It is early morning in Dullu, Dailekh, when Dr Pooja BC’s phone begins to ring. As one of four physicians at Dullu Hospital, she is on the frontline of Nepal’s Covid-19 pandemic. Her phone continues to ring all day: she gets test reports from the lab and health coordinators in the district, and she coordinates logistics and stays updated on patients. Her work requires her to supervise a team of 38 and juggle her time between managing the outpatient department and the isolation wards. Every day, she gets in and out of heavy personal protective gear to take test swabs from those who need testing, coordinates the delivery of those samples, and follows up with contact tracers.
“I am the first point of investigation when someone comes in for tests,” says BC.
Across town, Shailesh Pandit’s routine too begins more or less the same way. He is a contact tracer and those early-morning phone calls are his alarm clock as well.
“Dr Pooja is the case investigator, I am the contact tracer,” explains Pandit. “When someone tests positive for a polymerase chain reaction (PCR) test, Dr Pooja sends them directly to isolation, but the infected would have met many people along the way, and my job is to find out who they have been in contact with.” He and two others keep digging further to find out who the infected have been in touch with and follow up with them for 20 days.
Pandit holds a degree in public health with a focus on epidemiology. He grew up in Kathmandu and had just completed his studies when the 2015 earthquake hit Nepal.
“I realised when I was working during the aftermath of the earthquake that my skills can be used in emergencies,” says Pandit. So when the pandemic hit and Nepal went into a national lockdown, he took the contact tracing training offered by the government and left for Dailekh.
When Pandit arrived in Dailekh, he understood right away that his job involved more than just contact tracing. He realised that many people there had very little knowledge about how to stay safe from the virus.
“You and I may know that to keep ourselves safe — that we need to maintain distance, wash our hands, and wear a mask, but what may have become common knowledge to us is still new in the villages,” says Pandit. So he did what he knew best. He started visiting quarantine centres to talk about the importance of physical distancing and handwashing.
In addition to going directly into the community to talk about how to prevent infections, Pandit has coordinated with local radio stations to make public service announcements about the benefits of handwashing and physical distancing. Every other morning, he is a guest on radio discussion programmes, giving interviews about how to stay safe during the pandemic.
At Dullu Hospital, BC is worried about the increasing community-infection rates and sees great value in the awareness and advocacy programmes conducted by Pandit. Every evening, the doctors and contact tracers connect, keeping each other updated on new cases and investigations.
“The work is more streamlined, as physicians can focus on the clinical part while contact tracers focus on the reporting, advocacy, and the follow-up part,” says BC.
BC grew up in Dailekh, and apart from the two years she spent completing high school in Kathmandu, she has called Surkhet and Dailekh home. When the pandemic hit, BC was already working as a medical officer at Dullu Hospital. She had two months left at the hospital and was planning to take a study leave to prepare for the MD examinations when the pandemic struck. The decision to stay and work in Dullu was quick even though her family was concerned about her wellbeing and she herself did not know much about the coronavirus.
Work for physicians like her has been non-stop since March. According to BC, she and her colleagues currently take care of the clinical and logistical aspects while also providing counselling for patients. In all this, taking care of her own mental wellbeing has taken a backseat.
“When Dailekh registered its first death, in May, it was worrying because that was the first fatality we had due to Covid-19,” says BC. Dailekh has reported two more Covid-related deaths since March 2020. While her family wished for her to return home, this incident made her more convinced that she was in the right profession.
In mid-July, BC had just completed her 14-day shift in the isolation ward and was self-isolating while waiting for the results of her PCR test. Dailekh now has its own PCR testing facility, and the test results are coming in faster than before. This week, Dullu Hospital has been treating 10 Covid-19 patients while also sending out teams to the community for sample swab testing.
BC and the hospital crew are gearing up for the next Covid surge, which will likely include patients infected via community transmission. In the meantime, she is trying to take it easy during self-quarantine, focusing on her mental and physical health.
“The fear that I may get Covid-19 is there, of course. It is always gnawing at me,” says BC. “But I also feel strong and I am healthy and I know I will fight really hard so the virus doesn’t win.”