This article presents three key emerging features in health care in Nepal during the pandemic. COVID-19 had several impacts on the health of the people and the health care system in Nepal. The three key features, in particular, are of importance in relation to the situation created by the pandemic. The first revolves around the infodemic. An infodemic refers to the abundance of information circulated to the public with regard to the pandemic that is often misleading. The second is about the increase in socially harmful behaviour such as stigmatization, segregation and intolerance to COVID-19 affected and other marginalized groups. The third is about the decreased resources and capacity for responding to the pandemic and general health care. All of these emerging features had an impact on the psychosocial health of the communities and families. The infodemic, intolerance and the lack of proper health services when needed, created confusion, distress and panic in the mind of people which lead to the possible rupture in interpersonal and social relations.
Infodemic during the Pandemic
Infodemic or the epidemic of information refers to a rapid and far-reaching spread of both accurate and inaccurate information about something. COVID-19 infodemic consisting of the spread of fake news, misinformation and conspiracy theories has been recognized as a massive problem that undermined the health institutions and responses against COVID-19 (WHO, 2020; Zarocostas, 2020). Infodemic may not only undermine the institutions and response programmes but also may increase unnecessary anxiety and in some cases harmful negligence (Dubey, et al., 2020; WHO, 2020b). In this study, we found a sign of fear, confusion and incoherent behaviours experienced by the participants as some consequences of infodemic. The interviews with the participants show that information and opinions with regard to coronavirus were widely available through various means including social media. In many cases, information was contradictory and confusing to the people. The lack of a method to verify the information, many took certain viewpoints as true based on their own personal judgment or hearsay. The responses from the participants
Infodemic or the epidemic of information refers to a rapid and far-reaching spread of both accurate and inaccurate information about something. COVID-19 infodemic consisting of the spread of fake news, misinformation and conspiracy theories has been recognized as a massive problem that undermined the health institutions and responses against COVID-19 (WHO, 2020; Zarocostas, 2020). Infodemic may not only undermine the institutions and response programmes but also may increase unnecessary anxiety and in some cases harmful negligence (Dubey, et al., 2020; WHO, 2020b).
In the run up to the study related to this article, we found a sign of fear, confusion and incoherent behaviours experienced by the participants as some consequences of infodemic. The interviews with the participants show that information and opinions with regard to coronavirus were widely available through various means including social media. In many cases, information was contradictory and confusing to the people. The lack of a method to verify the information, many took certain viewpoints as true based on their own personal judgment or hearsay. The responses from the participants show that the infodemics are wide in at least three areas. The first is with regard to the nature of coronavirus and its transmission. The second relates to the immunity or who can and cannot get the virus. The third but most widely spread infodemics are on the prevention and cure of the coronavirus.
A 34-year migrant worker from Darchula who returned from India during the lockdown when asked when and what he heard about the coronavirus first said; “I thought of it as an invisible and mysterious monster who enters into the human body and kills instantaneously.” He was in Banglore when the Indian government imposed a lockdown. He waited for several days to come back home. There were many variants of information on what coronavirus is and how it transmits to humans. All he remembers is that virus cannot be seen and it started in China and spread across the world like fire. And he further said, “there is no symptom and people suddenly die after one catches it.” Contrary to the perception of a man from Darchula, another person aged 45 from Kavre who works as a street vendor, held that coronavirus is a hoax. He said, “there is nothing called coronavirus. It is usual that people die. The idea of coronavirus
came from China and America. Its purpose is to make ordinary people afraid. It is their war. The government and media are fueling the idea of corona spread.” At one point the description of coronavirus as nothing but a “fatty substance” which needs to be simply “sneezed away” went viral on social media.
After hearing the news of many deaths in different countries and seeing crowded scenes in hospitals on television and on social media, people come to terms that it actually kills people and the coronavirus is real. People become obsessed with a desire to stay away from coronavirus. What do people think about the way the virus transmits itself from one human being to another? Multiple versions of the explanation were flowing through the community. The most common misinformation was that it is transmitted through the air. A businessman from Jhapa said, “I stay inside the house because I am afraid of catching the virus. With so much spread, I think the air outside now may be full of viruses. I worry about how to breathe now.”
