When the earth shook: a view from Patan Hospital in Kathmandu
On 25 April 2015 a 7.8 magnitude earthquake shook Nepal. Centered in the village of Barpak in the Gorkha district of the country, it is the most powerful quake to hit the country since 1934. So far it is estimated that over 7000 people have died, with hundreds of thousands more made homeless. Buddha Basnyat is the Director of the Oxford University Clinical Research Unit in Nepal, which is supported by the Wellcome Trust. Here, he tells us about his experience of the earthquake and the on-going effort to help people affected…
When the first tremor shook Kathmandu at midday, Saturday April 25, I was working at my desk peer reviewing an article about high altitude medicine. I thought this was a mild quake, another one of those earthquakes not uncommon in Kathmandu. It was only when I was going down the stairs (absolutely the wrong thing to do) and swaying like a drunk, I realized this was no ordinary quake (7.8 magnitude) and I could die sandwiched in my own concrete staircase. I flung the house door open and ran to the gate and prayed like a man possessed.
Most of the Nepalis that survived the quake experienced this immediate feeling of desperation. We had aftershocks that day, but when the second strong aftershock (6.8 magnitude) hit the next day, it felt like we were in the relentless grasp of a demon. It was only a few days later when we had our wits (or at least some) about us we realized that in all likelihood we would not have another major quake so soon in the Himalayas. The strength of the aftershocks would keep on decaying and level off.
At Patan Hospital, where there are 450 beds, and where the Oxford University Clinical Research Unit (OUCRU-Nepal) is based, the many disaster/earthquake drills and the retrofitting of the hospital building that had been patiently carried out by the hospital authorities over time paid rich dividends. In general the hospital building has withstood the quake – unlike many other hospitals in the valley.
In the immediate aftermath of the earthquake hundreds of patients with severe orthopedic injuries including many open fractures flocked to Patan Hospital from all over the country. Many were helicoptered in from remote villages. Dr Nabees Man Singh Pradhan and his team of orthopedic surgeons started operating on these patients almost non-stop using the many locally available implants, external stabilizers and other forms of orthotics. Clearly these surgical procedures, which were carried out promptly by these Nepali doctors at Patan Hospital, will be one of the most unforgettable things the hospital has done since it opened its door as Shanta Bhawan Hospital in 1956.
Dr Guy Thwaites who is the head of the OUCRU-Vietnam, with whom OUCRU-Nepal has been closely aligned for about 12 years, phoned me immediately after the quake to check on the safety of the staff. I was glad to report to him later that our OUCRU staff had escaped unscathed except for severe damage to property for three of us. Dr Jeremy Farrar, who Dr Thwaites replaced, also promptly checked on our safety. In fact post- earthquake Nepal has received a phenomenal amount of goodwill and help.
Immediately after the quake Dr Amit Arjyal and Mr Rajendra from OUCRU-Nepal, together with doctors from Patan Hopsital went to some of the worst hit districts, Sindhupalchok and Nuwakot. There, they distributed food, tents and medicines with money they had raised. They brought back many images including those of water shortages and children drinking water from a dirty pool.
Our work at the Patan Academy of Health Sciences (PAHS, which governs Patan Hospital) will soon focus on the imminent monsoon season and the subsequent onslaught of infectious diseases, which may possibly be made worse by poor sanitary conditions triggered by the earthquake.
OUCRU-Nepal, working closely with PAHS and OUCRU-Vietnam, are considering setting up targeted, rapid (non-culture based) surveillance for enteric infections in the Patan area and in various settlement camps around the city. This would provide real-time data for clinical management and may also help inform vaccination programme responses against infectious diseases like cholera, typhoid and hepatitis E.
All these programmes would be run in collaboration with the Nepal Health Research Council, the government body responsible for coordinating the healthcare response to the earthquake. We would also work closely with the Nepal Public Health Foundation, including working to help people outside the valley in remote areas of Nepal.
Clearly the unfolding saga of this great earthquake (“maha bhukampa” in Nepali), will have a multitude of surprises for us, perhaps beyond our imagination right now. But at the time of writing this it is heart-warming to see the Nepali people come together with almost palpable optimism. It is as though from this very tragic event, there will be a re-birth and reinvigoration of the nation which will enable people to deal with this tragedy and move, if I may dare say, confidently ahead.
Buddha Basnyat is the Director of the Oxford University Clinical Research Unit in Nepal and President of the International Society of Mountain Medicine. If you would like to find out more about OUCRU-Nepal, please visit their website.