The three-month-old son of Isara Gurdhami, a resident of Bahuradi in ward 5 of Kedarsyu Rural Municipality, was ill. He had for long been suffering from diarrhoea and fever.

After hearing that treatment for such an illness was available at Tamtana of neighbouring Bungal Municipality-5, Isara took her ailing son to Krishna Kunwar’s house in December last week. He administered injections to both mother and her baby. She returned home after Krishna assured that the ailing son would recover within a few days.

But the treatment did not work. Instead, the child’s health worsened. High fever led to short breathing. Panic-stricken Isara informed her brother-in-law Pratap Gurdhami. They rushed the infant to Khiratadi Health Post in Bungal.

“The child’s condition had already worsened. The doctor referred to Dadeldhura saying that treatment was not possible there. The child breathed his last on the way to Dadeldhura,” said Pratap.

Six-month-old son of Prem Bista of Nimili in Bungal-9 died on Saturday. He took his son to a local medical centre at Bijgada after he had blisters in the tongue.

“It was Saturday. We took the sick son to the medical [facility]. But the treatment failed. The child fell seriously ill. We rushed him to Khiratadi Health Post the next day where he was pronounced dead on arrival,” lamented Prem. He says the child could have survived if he was taken to the health post instead of the medical hall.

These are a couple of representative cases of the victims who died after failing to reach the health institutions on time. These are near daily occurrences in Bajhang, a remote district of Sudurpaschim Province. Health experts say many people die due to unregistered and illegally operated medical halls and quacks.

Dr Dil Bahadur Gurdhami at Khiratadi Health Post, who referred Isara’s son to Dadeldhura, suspected that the infant might have died due to an injection not suitable for the treatment. “The immune system in infants below one year is not fully developed. So medicines should not be used randomly. It seems that Isara’s son died due to wrong medication,” he said.

According to Dil Bahadur, many people without licence to sell medicines set up a medical clinic and offer treatment to the people in Bajhang. “They import medicines from India and prescribe them carelessly. They even use expired medicines, and drugs prohibited for sale,” he said. He guesses that over 50 percent pharmacies in Bungal Municipality are operating without fulfilling the legal process and the operators are not trained either.

The illegally running pharmacies and fake medicos are rampant in Bajhang due to ineffective monitoring. This is the case not just in remote villages but also Chainpur, the district headquarters. On Thursday, a team from the Department of Drug Administration (DDA) raided a pharmacy of Amisa Hospital in Chainpur and sealed the unauthorised pharmacy.

After learning that a monitoring team from the Nepalgunj office of the DDA was coming, almost all pharmacists of Chainpur closed their establishments and went out of contact. The DDA team then decided to monitor other local units of the district.

But, wherever they went, the team could hardly find any pharmacy open. The team had visited Chhabis Pathibhera and Kedarsyu rural municipalities where almost all the pharmacists had gone out of contact.

“The team entered Ritu Polyclinic in Kedarsyu. It had some patients. All other units of the polyclinic were open but the pharmacy was closed. We urged the polyclinic administration to open the pharmacy but they said that they did not have keys and the operator was nowhere to be found,” said Satya Kumar Joshi, an assistant chief district officer of Bajhang who was with the DDA’s monitoring team.

The team called people’s representatives to prepare a deed on the site and seal the pharmacy. “But the representatives did not come even after we waited for seven hours,” said Joshi. The monitoring team returned after pasting a notice.

Some pharmacies in Bajhang have also been alleged of smuggling banned drugs. The DDA filed a case against Prabin Mandal, operator of New Chain Medical in Chainpur on January 21 on drug smuggling charges. Police arrested him in October, 2023 for selling tramadol, a banned medicine in Nepal. He was later released on bail.

Mandal, a permanent resident of Rudrapur in the Indian state of Uttarakhand, has been operating New Chain Medical for the past 10 years. He does not have any academic degree related to health.

Talking to the Post, Mandal admitted that he did not even pass grade 10. “I don’t have any health training. I learnt to administer vaccines and sell medicines in the process of working,” he said. However, in the chargesheet filed against him, Mandal claimed that although he had done a three-year medical course he was yet to get a certificate.

Local people complain that many youths started taking drugs as they are easily available in pharmacies of Chainpur and other villages in Bajhang. They blame poor market monitoring of the unauthorised pharmacies.

“Many pharmacies in Chainpur and other places are selling drugs openly. The number of drug users is rising due as illegal drug users and sellers are both spared,” said Birkha Bohara of Mashta village.

Impunity, according to stakeholders, is the leading cause of health crises triggered by unauthorised pharmacies and clinics. Ramlal Thapa, then aged 52 of Jayaprithvi Municipality-11, died in the course of treatment at Mandal’s pharmacy. Thapa, who had a common cold, had walked into Mandal’s medical shop. He collapsed after Mandal gave him an injection. He was rushed to the district hospital where he soon died.

Mandal escaped legal action as Thapa’s funeral rites were conducted without a post-mortem.

It is estimated that there are around 150 illegally operating pharmacies and clinics in Bajhang.

“Many patients, whose health condition worsens due to haphazard treatment at medical halls, are taken to the hospital at the last hour,” said Lal Bahadur Dhami, chief at the district health office. “We broadcast notices on the issue through FM radio. We have also alerted the district administration office, district coordination committee and chiefs of various public offices. But the problem continues to be ignored.”