Earthquakes, Fuel Crisis, Power Outages, and Health Care in Nepal: Implications for the Future

Abstract

Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625-632).

Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

“…Similar findings were observed in the current study where many health facilities in rural areas were located in hard to reach areas, and often lacked qualified health workers, with high attrition and lack of policy supporting establishment of health care institutions in the rural regions [25,39]…”

“…Similar findings have been found in other resource constrained settings of low-and middle-income countries (LMICs)[23,24]. In general, driven by the lack of political stability and economic constraints, LMICs face significant challenges in maintaining preparedness of health system, coverage and quality of care.One of the major challenges in Nepal's health system is the disproportionate lack of human resources, medicines, equipment and supply chain logistics in remote regions of Nepal[6, 7,25]. In addition, other factors such as patient's socio-economic status, distance to health centres, transportation,direct and indirect costs associated with attending health centres further compound the utilization of health services in rural regions of Nepal [7, 26] and resonate with other LMICs [27].…”

Health system's readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

“…Similar findings were observed in the current study where many health facilities in rural areas were located in hard to reach areas, and often lacked qualified health workers, with high attrition and lack of policy supporting establishment of health care institutions in the rural regions [25,39]. Such a chronic shortage of health workforce and resources in the rural regions is likely to persist and can be compounded by the transitioning federal health system of Nepal with high level of unwillingness of health care workers to serve in the rural regions [40].…”

“…One of the major challenges in Nepal's health system is the disproportionate lack of human resources, medicines, equipment and supply chain logistics in remote regions of Nepal [6,7,25]. In addition, other factors such as patient's socio-economic status, distance to health centres, transportation, direct and indirect costs associated with attending health centres further compound the utilization of health services in rural regions of Nepal [7,26] and resonate with other LMICs [27].…”

Novel technology for storage and distribution of live vaccines and other biological medicines at ambient temperature

“…One simulation model found that of the $64 billion needed to introduce 18 vaccines to 94 countries within a 10-year time frame, $38 billion would be used to support distribution and administration alone (12). Even when developing countries can access vaccines, such as those available through the Expanded Program on Immunization (EPI) and other programs (13), maintenance and monitoring of required cold-chain conditions are not guaranteed due to varying access to equipment and resources needed to maintain optimal environmental conditions (14,15). For example, during the inspection of vaccinating facilities in Cameroon, only 76% had a functional thermometer in use.…”