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As Nepal commemorates the third anniversary of the two devastating earthquakes, our country still struggles to bounce back. While there is much that remains to be addressed—from rebuilding to restoring basic services— the lack of reliable electricity is causing many hardships. This includes threatening the prevention and treatment of an increasing number of drug-resistant infections known as antimicrobial resistance (AMR).
Today one in four Nepalese lack access to electricity—with those living in rural areas having far less access. The capital, Kathmandu, itself faces major energy issues and there are monthly schedules that, at the worst point, say which four-hour windows each day will have electricity.
The lack of access to a steady supply of electricity poses grave challenges for hospitals in cities as well as health clinics in rural areas. Imagine not being able to sterilize medical tools, or performing surgeries and delivering babies by candlelight. These serious lapses in hygiene and health care have led to increased numbers of infections from bacteria that cause disease and no longer respond to most available antibiotics.
This is the reality in the Kathmandu hospital where I work and conduct research on AMR. If a baby is admitted to the neonatal intensive care unit in Nepal, they have a four in five chance of dying from sepsis—blood poisoning—that is resistant to treatment. Ongoing research in a hospital in Kathmandu shows about a third of patients in an adult in the Intensive Care Unit get ventilator acquired pneumonia (another 40 percent get pneumonia from other sources) and patients with drug resistant pneumonia acquired from a ventilator has a one in two chance of dying.
AMR is worse when there is delayed diagnosis, so one of the main objectives of the World Health Organization’s Global Action Plan on AMR includes improving diagnostic tools. But most of the diagnostic systems that have been developed for effective and prudent use of antibiotics are automated and energy dependent. In energy constrained health care setting such as in Nepal, the majority of these tools are not being utilized, which means we have to wait days for test results. This leads desperate health care providers to use antimicrobials without concrete test results. This less careful use of antimicrobials only exacerbates the AMR challenge.
On top of this, without constant electricity, we are unable to have the automatic alerts that prevent inappropriate prescribing or tools that provide information to develop targeted efforts to prevent infections.
That is where solar energy comes in as a solution to enable Nepal to implement the newer diagnostic tools in, if not all, at least the referral hospitals across the country. The prevalent dire circumstances have already led many hospitals and health clinics to explore alternative power sources, and various organizations and groups—such as SunFarmer, Gham Power and Garud Energy— have found that solar is uniquely suited to the task. Extending the national grid to reach isolated rural communities in Nepal is expensive and unlikely in the near future as critical infrastructure is absent. Getting hospitals in urban areas to go hybrid could help relieve the pressure on the national grid, which could then eventually contribute to supplies in the rural areas.
Solar energy seems to be the most suitable alternative energy for Nepal, which, given its location, receives around 300 days of sun every year. In the last two years, solar paneled street-lamps have cropped up along certain streets of Kathmandu, along with solar paneled bus stops, which shows the potential of solar energy in Nepal. We know it can work here.
Understandably, cash-strapped hospitals in cities currently rely on diesel generators because the upfront costs for them are relatively low as compared to going solar. And it’s true that solar has a relatively higher upfront cost. However, studies done by Garud Energy in a general hospital in Kathmandu have shown that it is actually more expensive to operate diesel generators than solar panels in the long run, and that diesel generators tend to have a shorter life span.
We must also look at the need for energy independence in health care in the larger geopolitical context. After the earthquakes in 2015, India imposed a five-month blockade on the Nepal-India border, a point through which landlocked Nepal receives 70 percent of its imports, especially food, medicines and fuel. The country faced major energy challenges, and there was serious concern that the country had to start thinking of how to reduce the dependency on fuel. The energy crisis of 2015 was not an isolated incident. It has happened before in 1962 and 1989, and political instability in the country and the fragile diplomatic ties with its neighbors in the south means that it is a situation that can arise again in the future.
This is a solution that can work in other countries as well. I have delivered health care in more than 10 countries through Doctors Without Borders and I’ve seen where solar power can help combat AMR in other parts of the world.
This need for reliable energy is essential to improve health care and tackle the global concerns about AMR. To truly be effective though, all countries need the basic tools to join the fight. Solar power could be a key tool in this effort.
Abhilasha Karkey, PhD, is a medical microbiologist and the vice director of the Oxford University Clinical Research Unit-Nepal. She is a 2018 Aspen New Voices Fellow.