Essential harm reduction services in Kathmandu have continued to operate despite the devastation caused by a magnitude 8.1 earthquake which struck Nepal on 25 April, 2015, causing over 8000 deaths and massive damage to many communities across the country. To the relief of service users, Nepal’s self-identified peer-led methadone maintenance service, Saarathi Nepal, has continued to provide daily pick-up methadone access to over 200 opioid dependent people through its two sites in Ohm Bahl (central Kathmandu) and Chapel KaKarna (suburban Kathmandu).
Saarathi Nepal’s Program Manager, Ravi Krishna Shrestha, said, “Staff at Saarathi Nepal have been working tirelessly to service the drug user community. We realise that this has been an extremely difficult time for many people, and we know that drug users need methadone. It is testament to the dedication of Saarathi Nepal staff that people chose to attend work as usual rather than spending time with their families. Our staff have all received natural disaster response training so they were familiar with safety precautions for service users, and have actively been promoting post-earthquake health care awareness. Many staff and service users have also been leading rescue and relief efforts.”
Amin, a service user at Saarathi Nepal said, “Thank you to the staff at Saarathi Nepal. It has been amazing to be able to access methadone maintenance treatment during this time. Many drug users have been extremely traumatised by the earthquake and the continuing after-shocks. The Saarathi Nepal staff recognise that this time has been extremely difficult for many of us and have been incredibly flexible with increasing our doses as we request it.”
Bill, a 51 year old, male Saarathi Nepal service user from England who sustained a fractured rib during rescue and relief efforts added, “It has been such a relief to be able to access methadone maintenance. No one has been able to sleep since the earthquake and when we do, it feels as though the ground is still shaking. There have been many rumours amongst the general community that the 25 April earthquake was only the start of a series of major disasters. Subsequently, many people have been extremely scared- the uncertainly and lack of control many are feeling is what seems to be affecting people the most, at least we are assured that we can be dosed every day. Some international drug users fled Nepal following the earthquake, primarily because it has been impossible to obtain any brown sugar (local heroin) during this time. I’m extremely thankful that Saarathi Nepal staff understand that many of us need methadone now, more than ever.”
Although there were no deaths amongst the Saarathi Nepal harm reduction community, several staff and service users have lost their homes as a result of the earthquake and are now living our doors in make-shift accommodation. A Saarthi Nepal staff member also lost several close relatives in the earthquake. A small number of Saarathi Nepal service users were wounded in the initial major earthquake on 25 April, 2015, however all have received medical attention and are in the process of recovering.
However, despite being able to access methadone maintenance treatment, drug users with serious injuries have reportedly been refused treatment from central Kathmandu’s free public hospital, Bir Hospital. On 2 March, 2015, Kali, a former injecting drug user who fractured her finger in three places during the aftermath of the earthquake, sought treatment for her wounds at Bir Hospital; however, after undertaking a rapid blood borne virus test to detect HIV and Hepatitis C (HCV) anti-bodies, Kali was refused essential surgery after testing positive to Hepatitis C anti-bodies.
Arjun, a friend of Kali’s who is offering her support and comfort said, “Before the hospital will operate on anyone, everyone is being made to undergo a rapid test for HIV and Hepatitis C. We were told that the hospital is refusing to treat anyone who is Blood Borne Virus (BBV) anti-body positive. Kali was scheduled to undergo surgery yesterday, yet when her test results were returned, her surgery was cancelled and she was basically asked to leave the hospital grounds. Surgeons said that the operating theatre is full to capacity and that the hospital lacks the facilities to fully clean the space between procedures. We were told that the hospital isn’t adhering to universal safety precautions due to demands on their time, ostensibly due to the massive influx of people requiring emergency surgery. The surgery ward is like a factory; people are being admitted and discharged as quickly as possible. The staff told us that there was no time to clean the operating theatres between patients- this is why people with BBVs are being refused surgery.”
Arjun elaborated, saying, “When Kali’s BBV test indicated that she was HCV anti-body positive, her file was marked with a large red stamp. The files of every patient are marked with either a black stamp or red stamp- the black stamp indicates that a person is BBV negative, whilst the red stamp indicates that a person is BBV anti-body positive. They are not discreet stamps, they are large and are placed on the outer side of the patient’s folder. These stamps are clearly visible to everyone.”
Kali said, “Why should I discriminated against because I have Hepatitis C anti-bodies? Everyone should have access to medical treatment for their wounds, whether they are HIV, HCV or positive for any other BBV or disease .”
When asked about Bir Hospital’s policies regarding the refusal of surgery for people who are BBV anti-body positive, Ravi Krishna Shrestha, Program Manager of Saarathi Nepal and a high profile Nepalese harm reduction advocate said, “The hospital has a policy of refusing treatment to people testing positive to BBVs. This is because the staff are not well trained in universal safety precautions and in the aftermath of the earthquake, many doctors and nurses have been working relentlessly to operate on people with severe wounds. There isn’t enough time to clean the operating theatre between surgeries and there aren’t enough resources to sterilize the area adequately. Also, if doctors and nurses know that a person has BBV anti-bodies, they may treat the patient differently. The staff may be nervous around the person and may not give them the medical attention they require, which will result in the person receiving sub-standard treatment and will reinforce the trauma the person is already feeling. The hospital is literally over-run with people requiring urgent surgery. Saarathi Nepal encourages people who require surgery or invasive medical treatment to access Teku Hopital. Teku Hospital is a free public hospital which is a strong proponent of harm reduction initiatives and is the central access treatment point for people living with HIV, HCV and/or other BBVs.”
**Please note that the names of drug users have been changed to ensure privacy