Ad hocism in Nepal as Omicron threatens world and nations tighten curbs

Ad hocism in Nepal as Omicron threatens world and nations tighten curbs

https://kathmandupost.com/health/2021/11/30/ad-hocism-in-nepal-as-omicron-threatens-world-and-nations-tighten-curbs

The Omicron coronavirus variant has kept the world on tenterhooks.

The World Health Organisation warned on Monday that it carries a very high global risk of infection surges. As more countries reported cases, the variant has prompted border closures.

Scientists, however, have said it could take weeks to understand the severity of Omicron, which was first identified in southern Africa.

As its emergence has caused a strong global reaction, with countries imposing travel curbs and other restrictions, worried that it could spread fast even among vaccinated populations, concerns have grown in Nepal too.

Whether the new variant will enter Nepal is a matter of when, not if, experts say.

Doctors and public health experts, who have repeatedly stressed that there was no room for complacency and have urged the public not to let their guard down, have called on authorities to scale up measures to avoid any catastrophe.

Reacting to reports of the Omicron variant, the Ministry of Home Affairs on Sunday decided to restrict entry to people from African countries and directed the Department of Immigration, Tribhuvan International Airport office and administration offices of districts bordering India not to issue visas on arrival to people coming from those countries.

Fighting the virus in an effective manner needs a number of combined efforts—placing the right people in the right place, increasing tests, making testing, tracing and treatment effective and improving health infrastructure, among others.

In Nepal, however, there has either been a reactive approach, which means getting down to work only after the disaster strikes, or ad hocism.

A case in point is the decision of the Ministry of Health and Population to transfer several point officials, including Dr Anup Bastola, director at the Sukraraj Tropical and Infectious Disease Hospital.

Bastola, who is the only infectious disease expert serving under the Health Ministry, has been transferred to the SAARC TB and HIV/AIDS Centre.

Health Ministry officials say such transfers are “a regular process”.

“Transfers of doctors serving under the Health Ministry and other officials should not be made an issue,” said Dr Ramesh Dhakal, an expert adviser to Minister for Health and Population Birodh Khatiwada. “Dr Bastola is a very capable person and the ministry thinks his service is necessary in other agencies.”

But this is not the first time the Health Ministry has transferred the director of the Infectious Disease Hospital, the key facility treating people infected with the coronavirus, since the start of the pandemic.

Bastola was appointed director of the hospital after Dr Sagar Rajbhandari retired on June 28. Dr Basudev Pandey was replaced by Rajbhandari. Before Rajbhandari, Dr Basudev Pandey headed the hospital.

Ministry officials did not give a specific answer to why some critical point officials, including Bastola, have been transferred at a time when the country is staring at the risk of the Omicron variant.

Bastola said that he is aware of his transfer but has not received the transfer letter.

“I went to the ministry on Sunday to ask why I was transferred,” Bastola told the Post. “I was told it was the ministry’s prerogative to transfer officials.”

Bastola did not elaborate further.

Public health experts say transfers of government staff may be a regular bureaucratic process but transfers of critical point officials and experts need to be justifiable, especially when “there is a situation”.

“The transfer of an infectious disease expert at a time when we are faced with the risk of the new variant cannot be justified at all,” said Dr Baburam Marasini, former director at the Epidemiology and Disease Control Division. “The people and the country will bear the brunt of such ad hoc decisions.”

Though Nepal managed to survive the first Covid-19 wave somewhat uscathed, the second wave turned out to be deadly. At least 6,000 people died in around two months during the peak of the second wave of the coronavirus that hit the country in April.

But cases started to decline in a dramatic manner.

Nepal’s vaccination drive, launched on January 27 this year, faced some hiccups, but it has been going comparatively smoothly at present. More vaccines are arriving soon.

Nepal has already vaccinated 8,382,994 people (27.6 percent of the total 30 million population).

So far, Nepal has received 23,163,930 doses of Covid-19 vaccines—Vero Cell, AstraZeneca, Janssen and Pfizer-BioNTech.

As many as 11,524 Covid-19-related deaths have been reported since the pandemic began.

Over the past few weeks, cases have declined and there have been fewer deaths from Covid-19.

In the last 24 hours, 259 people tested positive for the coronavirus (243 in 7,231 polymerase chain reaction tests and 16 in 2,657 antigen tests). Just one death was recorded on Monday.

