Stories From the Field:

NEPAL

Disaster Response in Nepal

On April 25, 2015, a devastating 7.8- magnitude earthquake struck Nepal- the country’s worst in over 80 years. The death toll exceeded 8,000, 16,000 were injured and thousands more were left stranded. Only days after the calamity, the Massachusetts General Hospital sent two teams to aid the people of Nepal. The first team, supporting the International Medical Corps was led by Miriam Aschkenasy,MD, deputy director, Global Disaster Response at the MGH Center for Global Health, and included Bijay Acharya, MD, Grace Deveney, RN, AnneKathryn Goodman, MD, Kevin Murphy, RN, Jacquelyn Nally, RN, Sheila Preece, NP, and Laxmi Kasti,R.N.. The second team, working with Project HOPE, was led by Paul Biddinger, MD, chief of MGH’s Division of Emergency Preparedness, and included Hasmukh Patel, a lab technologist, Russell Demailly, RN, Lindsey Martin, NP, Nicholas Merry, RN, and Monica Stapes, RN. MGH physicians – Renee Salas, MD, and Lara Phillips, MD, both fellows in the MGH Wilderness Medicine Fellowship in the Department of Emergency Medicine – were working in Nepal at the time of the earthquake and later joined the IMC team.

The work ethic and spirit of the Global Disaster Response teams reflect the best of Mass General. As Dr. Aschkenasy summarizes from her reflection below “Yes, we're clinicians, and nurses, and doctors, and nurse practitioners, but if we need to move debris that's what we're going to do, and if we need to give medical care that's what we're going to do. We're going to really reach out and help the people of Nepal as best as we can.” Remarkably, the two teams from Mass General represented nearly 10% of the total U.S. personnel in Nepal. The need for disaster relief professionals can arise at anytime, so donate today to help Mass General answer the call for help in their global neighborhood. Learn more about Global Disaster Response’s mission and leadership on our website.

It’s 4 am. Another restless night, it is hard to sleep when you are constantly worrying about the ground shaking, another aftershock or earthquake. Your shoes and “go bag” sit by the slightly open door to your room. It’s warm and the electricity is out again, so no fan. You think about the next day. You make the mental check list: pharmacy and wound care boxes packed, food and water ready, enough translators for the team, still waiting for the chopper schedule. But, no matter what, the team is ready to go at anytime.

There is a routine: eat breakfast, usually an egg sandwich and curried potatoes, load into the cars by chopper schedule and wait.  The local logistician, translator, and I always go on the first helicopter run to make introductions and scope out the site for clinic and camp, find or figure out where to build the latrine, and evaluate the safety and security situation. After 2 or 3 more helicopter runs, the whole team arrives with all the gear. Depending on the time of day, we set up clinic or camp.

This day, in Dharke, we start with clinic. In this village of 5,000 people almost every single structure is destroyed. The only place for both clinic and camp is a small outcropping that we have to share with the Nepali Army. A small, square concrete meeting area will serve as clinic and we have to be mindful that both the clinic and camp are right over a major thoroughfare – a well-used walking path from the lower part of the village to the upper part.

We saw 114 patients that first afternoon. There is a lot of wound care to be done. Several of the wounds have been treated with a local remedy – as far as we can tell it is goat dung mixed with herbs and plants. It works remarkably well to keep the wounds clean, but can be difficult to remove for a proper exam. On the second day, several people arrive with earthquake-related fractures– one woman with both a wrist and foot fracture left untreated for nearly 3 weeks. Another woman has a lower leg fracture making it impossible to walk, a harrowing thought in this part of the world where strenuous walking is a required part of survival. A plan is made to evacuate them on the final helicopter ride the next day with their companions if there is enough room. The injured limbs are splinted and arrangements are made to transfer them to Katmandu for orthopedic care. Because their injuries are earthquake-related the government of Nepal pays for their care but the patients will be responsible for their travel home when the time comes.

Late in the afternoon we take down clinic, put away the pharmaceuticals and wound care supplies, and close the registration log book. It begins to rain as we set up camp. Our translators treat us to a dinner made of rice, soy, tomatoes, and a lentil broth and we go to bed. I barely make it to 9 pm every night. In the morning, we will turn the tents back into a clinic.

The next day, two more patients arrive that need evacuation. The first, a young girl with a burn, is starting to lose the function at her elbow joint and needs surgery. This is not an earthquake victim so her family will need to pay for her care. We begin discussing: can they pay?  Who will travel with her? How will they manage in Katmandu? In the end the girl and her father have spots in the helicopter. Earlier, I had to deny transport to a terminal cancer patient who wanted to go to Katmandu for treatment. We treated his pain with medication, but regardless of any action we took, his ability to withstand the flight was questionable. After consulting with the team member that primarily took care of this patient when he arrived to us, we agreed he was not a good choice for transport and would not take priority over the patients with fractures. Though it was a hard decision for everyone involved, it was the right and necessary one. We had to make tough decisions every time we decided to evacuate patients because the helicopter could only fit a small number of people.

After the little girl with the burn arrived we convinced one of the companions to care for both fracture patients so we could transport the younger girl sitting on her father’s lap. After much negotiation, the patient with the wrist fracture reluctantly agreed to go out without her designated companion to make room for the little girl. Luckily, in the end, the pilot allowed for the extra passenger because of their small size and all 6 went to Katmandu. We lined up on cornfield serving as the helicopter-landing pad with gear separated out by which helicopter run you were on, now in reverse order with the exception of the last helicopter, which would take our patients to Katmandu.  When we return, the routine starts all over again: Pack the boxes, buy the food and water, and find out the team composition and the helicopter schedule. In order to prepare for the next day, we try to get a good night of sleep. The ground shakes again.