Prof. Dr. Harish Chandra Neupane is the Chairman and Managing Director of Chitwan Medical College (CMC). He is also Past President of Association of Private Medical and Dental Colleges of Nepal. In an email interview with B360, Prof. Dr. Neupane gave his perspective on the COVID 19 pandemic, and the role private medical colleges can play to collaborate in the government’s endeavor to contain it. Excerpts:
In the fight with COVID 19, it is the government hospitals that are shouldering all the responsibilities from testing to patient admission. What are the probabilities of government-private hospitals collaboration?
Considering the present situation, neither the government nor the medical colleges can fight this alone. There is an obvious need for government-private medical college partnership. I believe, most of the private teaching hospitals have in some or the other way reached out to share the responsibility. Talking about Chitwan Medical College, we have donated 20 beds for the government operated Corona Hospital in Bharatpur, Chitwan. The medical laboratory is also run by CMC with lab personnel and supervisor. In addition, as per Nepal Medical Association (NMA) directives, a Scientific Committee was setup under the leadership of CMC faculties and the Mayor of Bharatpur Municipality. We also developed a handbook on COVID 19 management and distributed to all the hospitals of Bharatpur including the Bharatpur Government hospital.
It is generally perceived that there are factors stopping private hospitals from sharing the weight of the burden of government hospitals treating COVID 19 patients. Would you agree?
Medical colleges have never shied away from the burden sharing with the government. Yes, there are certain factors which pose huge challenges for us. All the private medical colleges are self-funded, we don’t receive any financial assistance from government and in addition to this we pay nearly 25 crores in tax per year to the government. You can calculate the amount, there are 18 medical colleges x 25 crores which is Rs 450 crores annually. At this time, we are also doing our best to procure PPEs for the frontline medical staff, we have set up Corona clinic in our hospitals wherein we attend to all suspect and confirmed cases and send samples to the lab for diagnosis. The clinic itself is bedded with a fully equipped ICU setup. We have not been able to recover full fees from students of existing academic programs due to which we are now facing challenges in providing salaries to our staffs. Will the government share our burden at this dire need of the hour?
News surfaced about some private hospitals showing the door to patients who demonstrated even the slightest symptoms of COVID 19. Is this ethical?
This is completely false allegation. Firstly, we need to understand the difference between a private hospital and a medical college. Medical colleges unlike private hospitals run hospital services at almost equal cost whereas private hospitals are expensive. No one can say we have not attended to cases in medical colleges.
As per data, out of the total occupancies across all hospitals in Nepal, 77% of patients take service from private hospitals and medical colleges. Out of the total Intensive Care Unit beds, 80% are from medical colleges which clearly shows the significant role that private medical colleges are fulfilling in the health care industry of Nepal besides contributing to the economic growth of Nepal.
How is CMC bearing the economic repercussion of COVID 19?
Every size business is undoubtedly affected by COVID 19. Private medical colleges are no exception. Despite the odds, we are running the OPDs with optimum PPE to protect and safeguard our doctors and nurses. The hospital’s main income source has been completely paralysed and the academic section due to our incapability in recovering student fees. Our savings are perishing. Slowly we are inching towards ‘shut down’ status. We are looking to the government of Nepal for assistance to cope with this crisis. Due to the pandemic, almost all medical colleges are facing financial breakdown due to significant reduction in the number of patients visiting outpatient departments as lockdown has been imposed across the nation; not only this the colleges are also expecting huge losses in academic fees and we are pretty unsure of the future as the students these days are highly influenced by political interests.
The government has not provided any sort of financial or material aid to the private medical colleges in this need of the hour. Despite this, we are offering all medical services free of cost to the financially weak and many services at huge discounts. This is all just to make sure the nation fights back the pandemic successfully.
To complement the government’s efforts without even being officially invited to do so, all private medical institutions are lending their services and contributing their best. For example, we offer a total of 10% of our beds free of cost at all times. We run all the eight programs initiated by the Government of Nepal: Aama – Suraksha Program, Head Injury Program, Spinal Injury Program, Heart Program, Cancer, Parkinson, Alzheimer, Free Dialysis and Samajik Suraksha Bima Program.
What are your expectations from the government to assist in the fight against the COVID 19 in the country, and what capabilities are above par in comparison to government hospitals?
The most important thing the goverment can do is to disseminate the PCR testing facilities to private teaching hospitals so that large number of tests can be done in shorter period of time. If the government can provide sufficient PPEs to us, we can convert the entire hospital into Corona Facility.
In today’s date, most number of ICU beds with ventilators and adequate staff ratio can only be seen in private hospitals of medical colleges. If the government braces us with proper facilities, we can do much better to cater to the need of the hour than what we are doing presently without any help from the government. Ultimately the government has to depend on the medical colleges for effective execution of healthcare services especially in the current scenario; being prepared in advance is always favourable.
With are the grievances of private medical colleges with the government?
Our main concerns are financial sustenance, provision of adequate number of PPEs, and allowing us to perform diagnostic tests to strengthen the fight against COVID 19.
Apart from these, there are some vital areas that need to be addressed by the government. The medical colleges have a huge responsibility in the healthcare delivery system of Nepal, despite this the government doesn’t involve medical colleges in the policy-making processes, many specialty services are run by medical colleges but government is not even aware of it. At this time, specialisation of Infectious Disease personnel is of utmost importance but we have not seen the government thinking along these lines. And if these are not enough, the officials who come for inspection representing government regulatory bodies harass us at all levels in all possible ways.
According to you, what measures by the government for containing COVID 19 are proper and what need revision and correction?
I do appreciate the efforts put in by the government to combat COVID 19. They have successfully created awareness among general public about the disease and simple ways to protect them. The government has successfully implemented lockdown across the nation and the citizens have cooperated. The setting up of temporary Corona Hospitals in all the provinces is commendable job and most importantly providing quarantine services for those suspected with COVID 19 or for migrant Nepalis who have come to Nepal recently from different parts of the world.
However, there are some things which still need to be improvised like allowing diagnostic facilities in all medical colleges. Unstable policies related to COVID 19 make it challenging for health professionals to plan our actions which is further enhanced with the inadequate supply of PPEs. One very important thing the government has not yet considered is the insurance policy for frontline warriors which I think is a must for all doctors and nurses and other health professionals dealing with infected or suspected cases.
How are private medical hospitals and colleges investing efforts and resources in research and findings on the Coronavirus?
All the medical colleges have research units in their respective institutions, and CMC too has a research wing with efficient experts on the team. We were among the first medical colleges to begin research activities related to COVID 19. We conducted web surveys to know about the awareness of the disease among healthcare professionals; we did a survey to assess the amount of stress and anxiety among nurses working in the frontline; we wrote few articles on the effects of COVID 19 on different medical practices like surgery; we also did a survey among medical students to see their willingness regarding online classes and so on. Due to lack of funding from the government, we haven’t been able to initiate trial based studies yet. The government should proportionately balance funding plans for research based activities in medical field rather than only strengthening sister organisations of the government.