The number of active cases throughout the country currently stands at 6,944.

Just as the country appeared to be somewhat safe and on track to vaccinating all its eligible populations, the emergence of the Omicron variant has left everyone worried.

Tedros Adhanom Ghebreyesus, the director-general of the World Health Organisation, said on Monday that Omicron’s emergence “shows how perilous and precarious” the situation is, as he called for pursuing a new accord on pandemics.

The UN health agency has said that preliminary evidence suggests there may be an increased risk of reinfection with Omicron in the people who have previously had Covid-19, as compared to other variants of concern. It, however, has said that information is limited and it is not yet clear whether the new variant of virus is more transmissible compared to other variants, including Delta.

“It is also not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta,” reads a statement issued by the WHO.

It said that the number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiological studies are underway to understand if it is because of Omicron or other factors.

Reports say there is no information immediately available to suggest that symptoms associated with Omicron are different from those with other variants.

Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.

The SARS-CoV-2, which causes Covid-19, has since its emergence confused the scientific community across the world. Governments across the world have tried to engage their best brains to figure out a way to fight the disease.

But in Nepal, experts say, almost every measure has been by and large reactive. According to them, doctors and people with expertise on related subjects understand the seriousness of issues better than others and take decisions accordingly.

At a time when the government should be keeping its guard up, it is still engaged in taking ad hoc decisions, said Marasini, a former director at the Epidemiology and Disease Control Division.

“It is very unfortunate that the Health Ministry transfers critical point officials like in the days of the Panchayat regime,” said Marasini. “People used to joke that the Panchayat regime transfers experts on culture to the horticulture department, and agriculture experts to cultural agencies. We are seeing somewhat similar practices these days.”

Since the start of the pandemic in 2020, the Health Ministry has transferred several critical point officials.

The Health Ministry has seen four ministers–Bhanu Bhakta Dhakal, Hridayesh Tripathi, Sher Bahadur Tamang, and Birodh Khatiwada. Umesh Shrestha served as state minister for health for a brief period.

Every time a new minister has assumed office, there have been transfers of various health officials.

The director general at the Department of Health Services, which is responsible for making policies, taking decisions on health related issues and mobilising health agencies, has been changed five times in the last two years.

This is the second tenure of Dr Dipendra Raman Singh at the department. He was removed by Umesh Shrestha after he was appointed state minister for health. Singh returned to the department after Khatiwada became health minister.

Neither Singh nor officials at the Health Ministry could offer an answer to why he was transferred and why he was brought back.

The Epidemiology and Disease Control Division, the key agency to fight the pandemic, has seen three directors in the last two years.

Experts say a country’s public health system is not just about infrastructure, as human resources—experienced doctors, public health specialists, laboratory technicians, information analysts and competent managers—make up a crucial component.

Transferring key persons overseeing the Covid-19 response could be counterproductive and dangerous, according to them.

As far as Bastola is concerned, he is one of the doctors directly involved in the treatment of Covid-19 patients since the pandemic hit the country.

Several former bureaucrats the Post spoke to said that transfers of government officials should be a “routine and regular process”, but any decision on transfers of officials serving at key agencies should not affect the fight against the pandemic.

“Transfers of officials are a regular thing and this is not the first time the Health Ministry has transferred officials,” said Dr Mingmar Gyelgen Sherpa, former director general at the Department of Health Services. “Ministers usually try to bring officials with whom they can work in a comfortable way.”

Some officials at the Department of Health Services, however, say sudden transfers of experienced and technical manpower are an indication that the government is not showing seriousness towards public health and people’s safety.

There are also instances in the past when ministers have transferred officials and doctors for making statements of not their liking.

Earlier in April 2020, during Bhanu Bhakta Dhakal’s tenure as the health minister, the Health Ministry had sought clarification from Dr Sher Bahadur Pun, a frontline doctor working in the fight against Covid-19, allegedly for his public statements and articles about authorities’ lackadaisical approach to the pandemic.

Pun had given critical statements regarding the languid approach of the authorities towards Covid-19.

“The government can transfer any staffers and it might be its prerogative but its decision should not hamper public safety and services,” said Dr Sagar Rajbhandari, former director at Sukraraj Tropical and Infectious Disease Hospital.

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