Nepali Times

Inside a cabin of the isolation ward at Shahid Sukraraj Tropical Hospital in Kathmandu, a frail young man has been lying in bed for the last five days.

Ram Krishna Giri, 23, was admitted after being infected with swine flu while treating patients in the remote village of Paink in Jajarkot that was at the epicentre of a deadly flu outbreak three weeks ago which has so far killed 26 people.

Giri had arrived at the sub-health post in Paink just two months ago, and immediately found himself overwhelmed with flu cases. He treated at least 1,000 patients before being infected himself.

IN ISOLATION: Health worker Ram Krishna Giri treated hundreds of patients before he himself was infected with swine flu. He is now recuperating at a hospital in Kathmandu. Photo: Gopen Rai

"When I look back, I feel an immense sense of satisfaction that we managed to save so many lives," he says, “there is nothing more fulfilling for a health worker than seeing a smile on the patient you cure.”

Giri is still weak, is on intravenous feed, and cannot even sit up, but he is determined to go back to Jajarkot as soon as he is fit. There are four other health workers at the post in Paink where the epidemic started after a 20-year-old woman died of flu-like symptoms on 1 April.

A few days later, a three-member team led by physician Dipak Pun reached Paink on foot to support Giri and together they worked 18 hours a day treating 1,200 patients. When Giri fell sick, he was rushed to Khalanga on a horse, taken to Nepalganj on a jeep and flown to Kathmandu from there.

"At one point there were so many patients that there was no space inside the sub-health post and we treated patients in the verandah and worked late into the night burning firewood to keep the cold away,” Giri told us in a feeble voice.

The challenge was to reach patients who were too weak to be taken to the sub-health post. Bir Bahadur Chhetri, 60, died in Paink after suffering fever and headache for days. His 18-year-old son, Prakash, had also fallen sick and was not able to walk to the sub-health post. Giri walked one hour to their house, but fell ill along the way as he was climbing a steep trail.

"I had not slept enough for more than a week and was feeling exhausted," he recalls, “I had been weakened by overwork.”

Amidst widespread criticism in the media of the government's perceived failure to tackle the Jajarkot epidemic, the contribution of health workers like Giri has been overlooked.

"It’s true the government was slow to react to the epidemic, and a lot of the help was too little too late,” Jajarkot CA member Rajeev Shah told Nepali Times, “but there were huge logistical and other challenges.”

As district health officer Pun also worked tirelessly despite showing some symptoms of flu himself, treating hundreds. “In the eight days I spent at Paink, not a single patient died in the health post,” he told us by phone from the Jajarkot capital on Wednesday. “Yes, the government could have reacted faster, but we could not have done more given the limited resources we had.”

Physician Moritz Tlagemann of the Chaurjhari Hospital examining a patient at Archhane in Jajarkot on Monday. Photo: Rajendra Karki

The uproar over the government's failure has also discouraged health workers toiling day and night to save people's lives in Jajarkot.

Physician Bibhant Shah said the relentless negative coverage in the media has thoroughly demoralised health workers like him. When he reached Paink, the outbreak had been contained, so he walked to Dhime, where there were no doctors. “But some Kathmandu media reported that I had fled Paink and left people to die,” he said by phone, adding that the Kathmandu media exaggerated the extent of the outbreak. Even so, he credits newspapers for highlighting the epidemic and forcing the government to act.

As of 21 April, 25 deaths had been reported in Archhane, Paink, Sakala, Pajaru, Talegaun and Nayakwada VDCs of Jajarkot district. Not all the fatalities were a result of H1N1 influenza, commonly known as swine flu.

Krishna Khatri, epidemiologist in the Jajarkot public health office, told us: "Only four deaths were caused by swine flu. Others were either newborns or the elderly already suffering from asthma, high blood pressure and tuberculosis."

Doctors are investigating if there might be other causes behind the Jajarkot outbreak. But samples of saliva and blood collected from the worst-affected villages of Jajarkot have tested negative for other water-borne and vector-borne diseases, including typhoid.

"No virus other than swine flu has been detected in Jajarkot," says Baburam Marasini at the Epidemiology and Disease Control Division in Kathmandu. "But more than swine flu, it is low immunity caused by poverty, malnutrition, illiteracy and lack of sanitation that led to the fatalities in Jajarkot."

Given this, public experts say, the Jajarkot outbreak appears to be more of a failure of state structure than the result of late response by government authorities.

What raised the death toll was that Jajarkot has very few roads, the population is spread out over the rugged mountains, and the sick have to be carried to health posts or the single hospital in the Khalanga.

@omastharai

Read also:

Running with the herd, Tsering Dolker Gurung

Swine flu in Jajarkot

Learning from Jajarkot, Om Prasad Gautam

Rajeev goes to Jajarkot, Dewan Rai

Learning the hard way, Sahina Shrestha