Healthcare Challenges after the Earthquake

Nila Manandhar, MD

Photo Source: EPA

A month has passed since the massive April 25th earthquake in Nepal, and the Nepalese people still continue to experience several aftershocks. Despite the daunting adversities that lie ahead, many are eager to start rebuilding their homes and country.  As the Nepalese people move forward, they need to be aware of another type of natural disaster - one involving their health. Nepal has lost thousands of lives to the earthquake, but more lives could be lost with a health epidemic.  Many earthquake victims who have lost their homes have camped outside in crowded conditions which, coupled with the lack of clean water and sanitation, could be catalysts for the spread of a variety of diseases. This could be compounded by the upcoming monsoon season, which will bring with it a rich environment for disease carrying hosts. Past earthquake in various parts of the world have taught lessons that need not be repeated.

Preventing & Treating Cholera After the Earthquakes in Nepal

Post by Gina Gabelia 

A cholera outbreak, which spreads rampantly through infected water sources, is a real threat post two major earthquakes, which significantly damaged Water, Sanitation, and Hygiene (WASH) systems and displaced tens of thousands of people, forcing them to live in congested, poorly constructed areas with limited access to potable water and sanitation.  These dismal risk factors are compounded by the imminent monsoon season.  Soap, bottled water, water purification tablets, and oral rehydration tablets alongside cholera messaging need to be widely distributed to all communities to prevent outbreaks. 

OVERVIEW:

Cholera is an acute enteric infection caused by the ingestion of the bacterium vibrio cholerae, which is present in fecally contaminated water or food (4).  Cholera spreads when vibrio cholerae from infected persons' feces spreads to potable water or food (6).  Cholera is linked to poor access to clean water and proper sanitation and its incidence is pronounced when basic WASH systems have been damaged or destroyed (4). 

Nepal Specific Considerations:

Cholera is endemic to Nepal; the first case was recorded in 1823 (1).  The majority of reported cases occur during the monsoon when flash floods and landslides can destroy WASH systems (1).  Rural and urban areas are susceptible to cholera.  The most recent outbreaks occurred in Rautahat in 2014; the deadliest outbreaks occurred in 2009 in Jajarkot, which affected 30,000 people (1).

Before the earthquakes, roughly 37% of the population had access to latrines, making open defecation common practice; if latrines are unavailable, please refer to the guidance below for cholera prevention practices.  Nepali people eat with their hands and in this environment, it is more important than ever to wash hands thoroughly with soap before and after eating, preparing food, using latrines, etc.  If soap is not available, scrub hands with sand or ash and safe water.  The search for survivors is ongoing, and decomposing bodies contaminate water sources.  Therefore it is crucial to ensure water sources have not been compromised – if you are not sure, it is better to be safe than sorry, and purify water before consumption.  Remote, isolated communities need to be especially vigilant in protecting water sources; if those have been compromised, take measures to prevent disease contraction by following guidelines listed below, and purify water before consumption.   

The Invisible Aftershocks of Earthquakes: Trauma [भुइँचालोको अदृश्य धक्का - मानसिक तनाब ]

( नेपालीमा पढ्न तल जानुहोस् )

Guest Post by Gina Gabelia

Nepal is reeling from not one, but two devastating earthquakes, and countless aftershocks, that hit the fragile nation within three weeks.  Recovery efforts which were well underway to clear rubble, provide temporary shelter, medical care, and rebuild homes, schools, hospitals, and cultural relics after the first quake hit on April 25 have reverted to emergency relief efforts to manage the damage and destruction caused by the May 12 quake.  While domestic and international teams search for survivors, mobilize and align efforts and resources to provide emergency medical care and deliver food, water, tents, clothing, tools, etc., another important consideration is psychological care.  Natural disasters, and earthquakes in particular, can cause concrete psychological distress to affected populations because they occur without warning and do not have a definite endpoint as after-shocks continue for days, and even months after the initial quake (1).  The unpredictability of earthquakes and the duration of aftershocks, in addition to continuous physical reminders of the actual quake and ensuing destruction, enhance feelings of uncontrollability, which contribute to psychological distress and trauma (1).

The Forgotten Care

OP-ED

By Sadikshya Nepal

When CNN broke the news about Dr. Sanjay Gupta performing brain surgery on fifteen-year-old Sandhya Chalisa, the thought that came immediately to mind was praise for the doctor who saved the young girl's life. However, the conversation of Chalisa’s extent of illness and her long journey of rehabilitation is not discussed. In a disaster situation, years of rehabilitation are something no one thinks about. However, for the patients in these stories, survival is just the beginning of a lifelong rehabilitative battle.

Nepal is coping with its worst disaster in over eighty years and our hospitals are clearly overwhelmed. For doctors, saving as many lives as possible is the most important matter. Due to the number of patients flooding in, doctors might not have time to provide thorough care. Dr. Rajendra Koju, a cardiologist at Dhulikhel hospital, echoed that sentiment in a recently released New York Times video. He stated that, “We are not doing everything very correctly because this is a disaster. Everybody wants to do best but some limitations are there and sometimes they are not wearing the gloves properly, or even asking the patient their names on the spot. But saving a life in a disaster, it might happen.”This scenario is not new or unique to our country alone. Hansa Dave of the general hospital at Bhuj noted, one-year after the 2001 Gujarat earthquake in India, that “At the early stages, lots of operations took place without sterilization of instruments. Hospitals had been completely destroyed. There were no operating theatres, no structures. … Now, we see the effects. Many patients are coming in with malunion of bones.” In countries that are coping with catastrophes, sound medical care is rarely practiced and survivors often become lifetime victims of unintentional medical neglect. For most patients severely affected by the different effects of the earthquake, long-term medical rehabilitative support is as essential a part of recovery as saving their lives.