Nepal is a country with no rehabilitation physicians, and one 25-bed spinal injuries centre, so when the Kathmandu Valley was devastated by an earthquake and the subsequent aftershocks, an elite team from Melbourne went into action
AT 12.30 pm on 13 May this year, Professor Fary Khan, director of rehabilitation medicine at Royal Melbourne Hospital (RMH), was completing her ward rounds in the small spinal injuries centre 15 km outside the Kathmandu Valley in Nepal.
Professor Khan and the rest of the seven-person Foreign Medical Team she led had been in Nepal for 5 days, and were caring for 89 patients with severe spinal injuries, most of whom were 1 or 2 days out of surgery, and still in spinal shock.
Just as Professor Khan finished her rounds, a second earthquake struck, this one registering 7.3 on the Richter scale.
The first, on 25 April, had hit 7.8 on the scale, killed almost 9000 people, and injured what was conservatively estimated at 76 000 others. Over 200 villages had been flattened, and Kathmandu had been devastated.
No wonder then, that when the second quake struck, the patients in Professor Khan’s care were terrified.
“It was absolute mayhem”, Professor Khan tells the MJA.
“It was a massive jolt, like nothing I’ve ever experienced before. The walls were cracking. Anybody who could began crawling out of the building. Relatives who could lift the patients were carrying them and people were running out of the building screaming.”
Professor Khan and her team didn’t run. They tried to calm their patients and together began carrying out their patients — as many as 13 had injuries classified as American Spinal Injury Association (ASIA) A (complete) — by any means possible.
“Two of my team went back in repeatedly to bring patients out”, Professor Khan says. They have been nominated for bravery awards, she adds.
Because the Nepalese Government were unable to clear the building for use, the patients were treated on the ground, under tarpaulins, in monsoon conditions for 2 days and nights.
Eighteen of the most seriously injured patients developed pressure sores which was “particularly hard”.
“We were having to debride their wounds without anaesthesia”, Professor Khan says. “We had no sterile equipment — none of the things we take for granted in Australian hospitals.”
It was, she says, a terrifying experience that didn’t really hit home until they returned to Melbourne.
“In the middle of it, you’re too busy, there’s not time to think”, she says. “To be honest we didn’t know if we were going to get out alive.”
Communications were down after the second quake and there was no way of contacting family or the RMH.
“When the second earthquake hit, it was heartbreaking to see the looks of absolute desolation on the patients’ faces.”
She and her team had daily debriefings and her teammates were “brilliantly open with how they felt”, and they have been heavily supported by staff at the RMH since their return.
But there are ongoing effects, and not just for the team members.
“Nepal has no rehabilitation physicians at all”, Professor Khan says.
“They have only one 4th-year trainee who was studying in Bangladesh. He was seconded back by the Nepalese Government but he had never seen a spinal injury before, so you can imagine that when we arrived he was delighted.”
Consequently, the RMH has agreed to bring the young trainee to Australia to complete his training. Additionally, as he is a polio survivor himself, the hospital has given him an electric mobility scooter which has been shipped to him.
With severe spinal injuries, missing family, no home, and no rehabilitation facilities, the prospects for many of the 140-odd patients Professor Khan and her team treated are grim.
Apart from sponsoring the Nepalese trainee, Professor Khan has arranged for herself and her Canadian and American colleagues to be available on Skype for Nepalese rehabilitation staff to consult with after hours.
“It’s not ideal, but they can at least get an idea”, she says.
Additionally, the Nepalese have been encouraged to form their own society of rehabilitation staff so they can tap into international resources and gain global recognition.
Professor Khan is a veteran of foreign emergency work, but is it a career path she would recommend to others?
“Yes I would”, she says, “but it’s not for everyone.
“If you feel you have something special to offer, then by all means, but do it in an organised manner. Don’t just rock up.”
It’s a problem which has plagued many an emergency response. Good intentions don’t necessarily make up for the added burden of finding accommodation and food for volunteers in a system already stretched to breaking point.
Professor Khan cites 400 amputations which were performed in Haiti unnecessarily by unregistered surgical teams.
“Here, in Nepal, it’s been found that there was an unregistered team dressing wounds in one of the villages, and every wound has since become infected”, she says. “The government was a bit miffed.”
Leading an official Foreign Medical Team involves huge amounts of paperwork and red tape, but the necessity of having an exit plan is perhaps the best consequence.
“We wanted to stay, very much”, Professor Khan says. “But we also wanted to come home. We’re so lucky here in Australia. It’s safe and wonderful.”
In the wake of the Nepal disaster, the World Health Organization has estimated that one in three injured Nepalese will need rehabilitation, and around 12% of those have sustained damage to the spinal cord.
“Nepal neither has the human resources nor medical facilities to deal with the needs of those suffering spinal injuries”, the WHO reports.
“The number one need now is spinal cord rehabilitation — human and medical resources related to that are the most important because we do not have those kinds of resources”, Dr Ganesh Gurung, who is coordinating operations in Nepal, said.
Professor Khan believes the final numbers may be even scarier.
“The [estimate of the] number of injured is completely arbitrary, of course”, she says. “So many villages were flattened and the Nepalese Army hasn’t been able to reach many of them. They are bound to find more.”
It may have been only 8 days, but for Professor Khan and her team, their time in Nepal was life-changing.
“It’s very hard to describe”, she says. “You keep it together, focus on the job ahead. There’s no time to think, and you go on autopilot.
“It was a real challenge, and traumatic.”
But the certificate of appreciation the RMH team received from the Nepalese Government before they left made it worthwhile, she says.
“I’m very proud of the team and the work we did.”
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