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With lack of testing facilities in remote mountainous districts of Karnali, undocumented COVID-19 cases are higher: fortunately critical cases remains low

After crossing the mighty Karnali on a ropeway in Gamghadi, Mugu – the only way to haul goods across the river to the surrounding villages and Humla – the operator when asked about the COVID situation in the area casually said “Corona le Karnali Katna Sakena.” Literal translation: Corona cant cross Karnali.

This has been the general perception of many of the members of the rural communities in the region. Mild symptoms are dubbed as common cold and seasonal flu and dealt with a strong hot cup of herbal tea. The total number of COVID positive cases in Mugu as per the official government data till date has reached 91 with 9 females and 82 males. Interestingly, Mugu doesn’t have any PCR testing facilities. All the testing done in Mugu are only antigen tests.

It is a similar case in Jumla. After the initial surge, things are more relaxed currently. The lockdown has loosened and things seem to have moved back to the old ways. But as the Mercy Corps team deployed to distribute home isolation kits at a recently established isolation center in Depal Gau of Guthichaur rural municipality, there were 8 new cases overnight. The number of COVID cases in the temporary hospital nearby had also risen with more than 5 new patients. Amidst all this, the total number of deaths in the Karnali zonal hospital in Jumla has reached 9, with 2 patients from Kalikot and one from Surkhet. Comparatively very low to the southern districts of the country.

Mercy Corps Nepal now has provided 80 oxygen cylinders and 35 oxygen concentrators in the Karnali province. It has already distributed 586 home isolation kits through district health departments, DCCMC authorities, health institutions and local governments. To date our response has supported an estimated 20,167 participants in 11 districts.

“These items are very necessary specially during these times when the cases have started to decrease and people do not take the necessary prevention required,” explained Bhupendra Thapa, Chief District Officer, Jumla. “As we just observed this morning, from the increase in cases in Depal Gau, community transmission is still ongoing. We are glad that we are better equipped to handle the cases in the future.”

Of course, the primary concern is the lack of vaccinations. Among the 52,000 Vero Cell vaccines distributed to Karnali province, Jumla has been allotted 4000 of the total. This does not even amount to 5 % of the population. Along with this, lack of adequate testing supplies is also one of the major concerns. PCR tests in Jumla have to be prescribed by a doctor. Only serious cases are referred for PCR tests. This vastly underrepresents the current active cases in the district.

Meanwhile, tests assigned by the Palikas to communities that have shown high numbers of COVID symptoms are not so welcomed by the communities during plantation season. The villagers of a community in Tatopani rural municipality of Jumla fled from their village to nearby hills when they were aware that a team of health workers from the municipality were coming to test COVID transmission in their village.

“It is harvesting season. No one wants to get tested. If they are found positive they will have to stay in isolation. Its either that or sacrificing this year’s plantation,” says Krishna Acharya, a local of Jumla. For the majority of the subsistence farmers in Jumla, production from the fields last only upto a six months maximum.

Not long after the conversation with the ropeway operator, a helicopter appeared on the narrow valley of Gamgadhi to airlift a critical COVID patient to Kathmandu. Despite the relaxed perception on COVID, it was very difficult not to find community members who hadn’t suffered COVID symptoms of body aches or fever in the last couple of weeks.

“My body was aching and I was feverish for a couple of days. But there is nothing strong traditional herbs cant take care of,” explains Batuli Lavad of Mugu in a very nasal voice while serving us tea. This only indicates the risks of a greater community transmission as people grow more complacent while lockdowns and restrictions are eased by the day.

It is good to know, even in some of these rural areas, they for now at least have a backup of oxygen and critical medical supplies for critical cases and the imminent third wave.

Community transmission in remote communities

Daljit Yogi didn’t do his usual round of India trip this year due to COVID-19. Daljit yearly traveled to India to do labor work to earn a little bit for his family.

Daljit is from a small village in Jogibada of Jumla, a remote mountainous district in western Nepal. Most of the male population of the village travel to India seeking employment opportunities as labor workers. Soon as you enter the village, you will notice the large number of female population with hardly any men. But things have changed slightly these days.

Soon after India suffered the deadly second wave, Nepal India entry points saw around 1500 people returning to Nepal during the early weeks of May.

Jumla didn’t see increase in COVID cases till late May. While the overall cases in the whole nation is gradually decreasing, some remote mountainous districts including Jumla have seen a slight increase in the number of cases. It is the gradual community transmission and the exodus of Nepali population returning to their home villages.

Despite the increasing number of cases, people in rural villages still have not yet understand the gravity of the situation. “Most people do not go for checkups or get tested. They think that it is a case of common cold,” explains Daljit. “People don’t take precautions and now we can see more and more people getting affected daily,” adds Daljit.

Jumla has seen fewer cases compared to the hilly regions and Terai districts of Nepal. Till date, the official number of cases in Jumla has reached 955. The lack of health facilities, its inaccessibility and the unwillingness of the community members to get checked leaves a large chunk of population unaccounted for.

“People still believe in traditional healing methods and think hot water with local herbs is the cure for the disease,” explains Daljit, adding, “I am very careful and advice my family and friends to take as much necessary prevention measures as possible.”

As the big surge has now gradually simmered down, people have started returning to India. Currently the number of Nepali workers returning to India is more than the number of people coming back to Nepal.