Stigmatization and Intolerance
The COVID-19 pandemic started with a lot of unknowns and uncertainty about it and created great fear among the mass about the infected people. Lack of knowledge on one hand and infodemic on the other caused people to resort to the extreme measures of emotional distancing manifested in stigmatization of the infected people or people suspected of carrying the infection. The stigmatized people went through a great deal of pain, difficulty and emotional turmoil. This study has documented the cases of stigmatization and sense of intolerance and the adverse effect on the people.
The common understanding that COVID-19 is transmitted from person to person. This instigated discriminatory and intolerant actions among people in all communities. Such stigmatization affected coronavirus-infected individuals, minorities and marginalized, and also migrant workers especially those who work in India. All of them were looked upon with “suspicion” and “aversion” as they were suspected of being the virus carrier who could infect the whole community. For some individuals, whole family members were terrified of being near these people in the fear of virus transmission.
The case of a 32-year-old migrant worker from Sarlahi who returned from Saudi Arabia is an illustrious case of how he experienced stigmatization as the suspected to have been infected by the virus. With great trouble, he finally was able to get the ticket to fly back to the country as his work tenure was completed during the time. The lockdown and closure of the borders, and air travel left him in three months in isolation. When he arrived home, he was treated as a virus spreader. He recounts his experience in the following words:
“My difficulty did not end after my safe return home. I was portrayed as the spreader of the virus by my villagers. My family was stigmatized too. Someone from my neighbourhood informed the police about my arrival. The police came to see me and quarantine me at the village quarantine centre.”
The pandemic has given rise to racist attitudes, actions and behaviour. Despite the disease impacting people of all races, ethnicity and profession some specific groups were targeted in particular. The social stigma associated with the health workers and the infected makes the situation more challenging. Along with the corona-positive individuals their families, and returnees, were stigmatized and have to face social rejection.
Insufficient Access to Healthcare
The health sector in Nepal is already crippled and with COVID-19 overwhelming the system, health care services dwindled further. There are particularly three areas that are pertinent themes emerging with regard to access to health care during the COVID-19 pandemic. The first is related to inadequate service provision. The second is about affordability to the ordinary citizens and the third is concerned about the efficacy of the service provided.
The people over the period increasingly developed a definite sense of the insufficiency of the health care service in the country. The poor management of the quarantine, lack of human resources in the hospitals, and proper care to the patients were widely experienced by the people who experienced and observed the health care service during the period. Compounded with infodemic and associated misconceptions as well as anecdotal references, hospitals were even perceived as being the centre from where COVID-19 transmission takes place.
A person from the Bajura district, describing the situation at the quarantine centre on the India-Nepal border in western Nepal, explains the inadequacy of the service in the centre. He was on the way home from Kathmandu and spent 14 days in the quarantine centre together with the people who arrive there from India. He said, “Quarantine conditions were not so well organized. They didn’t follow the health mandates. We were kept in a school, and we had to bring our own bed sheets, clothes etc. I had to make personal arrangements. The food was not up to standard and wasn’t even nutritious. There was no social distancing and so it was very risky. There were no toilets or proper water taps. People coming from India were treated differently from those coming from Kathmandu. Those who came from India were discriminated.” A typical scenario when one enters the district hospital was explained by a participant from Rautahat. He had his wife tested for COVID-19 positive and got severely sick. She was admitted to the hospital where the hospital management took her to the COVID-19 ward. He recounts his observations, “The hospitals did not have enough beds, enough PPEs for the health workers, enough oxygen and even the doctors were losing hope. The hospital has set up a ventilator but it’s not in use due to a lack of manpower. The hospitals do not have enough oxygen concentrators for everyone.”