The cost of illness in Nepal
I worked in Australia’s enviable health system for decades, part of its strong foundation of general practice. I knew that this, of all of the medical disciplines, makes the biggest difference to a country’s health outcomes. When I came to Nepal 20 years ago I saw a country that was making some moves to make primary care (general practice) a significant part of its health planning. It’s tough in such a resource-poor country. On this visit, though, I only see the failures of a health industry that exploits its population and causes financial devastation.
The towns of eastern Nepal are dotted with private hospitals under construction. People are fearful of getting sick. A fever triggers a discussion about where to go for care and how to pay for it. Affordable or ethical care is unavailable to most in a system built on user-pays private care. A trip to the doctor is likely to produce a bill that lists some combination of multiple medications, blood tests and imaging. The bill for a trip to hospital also includes cannulas, iv tubing, bags of saline and more expensive drugs. People have no way of knowing what is appropriate or needed, trusting that the doctor will do what is necessary. I hear that most people diagnosed with COVID have been treated with antibiotics and multiple vitamins. The same thing is happening during the current surge in Dengue fever cases. All useless treatment, all costing money.
Private hospitals are springing up in paddy fields
I already knew how the system worked from my years working in a major hospital here. Many people received good care and got better, looked after by some great doctors. Some recovered from serious disease and injury in amazing ways. But I also saw people die for lack of money or become financially ruined by futile treatments. Out in the community it is much more ‘anything goes’. Coming back after years away and sitting and talking with the women at Samunnat Nepal has given me a fresh appreciation of the challenges that they face. The private hospitals, clinics and medical colleges are increasing as the business model drives behaviour. Appropriate, affordable care seems further away.
Samunnat is able to help women with their medical issues. Kalpana* has a daughter who got sick one night, coughing and struggling to breathe. Her trip to the doctor cost her 2000 rupees – around $25 AUD, a lot of money. She recovered. If she hadn’t received financial support, what would she have done? Sarita* was assaulted by her husband and sustained a fractured forearm as she defended herself. The injury was untreated for many months, she was unable to work. Samunnat undertook to fund her surgery. She had a plate inserted, at a cost of 30000 Rs (around $370 AUD) and was able to resume her usual life. No money, no surgery.
Every country has financial barriers to healthcare and the haves and have-nots are growing further apart. Governments in wealthy countries can provide support and a safety-net but, even in some wealthy countries like the US, illness can lead to financial devastation. In resource-poor countries like Nepal, though, this is the reality of life for the majority of people. Systemic change in the health system is necessary, a huge challenge, and isn’t happening. In the meantime, we help those whom we are able to. Sometimes that has to be enough.
*names are changed