Dipesh Rai is 17 years old and lives in central Nepal. When he was 14, he started experiencing severe headaches and fever, his feet felt numb, and “I felt my heart trembling.” His family took him first to a shaman, then to the closest hospital, which referred him to a hospital in Kathmandu. There, doctors found that rheumatic heart disease (RHD) had damaged one of the valves in his heart so severely that he needed surgery to replace it. But his family was unable to pay for the operation, so he returned home and took medicine to manage the condition. For a while he was able to return to school, working toward his goal of completing high school and getting a job to support his family. Then his symptoms worsened. When he returned to the hospital, he learned that a second valve in his heart had been damaged. Dipesh has recently received his operation under a government program that has reduced the cost of cardiac surgery for patients in need throughout Nepal. He is doing well.
What Dipesh’s story teaches us
Dipesh’s family home was destroyed in the 2015 earthquake in Nepal. His family has been working to rebuild their home since and is trying to find the financial means to get Dipesh the surgery he needs. His condition is a massive financial burden on his family of subsistence farmers. Just to pay less than $200 for medications and traveling to and from the hospital in Kathmandu, they have had to mortgage their small plot of land. To cover the cost of surgery, even with government support that would reduce the family’s share to about $500, they would need to take out a high-interest loan.
“Though we work painfully hard, we’re unable to earn so much money,” Dipesh’s father explains: “I don’t feel good at all. When he is off in Kathmandu for appointments, I miss him a lot. I wonder what he must be doing there. I am constantly thinking about how to save his life. I wonder whether he will ever be cured. It makes me want to cry.”
Dipesh has recently received his surgery, something he was hoping he’d be able to undertake before his condition worsened. He is now doing well, but as he explains: “I worry about my parents a lot. I want to educate myself to take care of them.”
A stronger health system in Nepal is needed to address multiple parts of Dipesh’s story. Early detection and available treatment of penicillin for strep infections and rheumatic fever would help prevent severe cases of RHD like Dipesh’s. Investment in the training, medicines, and equipment needed to provide sufficient cardiac surgery would further enable young people like Dipesh to be able to access the treatment that is needed to effectively control RHD. Nepal’s program to reduce the cost of surgery to poor patients in Nepal is an encouraging first step towards providing care for the poorest and most vulnerable children and young adults.