Visit to CDC and EBOLA display: A twenty-first century Global Health Marvel. Tribute to the health workers and the true citizens.

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The Story of CDC

  • First established in 1946 under the name of Communicable Disease Center by the Public Health Service, USA.
  • Was stationed in Atlanta in the first place because of its limitation to communicable diseases then and higher concentration of malaria in the South.
  • Now expanded to include all infectious diseases, occupational health, toxic chemicals, injury, chronic diseases, health statistics and birth defects.
  • Reports to the Department of Health and Human Services and works in collaboration with other public health partners.
  • Though the initials CDC has remained constant over time, the meaning has expanded over time to:

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  1. Communicable Disease Center

  2. Center for Disease Control

  3. Centers for Disease Control

  4. Centers for Disease Control and Prevention ( at present)

 

 

CDC today leads the Global fight against known, new and emerging diseases around the globe with expanding preventive efforts to reduce the global burden of preventable and chronic diseases. As frequent as the expansion of their name has evolved, CDC has come a long way creating their legacy all on the way. Anywhere around the globe, when the issue of health and safety is of concern, CDC has been a center for hope, a beam of trust, an architect of research break-through and novel treatment modalities.

Through the relentless effort of our organizers from Georgia State University in Fulbright seminar we were able to schedule a tour inside one of the heavily guarded office buildings I have ever been to. The level of sophistication of their work, subtlety, numerous bio safety level 4 (BSL4) labs and with volume of pathogenic specimens dealt every day, I firmly believe those security requirements was a just.

 

David J. Sencer CDC Museum

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First step of our tour was through the David Sencer museum. After a round of security authorization we were greeted at the main lobby by chairs of the museum. The lobby on the left, opened into a simulative third generation auditorium with large billboard sized screens hanging on from the ceiling flashing up their graphic retina display of health messages and information on CDC.

If I am not mistaken, the messages and people showing up on those televisions appeared to be communicating with you personally. At least for me they appeared to have their gazes fixed at me, upheld full eye contact throughout the time. While I pretended to be attentive to the debriefing, I kept on peeking through the corner of my eyes, it was surprising for a few seconds and then started to grow creepy later on- People on the screens, follow you directly and try to talk to you on washing hands!

 

EBOLA display

Upon entering the museum, on the second floor right next to the lobby, to welcome us was the recently setup temporary Ebola gallery. For a budding public health scholar, which I like to refer myself, it was the highlight of the whole tour.

Back in the year 2014, the Ebola outbreak in Western African nations of Guinea, Liberia and Sierra Leone took the whole world by a major surprise. Until then Ebola was a disease only known for its academic interest. Speculated to have originated by consumption of infected bat easy spread, rapid disease progression, potential fatal outcome, and remoteness of the outbreak setting made it an overnight global threat.

 

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“The citizens of Guinea, Liberia and Sierra Leone- with so much to gain and so much to lose- were the true first responders to the epidemic. Time and time again, they took responsibility for their destinies.”

 

 

 

 

 

 

Citizen- Driven Response

The propensity of EBOLA to grow into a global pandemic became very clear in a matter of days which demanded vigorous measures not only in terms of clinical care but public health efforts, which could not have been anywhere near successful without dedicated community participation.

From Cellphones to Megaphones to Motorcycles: Tools to Engage Citizens

Often at times of emergency, communication is the first line of defense. Communities need to understand the situation and communication is the only means of bridging the gap between science and public.

Social mobilizers used every tool at their disposal in spreading awareness about Ebola. The communication toolbox compromised of all forms of written and audio/visual media, Short Message Service (SMS), traditional use of mikes and megaphones at the town centers, even town criers, arts and drawings on walls at public places, spreading message through school children, volunteers, health workers.

