Background: The COVID-19 pandemic has highlighted the need for global unity and timely access to healthcare for all including multilingual and intercultural societies. This study aimed to identify barriers to healthcare access due to the COVID-19 crisis among Nepalese migrants in Japan and explore ways to counter these barriers, both in routine and crisis situations. Methods: This study used an exploratory sequential mixed-methods study design. The researchers conducted 11 focus group discussions including 89 participants and an online survey involving 937 respondents. The integration of focus group discussions and logistic regression analysis from the survey was reported via a ‘joint display’. Results: Twenty-six themes on barriers to and six on facilitators of healthcare accessibility were identified by the focus group discussions among which 17 barriers like lack of knowledge of health insurance, language barriers, lack of hotline services, unawareness of available services, fear of discrimination etc. had significant association in our logistic regression analysis after adjusting for all confounders. Similarly, the only facilitator that had a significant impact, according to the multivariable logistic regression analysis, was receiving health information from Nepali healthcare professionals (OR = 1.36, 95% CI = (1.01 – 1.82), p-value < 0.05). Conclusion: The study suggests the need for a crisis information hub which could be coordinated by the Nepal embassy or concerned authorities, flexible policies for active deployment of Nepalese health workers and volunteers, accessible hotlines in the Nepali language, and incorporation of Nepali telehealth services in Japan.

Migrants in Japan often face difficulties accessing healthcare due to language barriers, lack of information, shortage of interpreters, amongst other barriers. With an increase in the number of foreigners in Japan, it is also expected that health and safety concerns for migrants will rise during times of crisis or disaster. The purpose of this article is to present recommendations from Nepali migrants themselves about various actions that stakeholders or policymakers could take to improve healthcare access during future disasters, emergencies, or crises in Japan. Recommendations from Nepali migrants in this study include mobilization of Nepali healthcare professionals, self-preparedness, a disaster information centre by the embassy, Nepali hotline services, telehealth services, and mutual help. By working together and leveraging available resources, it is possible to ensure that migrants are not left behind in the face of disasters and emergencies. Further research is required to determine the most effective ways to improve healthcare access for migrants in Japan during disasters, crises, or emergencies.

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 mixed medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results A total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Background Patients are often admitted to intensive care units (ICUs) after surgery for advanced monitoring and management that are usually unavailable in general wards. This study aimed to examine the characteristics of postoperative patients admitted to ICUs and their outcomes. Methods A retrospective observational study was conducted across 18 ICUs in Nepal from January 1, 2020, to December 31, 2023. Data were obtained from the registry maintained by the Nepal Intensive Care Research Foundation (NICRF). Surgical patients aged over 16 years with ICU stays of at least 8 hours were included. Demographics, types of surgical procedures, comorbidities, readmission rates, and mortality rates were analyzed. Continuous variables were reported as mean ± standard deviation or median with interquartile range, while categorical variables were expressed as frequencies and percentages. Results Of the 29,148 patients admitted to the ICUs during the study period, 4,755 (16.31%) were surgical patients, and 4,509 were included in the analysis after exclusions. Among these, 2,973 (65.9%) were admitted directly from operating theaters, while 1,080 (23.9%) were admitted from wards. The average vital signs and blood test results were within normal ranges. The readmission rate was higher for patients admitted from wards (11%) compared to those from operating theaters (3.66%). Overall mortality for surgical patients was 9%, with significantly higher mortality among those admitted from wards (15.8%) than from operating theaters (6%). Conclusion Surgical patients constituted a substantial proportion of ICU admissions. Patients admitted directly from operating theaters experienced better outcomes, including lower readmission and mortality rates, compared to those admitted from wards. These findings underscore the need for targeted interventions to improve outcomes for patients transferred from wards.

Introduction and Objective: On November 3, 2023, a 6.4 magnitude earthquake struck Jajarkot in the western part of Nepal, resulting in 154 fatalities, 366 injuries, the complete destruction of 26,557 houses, and partial damage to 35,455 houses. This report analyzes the situation 3 months after the earthquake. The primary objective is to assess recovery efforts, living conditions, and the roles of governmental and non-governmental agencies in the aftermath.Approaches: A three-member team from the Disaster Preparedness Network (DPNet)-Nepal conducted a field visit from February 5 to February 11, 2024. The study is based on observations, focus group discussions with NGOs, and interviews with local government officials, and disaster survivors.Findings: The team found immediate search and rescue operations satisfactory, but relief distribution faced significant discrepancies, leading to conflicts. Delays in government reconstruction assistance and challenges in constructing temporary shelters, primarily made of galvanized iron sheets, were major issues. A bamboo and mud model shelter showed promise as a better alternative. Health services faced severe challenges, including inadequate maternal healthcare and rising mental health issues. Misuse of relief funds influenced by political affiliations, insecurity for families constructing temporary shelters on rented land, and lack of accurate data on vulnerable populations hindered effective aid distribution. Participants in focus group discussions and interviews rated the overall governmental disaster response 7 out of 10.Discussion: The report emphasizes the need for improved coordination, equitable aid distribution, sustainable reconstruction practices, pre-disaster data collection, training and activation of the national Emergency Medical Team (EMT), designated warehouses or evacuation centers, a uniform reporting mechanism, and adherence to Sphere standards. Effective collaboration among all stakeholders is crucial to addressing ongoing challenges and supporting affected populations comprehensively.