Teamwork Key to Success to Nepal Overcoming Pandemic Challenges

The COVID-19 pandemic has disrupted and strained health systems globally. Finding ways to adapt and overcome has been crucial for countries to address the multiple waves of COVID cases. Nepal dealt with numerous challenges at the start of the pandemic including disruptions to health care delivery, including infant immunizations and restricted access to medical facilities.

The Patan Hospital, the main teaching hospital of Patan Academy of Health Sciences, provided crucial pandemic support for Nepal thanks to a combination of research expertise, public health activities, medical care, and training.

To learn more about their experiences, Maria Deloria Knoll, PhD, IVAC’s Director of Epidemiology, talked with Shrijana Shrestha, MD, Dean School of Medicine at Patan Academy of Health Sciences, about how the pandemic has impacted the Patan Academy’s work and which resources proved most valuable in the team’s response to COVID-19. Dr. Shrestha highlighted the Gavi-supported Targeted Assessments because this work helped to build local capacity that enabled the team to respond to the pandemic quickly and appropriately.

Maria: The pandemic interrupted your work evaluating the effects of introducing pneumococcal conjugate vaccine (PCV) into the national childhood immunization program. Can you tell me a little about the Targeted Assessment that has been underway since 2014 in Nepal?

Shrijana: The main objectives of the assessment were to evaluate the immune response of a PCV vaccination schedule that differed from the standard WHO schedule, and to measure the impact of nationwide PCV introduction using that schedule on pneumonia cases and on the pneumococcal serotypes circulating in the community and causing disease. Our study demonstrated that using a shortened interval between the two priming doses resulted in minimal differences in immunogenicity after the nine-month booster. It also showed that the vaccine was efficacious as there was a measurable impact in nasopharyngeal carriage of vaccine serotypes in children. Carriage of the PCV 10 vaccine serotypes decreased by around 70% among children less than 2 years, in both healthy children and in children hospitalized with pneumonia. Data from our study informed WHO guidelines, leading to a reduction in the minimal allowable gap between two doses—from eight weeks to four weeks in special circumstances when programmatically necessary to achieve high vaccine coverage.

Maria: How have personnel and capacity developed through activities like the Targeted Assessment assisted with Nepal’s COVID-19 response?

Shrijana: Our research unit worked closely with the staff, doctors, labs, and faculty of the pediatric department during the pandemic. They shared their experience and helped bolster the institute’s response to the pandemic. Specifically, they brought expertise to nasopharyngeal swabbing, record data keeping, and disease reporting.

My role in a leadership position both at Patan Academy and on the pneumococcal research project has directly and indirectly helped me contribute to the institutional COVID decisions with a clear vision. I was able to contribute to important decisions of the Patan Academy Executive council related to the pandemic such as when to activate a disaster mode, how to deliver services, how to adjust the academic activities and in the establishment of the PCR testing labs.

Maria: How has the pandemic affected routine immunization of children?

Shrijana: During this pandemic and with the lockdown, there was a significant decrease in the children coming in to get their routine vaccinations. The inpatient department and vaccination clinic saw the number of children coming for vaccinations drop down more than 50%. Prior to the pandemic, we would get around 80 children per day, but it decreased to only 30 to 35 per day. While it is possible that some children and their families went to local clinics to avoid encountering COVID patients at the hospital, overall the numbers of children vaccinated have gone down.

Maria: What challenges have you had to overcome with the pandemic?

Shrijana: There were many challenges such as shortages of PPE gear. We decided to produce our own reusable autoclavable PPE gear, which we made in the hospital using locally available materials. At the same time, the basic science faculties helped in preparing the face shields and visors, and the hospital pharmacy produced the sanitizer for the whole hospital.

This took tremendous teamwork, and the senior faculty and doctors stepped up by taking rounds at the COVID wards to encourage junior staff and doctors. The Department of Psychiatry organized group and individual counseling sessions for staffs, students, and faculties. Together as a team, we have been able to work through this pandemic.

Maria: How does the community feel about a COVID-19 vaccine and has it been welcomed by healthcare workers and the elderly?

Shrijana: We started with vaccinating our health care professionals against COVID-19, and very few healthcare workers were hesitant or against taking the vaccine. The number of vaccinated people grew significantly when we expanded to vaccinating the elderly, aged 65 and up. At that point, people in Nepal were more willing to take the vaccine because they could see all the health professionals were vaccinated and experienced no serious issues.

The Patan Academy of Health Sciences is a public not-for-profit tertiary academic institution dedicated to improving Nepal’s rural health by training health workers for rural Nepal.

Maria: How has the pandemic impacted the medical training at Patan Academy, which is a major teaching hospital in Nepal?

Shrijana: About six weeks into the pandemic, we started online classes for undergraduate medical students. The faculty had to become comfortable running online classes and students had to return to their hometowns and adapt to online learning. This was a challenge for many of them who live in rural areas where internet access is a challenge. Once the lockdown eased, the practical and clinical sessions, which had to be conducted in-person, resumed when they were able to return.

We continued the Residency training throughout the pandemic. To provide the Residents with enough cases to fulfil their academic requirements, we had to extend the academic calendar a little bit.

We learned that teamwork is the key to the success in responding to the pandemic.
The Pediatric Research Unit of Patan Academy has been conducting several research projects with the main focus on vaccine preventable diseases. We believe that the research we conduct will make a difference in child health and the overall wellbeing of the children. More importantly, our success will help attract young scientists into the field of research and generate a bigger impact globally.

Dr. Shrijana Shrestha currently works as professor of Pediatrics and Dean School of Medicine at Patan Academy of Health Sciences. Shrijana does research in pediatrics and medical education. She is currently working on the Nepal pneumococcal vaccine impact assessment project.