The unprecedented use of awareness spread campaigns and social mobilization was the key for EBOLA control. Community engagement was recognized as the detrimental tool very early and hence all NGO staffs, community members, volunteers, students were encouraging members of the community for their active participation. Their involvement resulted in developing strategic dialogues, large coordinated campaigns and above all the much-needed community ownership and participation.

Some communication strategies

U-Report

  • A novel form of text-based communication platform that allowed individual subscribers to ask questions, get real time answers and share information.
  • Developed and funded by UNICEF and used in Liberia.

Social Mobilization Action Consortium (SMAC)

  • Implemented in Sierra Leone to intensify village-level effort by sending out community mobilizers in villages with critical life-saving and behavioral change messages.
  • A joint action committee between GOAL, Focus 1000, BBC Media Action, Restless Development and CDC serving as a technical consultant.
  • More than 2000 community members mobilized and 70 % of Sierra-Leone community reached.

Sacrifices in the line of duty

Health care workers directly involved in patient handling and care are always susceptible to the infectious diseases. Even before the disease diagnosis, establishment of preventive protocols many health care workers were already infected with the disease. Out of documented total 881 doctors, nurses and midwives infected 513 lost their lives to EBOLA.

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The fragile public health system of these nations weakened by years of war, political unrest and poverty suffered the greatest setback from this outbreak. Liberia and Sierra Leone lost 8 and 7 percent of their total health care workers, including doctors and nurses to EBOLA respectively, with an attributable 23% of decrease in health care service in Sierra Leone alone.

A global health marvel

The gallery housed display of boots, gears, masks, safety robes including the white boards used for tracking cases. Maintaining counts of sick, dead and contact tracing is essential for out-break control. There I saw back of folders with actual hand drawn diagrams and calculations used for record keeping.

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The EBOLA display was a real-life demonstration of how different nations and agencies can come to a common ground of understanding. It also displayed on how epidemiological tools can be meticulously formatted to prevent an inevitable catastrophe to the mankind. It left me with the deeper understanding of my chosen field of interest and above all, an honor to the real soldiers, citizens of West Africa- with so much to gain and so much to lose- the true first responders!

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“Japanese wife and American Life” Taking them with a pinch of a salt!

I landed in Seattle to begin my Fulbright Journey, in September 2017.  I was accepted for Global Health program at the UoW, pronounced as U-dub, for some reasons I am yet to comprehend.

 

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This country has never failed to amaze me every day. Now and then I have had my own versions of travel outside Nepal. I was and am an avid fan of Hollywood, FRIENDS used to be my favorite show on the TV, we tried to hum Guns n Roses in the neighborhood alley. But still, I was prepared for an unprecedented shock here. This is a post I have started to enlist my observations/ experiences that go beyond my “open mind”.

  1. United States is as heterogeneous as it can get.  On top of that I have started to believe Seattle is the most versatile city in the world (not necessarily proved by facts).  My first week in Seattle I had started to think I have never seen so many people of Indian and Chinese decent even during my stay in India and China.

2. Confusion with- “How are you?”

How are you for me is a polite question, the person asking me is concerned with how I am. Folks, this is strange, but here it is not a question, they might not be concerned with how you are, how your classes were progressing, nor how your family whereabouts. They are trying to be polite, get it!

And the reply- smile, nod and “How are you? “. Yes it is.

3. During classes: Take out your laptop, take notes on them – it is a difficult to digest normal.

Take out you lunches, start nibbling them it is not.

And wait, one class today crossed all the boundaries- Wine in the class! As a part of the potluck party, one of my fellow classmate decided to show up with wine. I took a glass,  just to blend (wink).

I so much remembered my Nepali teacher back in school. I was caught  “red handed ” for eating my favorite pastry in his class. I knew he was strict, would never dream of challenging his authority then, may be even today am equally scared with him, but my temptation for a bite, of the whipped cream on the top had over powered me.

Despite my highest level of discreteness, Bam! boy most of my worst childhood memories revolve around him, but this tops all!

