By Naresh Newar in Udayapur District, Nepal

Udayapur is one of the 40 districts in Nepal where OHW provided support to the government’s COVID-19 emergency response. This was also a COVID-19 hotspot district, where OHW was one of the first international non-government organizations to provide emergency response on the ground in Udayapur.

Belka Hospital in Udayapur district, where the situation is returning to normal compared to 2020 when the first wave of COVID-19 started. Udaypur had the highest number of cases in the country than any other district during the first wave.

Working at Belka Hospital of Udayapur district, Skilled Birth Attendant (SBA) Nurse Sabnam KC hardly has time for a social life. She has a very tight work schedule. With more than 224 birth deliveries in a year, the workload is heavy for Sabnam and her small team of nurses in this hospital located in Rampur ward of Belka municipality in Udayapur district.

“So many mothers count on us for their lives and safe birth deliveries, and even during the height of pandemic situation, we couldn’t stop our services,” says nurse Sabnam. Keeping herself positive and energetic, she is happy to be in this profession and working at this hospital that has helped to save a lot of lives even in the most difficult circumstances, especially during the beginning of the COVID-19 pandemic.

Today, the situation has been returning to normal for Sabnam and her team after a long time. She recalls the extremely stressful situation when the first wave of COVID-19 hit the district in April 2020. Udayapur, which had the highest number of cases than any district across the country, even more than Kathmandu during the initial months of the first COVID-19 wave.

*The nurses were also at high risk of infection but were able to prevent infection with help of protective kits provided by OHW.*

“OHW’s support boosted our morale during a very difficult situation”

Belka hospital is close to Bhulke ward, which gained notoriety for being the hotspot for COVID-19. Over a dozen people were infected alone in this ward when Nepal as a whole recorded only a handful of cases in the beginning. That caused a huge panic and anxiety across the country due to fear of more population getting infected. On top of infections, local residents suffered from social ostracization, discrimination and, also human rights violation to some extent.

When people from this ward traveled across the district, the shops and restaurants, and even health centers refused to give them service, and even take money due to fear of being infected.

*Binod Mishra, Public Health Officer, Belka Nagar Hospital*
*“We can never forget the humanitarian support from OHW when we urgently needed help. No other organization has helped like OHW since the beginning of COVID-19 and until now.”*

“It was a horrifying situation as we didn’t know then about COVID-19 management like we do today. We were all very nervous then because we were not prepared for this kind of situation,” says Binod Mishra, Public Health Officer of Belka Nagar Hospital.

His hospital team was also under a lot of pressure, with an overwhelming flow of patients, and there was little external help to deal with the COVID-19 situation.

“It was One Heart Worldwide, which provided us quick relief by bringing us with the most essential kits to protect our team from COVID-19 infections. That was true humanitarian support that helped our hospital nurses to feel safer and continue our health services,” recalls Binod. He recalls how OHW swiftly dispatched complete sets of PPE kits, hand sanitizers, gloves, masks, gowns, antibacterial soaps, delivery kits, and several other kits.

He explains how these kits boosted the morale of health service providers and made them feel secure, especially because the nurses had to work in close proximity with patients infected by the virus. There were also pregnant women who had been infected by COVID-19. But a lot of mothers were able to prevent infection after the hospital team provided masks and sanitizers, and also provided them education with help of OHW.

*Nurse Sabnam KC, Belka Hospital*
“The health service providers are at high risk of infection as they have to work closely with patients but we could prevent infections with protective kits provided by OHW. This enabled us to continue provide care of pregnant women, mothers and newborns.”

“If help hadn’t arrived, we wouldn’t be able to continue to deliver our services. We can never forget the support from OHW, which was the first organization to help us so much,” recalls nurse Sabnam. Despite every precaution, she also got infected, and that worried her because the hospital was already short of nurses working in maternity care. She was glad that her colleague Binita Mahaseth, an experienced nurse who received skilled birth attendant (SBA) training with help of OHW.

*Nurse Binita M., Belka Hospital:*
*“We wanted to make sure that the institutional birthing continued and we were able to convince the mothers to visit our hospital, and we were successful, thanks to OHW.”*

“Our most concern then was for safe birth delivery and that was also the time when home deliveries were growing because the families were afraid to visit here with fear of getting infected,” says Binita. She explains how they were able to create a secure environment with the help of COVID-19 related protective and infection prevention kits from OHW.

