If nothing, the Covid-19 pandemic has taught everyone across the globe that maintaining hand hygiene holds utmost significance in order to keep infection at bay.

In Nepal, 52% people do not have access to hand washing facilities with soap and water at home (JMP 2017). Similarly, 54% of healthcare facilities in Nepal do not have handwashing facilities available at point of care (Global Baseline Report 2019).

Biratnagar, the second largest city of the country that shares its borders with Bihar of India, has one only a single government hospital – Koshi Zonal Hospital – and one Covid-19 Hospital.

Dr Laxminarayan Yadav, senior consultant physician at Koshi Zonal Hospital, informed that 12 handwashing stations, two of them contactless, have been built at the hospital premises so that incoming patients as well as their visitors can have access to water and soap.

“Though our staffers also administer hand sanitizer at the hospital’s gate before people are allowed to enter into the premises, handwashing stations were built for its cost effectiveness. Hand sanitizers are expensive as compared to soap and water, and so we have to use hand sanitizers sparingly,” he said.

According to Dr Yadav, the two contactless hand washing stations were donated by non-profit non-governmental organizations. A contactless hand washing station is a simple mechanism operated by foot and aids in reducing human hand touch.

“Koshi Hospital is mostly visited by people with low income strata since it provides affordable medical care in contrast to expensive private hospitals. Such people are usually uneducated and come from the core villages of the city. However, due to the spread of coronavirus, most people have understood by now that hand hygiene is important not only for their personal wellbeing but also for the overall welfare of the society,” he said.

He informed that the Hospital has a six-bed isolation ward readied with the financial assistance of Ministry of Social Development Province 1 and the ward can accommodate upto 10 patients.

The ward, however has a single toilet for all patients.

The isolation ward at Koshi Zonal Hospital in Biratnagar.

Yadav said WASH facilities at the Covid-19 Hospital was, however, quite different with ample toilets for the patients and perennial supply of hygiene materials. The importance of WASH is also being prioritized at the Covid-19 Hospital, according to Yadav.

Typical WASH facilities include clean running water, wash basins, clean toilets, soaps, and segregated dustbins. These facilities at healthcare centers help in prevention of infections and spread of diseases as well as the protection of staff and patients.

The Covid-19 Hospital, a dedicated isolation center being run under the management of Koshi Zonal Hospital, is currently (by the time this article was written) housing 32 Covid-19 patients.

The building housing Covid-19 patients in Biratnagar.

The entrance of the Covid-19 Hospital has a temporary station that administers a squirt or two of hand sanitizer to visitors. Toilets are segregated for patients, visitors, administrative staff, and medical professionals.

Ananda Lamichhane, Public Health Officer stationed at the Covid-19 Hospital, informed that the hospital has a total of 14 toilets and three attached toilets for the 32 patients. The patients are required to clean their bathrooms on their own while the Hospital provides them with phenyl and toilet cleaner on a daily basis, said Lamichhane.

A toilet cum bathroom built for hospital staff at the Covid-19 Hospital in Biratnagar.

Lamichhane informed that the hospital provides a “hygiene kit” consisting of a bar of bathing soap, a tube of toothpaste, a toothbrush, some Ayurvedic medicines, and one glass to drink water from to each incoming patient when they arrive.

“We do have sweepers, plumbers and cleaners on call. They are called whenever we have a blockage or leakage, but other times the patients clean the toilets they use as they would do at their own homes,” he said.

A hand washing station for medical professionals and hospital cleaning staff at the Covid-19 Hospital in Biratnagar.

He said the patients have access to uninterrupted water supply in their toilets and bathrooms and are provided with bottled mineral water for drinking purpose. He added that they are fast running out of soaps as it is the most used item by the patients.

Lamichhane said each room for the patients has one dustbin for all kinds of waste. He also divulged that the waste materials produced by the patients as well as medical professionals were collected and burned in a pit inside the hospital premises on a daily basis. Moreover, the dustbins inside the patients’ rooms are not segregated.

Segregation and proper disposal of medical waste are vital parts of the National Health Care Waste Management Guidelines prepared by the National Health Research Council and all hospitals are required to abide by the guidelines.

A hand washing station for hospital management staff at the premises of Covid-19 Hospital in Biratnagar.

Nobody was allowed to enter the building housing Covid-19 patients except for the hospital staffers, keeping in mind the risk of transmission. So, there was no option but to rely on the information provided by the government officials without being able to see the ground reality.

Government staffers assuring to have ensured access to WASH at government healthcare centers results in a biased data. Meanwhile, information collected and provided by independent researchers can show the ground reality of the matter as their findings do not need to favour anyone.