4. So America is “the land of the free and the home of the brave.” So,  It has the best practice of democracy.  So, it has the best human rights. It teaches the world to respect to rights of women and rights of minority- So what is with the cheer leaders???

Have never got a chance to to visit one of the girls team playing in the field but I am wondering are there boy cheerleaders dancing, jumping and doing the crazy acrobatic skills in between the games?

It can be chilly and Seattle can be cold.  So if you make the beautiful girls, wear scanty clothes jump and dance around in the fields, may be you need to have the boys do the same. Just to be even! a simple democratic thought on equity. At least during the women games!

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5. Covering the cameras on the laptop

6. Latino paradox: recent Latino immigrants have better health outcomes than other US populations despite being in average poorer. However, the longer they live here, the worse they fare. This phenomenon is called the “Latino Paradox.:

2018 Fulbright Orientation Day 2 Around the word in 48 hours and Fight Inside you: A Cherokee story

 

Day 2 of the Fulbright 2018 program started with a talk on “Sustainable Development- Progress and Challenges”, goals by Dr. Jeffrey  P. Koplan, vice president for the Global Health program at the Emory University.

 

One take away, “ In today’s world, TRAVEL- is also a risk factor for diseases. “Your presence, (84 of us, from 54 different countries) is a testimony of shrinking world.” Mutually everyone is a risk factor to the other. “Time taken to go around the world in 1873, when the French writer Jules Verne, published his action adventure “Around the world in 80 days“ was actually 200 days and the population of the world was 1.5 billion.  Now it is definitely less than 48 hours and population is more than 7 billion.”

 

  • Fight Inside you: A Cherokee story

An old Cherokee is teaching his grandson about life:

“A fight is going on inside me,” he said to the boy.

”It is a terrible fight and it is between two wolves. One is evil–he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.”

He continued, “The other is good – he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you–and inside every other person, too.”

The grandson thought about it for a minute and then asked his grandfather: “Which wolf will win?”

The old Cherokee simply replied, “The one you feed.”

A life of an “American dream.” Day 1 2018, Fulbright Seminar

No one leaves home, unless home is the mouth of a shark.”

Warsan Shire- “Home”

Despite recent hurdles, America has remained a land of hope and dreams, a land of opportunities, a land of the free and the home of the brave.

Today on the stage of Clarkston Campus Library Hall, I witnessed five young souls – Shahed, Douna, Ali, Kpor and Ogbai – all forced out of their different home countries, proving their bests in the United States.

“Typical Students with Atypical Stories”, Dr. Mary Helen O’Conner, Assistant Professor at the University, began her session with the short documentary on the remarkable journey of these ‘typical’ students. The video was about the stories of their past, their adventures in search of a safe land away from the ‘shark’ and how they had made Clarkson their new home.

The auditorium echoed with Dr. O’ Conner’s resonant “teacher” voice – “less than a year ago, I had to use google translate to talk with her”, she exclaimed, ” today she is studying with a pharmacology major!”. Today, overcoming all odds of language and culture their enthusiasm and their gratefulness for the opportunity of education, is more than evident from their academic achievements.

“…and this is what Clarkston campus is all about.”

(http://www.dekalbsymphony.org/tag/georgia-perimeter-college)

Clarkston Campus (also known as Perimeter college) – Georgia State University is a faithful portrayal of the Clarkson city in the DeKalb County, Georgia. Known for its ethnic diversity – “the most diverse square mile in the United States of America” and “the Ellis Island of the South.”

Ali, 27 years old, from Somalia, with a straight GPA 4.0 is on the presidents list. When questioned on what he wants to do later in his life, he answers – “The first thing that children at my country witness is violence. We should stop that.” “I want to go back to my country and open a school.”  “Our culture always teaches us to give back – I want to repay to this (Clarkston) community for this opportunity of education and life, and I want to contribute to my people back home.”