Almost every health center was either closed or very restricted and many health service providers were hesitant to be in close contact with their patients. This wasn’t good for the mothers and especially pregnant women coming for antenatal check-ups.

Then, the nurses were also just learning about how to create a very safe environment inside the maternity rooms, using sterilization, and many other things. “OHW provided us a lot of support and knowledge, and we were also able to constantly stay in touch with the mothers and pregnant women through virtual communications by providing us extra cash to top up our phone credits,” recalls Binita.

OHW’s ongoing support in Udayapur

OHW continues to provide help to the local government in Udayapur in all its eight municipalities, where its support to control the COVID-19 pandemic and care has reached over 40 health centers. OHW team has traveled from the town centers to the most remote rural municipality wards in the hills with the life-saving COVID-19 kits and medical supplies provided through its local efforts and international donors.

Among the most significant donors during the second wave were DAK Foundation and Direct Relief that provided nearly US$1.7 million worth of COVID care supplies including oxygen concentrators, oxygen cylinders, pulse oximeters, handheld oximeters, and highly essential medical supplies. In addition, OHW also locally collected nearly NPR 20 million worth of supplies.

Udaypur was one of 19 districts to receive aid through DAK Foundation and Direct Relief. It also received a huge number of oxygen cylinders to save the patients infected with Coronavirus.

*Dr. Jib Narayan Mandal, Chief of Udayapur District Hospital*
*“OHW provided us so much support that helped us to take care of hundreds of patients who were infected by COVID.”*

“We were able to provide intensive care and protection to hundreds of our patients. Thanks to OHW for providing us with the life-saving kits. We were able to provide care to 168 patients at our hospital and isolation centers, and they all returned home after their recovery,” says Dr. Jib Narayan Mandal, chief of Udayapur District Hospital.

He shares how COVID-19 management has improved a lot since the first wave. Even when there were fewer infected patients in 2020 than in 2021, it was more difficult as there was no system in place and the health team had panicked a lot. They also had little idea about creating isolation centers and most of the patients were sent to Biratnagar city in another district.

“Today, we have more experience in preparedness and we always want to thank you for supporting us during those most difficult times for supporting us to protect our health staff and also caring for our patients,” says Dr. Jib.

The fear of COVID-19 in Udayapur among both the government and health service providers is much less. They have more confidence in COVID-19 management, especially with the COVID care and protective kits in place. Most health centers in both rural and urban municipalities have preparedness plans and there is a safer working environment for the health service providers.

*Khadag Bahadur Pariyar, Chief of Udayapur DCC*
*“OHW has done remarkable job of helping Udayapur in COVID-19 response work. We can never forget how OHW supported us.”*

“We know that the COVID-19 situation is still alarming across the country and even in Udayapur, we are not safe. But we are better prepared and we know OHW will help us whenever we need support,” says Khadag Bahadur Pariyar, Chief of Udayapur District Coordination Committee (DCC). He shared that OHW provided over 4,000 kits useful for COVID-19 prevention and care including sanitizers, oxygen pulse oximeters, digital thermometers, soaps, oxygen concentrators, and several other essentials.

“Such support is an example of how civil society organizations can be a very good partner in times of crisis. OHW has been a very good partner and it has done a remarkable job in Udayapur,” says DCC Chief Khadag.

*OHW Nepal team worked tirelessly to pack and deliver hundreds of boxes of life-saving supplies across the country’s seven provinces for COVID care and protection.*

team spirit: how OHW staff worked tirelessly to reach the emergency supplies to the most affected districts in Nepal

“We have an amazing team at One Heart Worldwide. It was due to everyone’s effort, commitment, and dedication that made our COVID-19 response successful,” says OHW’s Admin Officer, Shreejana Sunuwar. She had a crucial role in coordinating the logistics, storage of and proper stocking essential supplies, mobilizing staff for, ensuring maintenance of storage facility, documentation for official clearance of supplies and dispatch, and so many more.

She recalls how the OHW team worked together, each with an important task in making official documents, planning, storage, transport, management, packaging, and delivery of the emergency COVID care and protective kits, and medical supplies across Nepal’s most affected municipalities and districts in all seven provinces.

Most of the offices were closed due to lockdowns during both first and second waves, and the OHW team was working from home. The government also had strict orders of vehicular movement, but OHW had managed to get passes for the staff and they were able to go to OHW’s temporary storage facility in Kathmandu for packing up the supplies to be dispatched across the country.

