on May 5th, 2015 No Comments
Paul Auerbach recently traveled to Nepal to aid victims of the April 25 earthquake; he wrote this post over the weekend.
I’m on my way back to the U.S. now and getting information from people who are still in Nepal. Because I’m inundated with requests to provide information from people who have read my previous posts, I’ll keep writing, but only if there’s something useful to report. Please let me emphasize that this is no longer firsthand, but rather, based on communications from persons in Nepal whom I very much trust. They are working really hard, so it is “above and beyond” (and very much appreciated) that they find time to keep us all informed.
Surrounding Kathmandu and seen from the air, there are many remote villages that have been devastated, with all or nearly all dwellings demolished by the earthquake. These buildings had mostly been constructed of bricks mortared with mud. They crumbled during the shaking and may have been struck by rock slides. Anyone caught within the buildings could have been mortally wounded or severely injured.
Many villages are situated one or more days’ walk from the nearest vehicle (4-wheel drive truck or SUV)-accessible roadway, so rapid access will need to be by helicopter if there is a suitable landing site or the ability to carry out long-line rescues (this requires the appropriate equipment and operators with technical expertise, both on the ground and in the helicopter). Helicopters are in short supply relative to the need, so that is a rate-limiting part of the operation. The helicopters will be needed both to get teams in and to get patients out. The first step will be to provide on-site triage in order to prioritize where to deploy medical and other resources. Patients will be assessed in order to determine whom to transport and in what order. Treatment will be initiated when possible. The possibility of trekking into villages will be dictated by the condition of the paths normally used for foot travel. The paths are often narrow, rocky, and steep. It is likely that there have been rock-and-dirt slides that will render traversing some of these paths extremely difficult or impossible. If the paths are passable, that may be how some of these villages will eventually be reached, and people and supplies delivered. The delays will be overcome by cooperation and perseverance.
Medical teams from around the globe have come into Kathmandu and are assisting or prepared to assist. They will be responsive to the Nepal government, global-health agencies such as the World Health Organization, and non-governmental organizations such as International Medical Corps. The search and rescue (SAR) component intended to find victims trapped in rubble will expect from this point forward to find only a few miraculous survivors of the initial event, so the role of SAR to extricate buried people will diminish. From this point forward, it will be about getting to the injured and sustaining them until they can be extracted to a higher level of medical care, if this is what they need. Reaching all the affected villages and injured persons may take weeks. To assist displaced (e.g., no longer have a home) persons, there is need to provide food, sheltering materials, and water disinfection supplies.
The public-health mission, in particular trying to prevent the spread of potentially epidemic infectious disease (particularly diarrheal disease) is hugely important. This is essential now and particularly as the monsoon season approaches. This includes human-waste management, providing safe drinking water, possibly providing immunizations, and surveillance that promotes early detection of disease.