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This is the story of a doctors experience in the worst case disaster situation. In here I will try to narrate the story of what happened, the stories of unsung bravery and courage staffs at Jiri Hospital displayed during and after the disaster. In the latter part I will try to cover the transition from tents to indoors.
A rural doctors tale on earthquake experience.
We had just finished examining new cases on that day, May 12th, and were following up with investigation results in our patient examination room when the earth beneath us began to beat the drums. Our team and patients along aware of the unique nature violent shakes from April 25th massive quake, which came along with noise of massive drums being beaten deep underneath, were aware of what was about to happen next so soon cleared the room and were running in all directions. The only word anyone uttered and thought of was “ayo ayo, bhuichalo ayo, bhaga bhaga” ( Earthquake, earthquake, run, run).
It took some time for me to gather my consciousness, some time to mentally assemble my next step based on my knowledge of things to do and not to do In cases of earthquakes. I remembered running in cases of earthquakes is a big no rather find a table, a bed, a door frame and save your head.
However, I was sitting on a chair, had my arms on a table and a bed just a few steps away. But no this time it was big, the shakes were violent enough to make me realize that my walls won’t be able to with stand it any further. I had to run, flee for a safe ground.
As I stepped outdoors, clouds of dust was rising from all directions and my hospital staffs, patients were running in all possible directions searching for an open ground. It was the busiest moment of the day for our nursing staffs and indoors, so I tried to run towards the indoor block. When suddenly one of our laboratory staff who was panic-stricken and so shaken from the quakes emerged out from the lab and collided with me that she fell flat on the ground. She was totally blank and wasn’t able to respond. I helped her up and had to take care to the open ground, where I saw almost all the patients and staffs were already there.
Up in the nearby town all we could see was clouds of dust and smoke. We could hear loud thuds of houses turning into piles of stone and woods. I felt that in any moment flocks of injured will be rushed into the hospital and we should be ready to receive them. But our story was no better.
Our store, our inpatient ward building all were like ticking time bombs ready to drop flat with big piles of rocks.
All the hospital staffs were panic-stricken. Everyone was trying to make futile contacts with their families; with telephone networks long gone, local staffs had already rushed to locate their families.
I tried to gather all the possible staffs around. Everyone was shaken; scared, with turmoil of thought processes in head, it was a situation where your senses and brain decide to give up on you, there was a unique combination of fear, confusion, anxiety and emotions. I had to shout at the top of my lungs to gather their attention. I grabbed each of the shaky ones, consoled them that this was our moment. It is us now who should be brave and be prepared for the worst case scenario.
Then we decided to use our badminton court as emergency arena, while the bigger challenge lied in gathering our medical and emergency supplies from piles of stones, earth beneath us still shaking. Time was of essence so I made a call that all the men will rush inside the building one by one, grab the first thing they can see and walk out as soon as possible. Surprisingly the ladies staff took part in this drill as much as the men did, if not more.
So in no time, we were all able to set up our emergency triage center, gather adequate medical supplies, be prepared for the emergency management of all cases about to come within few minutes of the disaster.
With the harsh monsoons knocking at our front door, all we lack is the pleasure of time! We have gathered all the resources possible and have started rebuilding!
Our target for now is to shift all the patients, outpatient clinics and the quarters indoors within one month.
Our first priority was to provide safe and clean drinking water to all our patients, staffs and the public, hence we have setup an electrical water purification plant near our tents.
Open to all patients, visitors, staffs and the public.
Strange but true, number of regular surgical cases increased drastically after the quake. It was a very difficult time for us, more for the new mothers. a very strange world indeed to welcome our new borns. We had to conduct 7 C-sections within a period of one month since the first quake in April; 20 deliveries. Five of the deliveries were conducted in the open since the patient and the family didn’t approve of going indoors.
Jiri Hospital was established in the year 1957 AD (2014 BS) with the support of Swiss Government as a part of holistic support to the people of Dolakha along with a technical school, now know as Jiri Technical School and Animal Development Farm, in Jiri. It was later handed over to the government of Nepal in the year 1972 AD (2029 BS). Under the model of Public Private Partnership (PPP) government handed it to the community in the year 2064 BS.
This hospital still runs under the PPP model and is operated by an operational committee compromising of 17 members from different public related sectors, and is among total of only 4 different institutions running in the same model throughout the country.
Jiri Hospital currently as 15 beds sanctioned by the government, however more than 30 beds are available to the patients to address the increasing inflow. Its services range from Outpatient department open on week days, Inpatient, 24 hours emergency services, Dental services, fully functional operation theater, Pharmacy services, Maternity and Child health care programs, Ambulance services. It also conducts all the preventive, promotive health programs as per guidelines of government of Nepal, Ministry of Population and Health. In addition to this, the hospital has been conducting regular health camps both in the hospital and in its different catchment areas to address varying health needs.
A successful example of Public Private Partnership can be observed in the hospital. This model has been able to build a strong sense of ownership in people of this area. The operational committee has been addressing immediate and has been planning for all the long term issues to come. The operational committee is created under inclusive ideology hence it is highly representative of the population here further strengthening the sense of ownership.
This institution serves as the referral center for all PHCs, Health Posts and Sub health posts of this region. It primarily receives patients from Dolakha, Ramechap, Solukhumbu and Okhaldhunga regions. Daily about 100 patients receive treatment in the Out patient department. This hospital also provides in patient services, Comprehensive Emergency Obstetric Care (CEOC), minor and major surgical procedures, Dental services, 24 hours emergency care.Regular health camps are also being organized as a part of the medical facility. This hospital conducts monthly outreach health camps to the inaccessible people at their doorsteps while more specialized health camps are being conducted in the hospital.
My experiments with health camps:
I had only one mission when I entered Jiri Hospital to increase the patient flow. On my way to Jiri, one socially active Jirel started giving me of what I was to expect next. All the people did was compare the hearsay of Jiri Hospital when the hospital operated under Swiss management. What they do not understand is why would our nation be in this chaos if we were Swiss?
Bringing the hospital service to the standards which was 40 years ago, seemed to be a very high set benchmark. Inspite, afte spending few days in the hospital, talking to few made me realize there is another important if not bigger issue needed to be tackled, ie hospital management.
The hospital seemed to be highly understaffed, staffs present also spend most of their time at their homes, weeks and weeks of absentese. There were few who had been lost from the office, still employed however for years. My skills as a leader was in doubt, I questioned my self as I was very naive to the Neapli health system, running a district hospital with more than 30 employee was a holy grail chase to me.