“Our team were working from early morning to evenings, and even when they were exhausted, they were very motivated as we had to rush to deliver the emergency medical supplies and other life-saving kits, as they were desperately needed in hospitals and health centers,” recalls Shreejana.

The Beginning of OHW response

Nepal received one of the biggest donations during the second wave from OHW partners the DAK Foundation and Direct Relief.

During the first wave of COVID-19, OHW quickly started its emergency response by first donating tents in Kathmandu and across the three Nepal-India border areas to set up mobile camps for antigen testing of Nepali migrants returning from India. Millions of Nepalis work in India as migrant workers, and many had returned from India, where COVID-19 cases were among the world’s highest.

OHW team then was able to collect protective and life-saving kits both through local resources and from international donations. But simply getting donations didn’t mean they would be easily distributed. There was a lot of paperwork and documentation that needed to be done for the government’s approval and tax clearance.

The approval involves liaising at many levels from Social Welfare Council to the Ministry of Women, Children and Senior Citizens (MOWCSC), Ministry of Finance, Ministry of Industry, Department of Commerce, Ministry of Health and Population. This lengthy process especially became a challenge during the second wave of COVID-19 in 2021, when Nepal had the world’s highest rates of infections on a per capita population basis.

“Our Executive Director did a lot of advocacy to expedite the process of approval and tax clearance and that really helped in avoiding delays in facilitating the delivery of supplies,” says Shreejana.

*OHW team worked together to successfully transport all 375 oxygen cylinders at a time when the country was running out oxygen for a huge number of infected patients*

There were no clearly defined policies and through OHW’s advocacy, the ministries also, the ministries also modified their regulations to ease the process as there was so much urgency due to shortage of oxygen.

During the second wave, as the cases grew by a huge number in all districts of Nepal, donations started pouring in. One of the biggest donations was by the DAK Foundation and Direct Relief that provided USD 1.7 million worth of support to Nepal and was handed over through OHW. In addition, OHW also contributed nearly NPR 20 million worth of life-saving kits and medical supplies through its own local resources.

Meticulous plan to distribute COVID-19 supplies

*OHW handed over a complete set of home isolation kits to a mother in a rural municipality in the hilly Khotang district.*

Getting these emergency supplies on the ground required an intensive process of documentation for approval and verification from the government. Especially the medical drugs needed approval from the Department of Drugs Administration (DDA). With OHW’s efforts, DDA helped to expedite of process and supported OHW by allowing the list of approved drugs to be dispatched soon to government health centers across Nepal.

Shreejana and her team’s next challenge was to transport especially the big oxygen cylinders (46 meters each) and already there were 8,000 kgs of these supplies. At the Tribhuvan International Airport, donated supplies from different donors to various agencies in Nepal were inadvertently mixed at the World Food Program (WFP) storage facility.

OHW administration team spent almost 12 hours from morning to evening finding the supplies, loading them, and transporting them back to the OHW storage facility. The next day, the team segregated the supplies and started packing everything for another 10-15 days.

“Everyone at OHW had made the joint effort. Many of our team members were very tired but we knew how urgently these life-saving supplies were needed in hospitals and health centers. We were successful in effectively packing all the supplies, labeling them, and preparing for transport,” explains Shreejana

The next step was to officially hand over the supplies to the government health centers in all seven provinces. Sunuwar and her management team had to make sure that they had the proper list for dispatch, ensure every box was properly packed and loaded and then dispatched.

*OHW staff handing over PPE kits to Solududhkunda Municipality of Solukhumbhu district.*

A Successful Mission

The biggest challenge for dispatching the supplies was the weather. There was torrential rainfall and the roads had become very dangerous. There were landslides, boulders falling off the cliff and destroying the roads, and mudslides had also deteriorated the conditions of the roads especially in the rural areas. During the monsoon, the length of the journey often gets longer, and the OHW team kept their morals high despite the difficulties and challenges of traveling with the life-saving supplies.

“We had fears of supplies being damaged and disruption in handing over to the health facilities where these supplies were urgently needed to be reached. In Kathmandu, we were also constantly worried about our staff because they were also traveling in those very difficult areas,” says Shreejana.

“Without the solidarity of our team, it would be really difficult to make our response successful because times were very difficult then,” she explains, recalling how the situation during both the first and second waves of COVID-19 were stressful. A lot of OHW’s own staff had been infected, and they all recovered and continued their work to ensure that all the COVID supplies were delivered on time.