asked all wards in local level to coordinate for keeping such people in quarantines. We have not yet traced the abroad returnees sharing plane with the infected ones even after mobilizing police. 5-7 such individuals are yet to be traced. We have formed a committee comprising health volunteers under the leadership of ward chair as a method to trace the people who are hiding them. We have also asked the committees to identify such people and convince them to stay in quarantines. If such people disobey police force would be mobilized in a democratic manner to keep them inside quarantine facilities.    
Q. What is the coordination for prevention and treatment at the state and local level?    
We do have cordial relations and sufficient coordination for this. There is a management committee under the premiership of state chief minister to this effect. Likewise, every district has committee headed by coordinator of District Coordination Committee. There is committee at local level. We are working against the pandemic in unison from centre to state and local governments. We have delivered human resources and equipments in the hardest hit areas and supporting materials to even unaffected areas. We are preparing to determine the quantity of the materials assessing the potential risks. The infection is seen in Kathmandu, Sudurpaschim state and Baglung of Gandaki so these are on top priorities. We have placed high alert after the virus got locally transmitted first time. The collection of swab has been intensified in all mountainous districts of Sudurpaschim state. We are trying our all-out efforts to contain the potential outbreak of virus in these areas by deploying doctors' teams with medial appliances and gear.    
Q. The capacity of the laboratory for test has been expanded. However there are complaints that the collections of swab sample are still inadequate?    
A. We have managed laboratory test stations in 10 different areas. This will be expanded to 15 areas in a week. The situation may also come to take the lab machines and conduct tests in mountainous districts. We are carrying out tests in the number of 1000 in a day. We have adopted the approach of expanding the scope of lab tests. Let us put our all-out efforts in collaboration among all sides including the governments to overcome the fight against the virus. ---  

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