Shahed, who was forced out with her family from Syria has a daunting tale of her own.  “Most of the health care providers have fled from Syria, and there is no one to take care of the sick”. “Because I survived, I got a chance of education”, she pauses- “I want to go back and help others in need.”

It was evident that, a degree of gloom is creeping from the scars of their past, memoirs of hatred they had witnessed, pain they had endured. When you hear Ali, you can’t believe that a few years ago, this boy couldn’t even speak English, “yes, we are refugees but please don’t ask us to forget our culture”.

“Integration and Assimilation can’t be aloof.”

On our first day of 2018 Fulbright Global Health Innovations Seminar, 86 Fulbrighters from 54 nations are witnessing you tell your story Ali. We are living James William Fulbright’s 1946 dream, I wish you my friend, a life of an “American dream.”

(http://thefederalist.com)

National Health Insurance Program in Nepal, a low-income country’s quest for Universal Health Coverage.

 

 

 

Introduction:

As a continuum of its quest towards Universal Health Coverage (UHC), Government of Nepal launched the National Health Insurance Program (NHIP) 2013, followed by the Social Health Security Development (SHSD) Committee 2015 as a legal framework for the implementation. The pilot phase of this insurance program was launched from 3 districts, now in the second phase 2016 – 17, has expanded over 25 districts and has a final nationwide target of 75 districts by year 2021. This program has seen many hitches already and the pathway to complete successful implementation of this program seems more daunting.

Background:

Nepal has made significant progresses in improving the health of its citizens in recent years, with remarkable achievements in women and children health, the country is on track to achieve the Millennium Development Goals, however the aim of UHC and even the sustainability of current achievements appears grim with the frail health financing system. Health expenditure in Nepal has compromised of only about 6% of the total national GDP, with a meagre $40 per-capita expenditure on health, almost half of which is covered by the international aids. The public are at risk of catastrophic health expenditureƗ with 55% out of pocket payment as compared to 48% in other low-income countries.[1],[2]

 

 

 

Ɨ Catastrophic health expenditure is defined as out-of-pocket spending for health care that exceeds a certain proportion of a household’s income with the consequence that households suffer the burden of disease and poverty. (WHO Bulletin, 2017)

 

Country/Group

Per capita health Expenditure (US$) Total Health expenditure in GDP Public share of total health expenditures % Out-of- pocket share of total health expenditures %
Nepal 38.96 6.43 44 55
Low Income 27 5 42 48
Low Mid Income 81 4 42 53
High Income 4,618 11 61 14

Source: World Bank, 2010.

Table1: Health Financing in Nepal (2010).

 

Government of Nepal has declared health as a fundamental right with every citizen’s access to free basic health services. The Nepal Health Sector Strategy(NHSS) 2015- 2020 also outlines the strategies towards UHC consisting of delivery of this right while minimizing the associated the financial hardship for which the insurance program.[3] This new insurance program is based on comprehensive social contributory scheme with government subsidies for the poor (Table 2) ensuring access to quality health service while reducing out of pocket payments.

The national health insurance scheme relies on prepaid pooling of funds with later entitlement to health care benefits, reduced vulnerability to the expenses of care at times of illness or injury (financial risk protection). The current scheme aims at risk and contribution pooling in three forms- from low to high risk, from rich to poor and from productive to non-productive age group. The modus operandi, non-refundable, non-transferable social contributory scheme with annual contribution from households of NPR 2,500 (US$1 ~ NPR 100) for household of up to 5 members and additional NPR 425 per person for additional members, with subsidies for certain exempt groups as shown in Table 2.

 

 

 

Categories Subsidy
Ultra-poor 100%
Poor 75%
Vulnerable groups 50%
FCHV 50%

FCHV- Female Community Health Volunteers

 

Table 2: NHIP subsidy scheme.

 

 

The benefit package consists of coverage of medical costs amounting NPR 50,000 for a family of 5 members with additional NPR 10,000 for an additional member with maximum NPR 100,000 ($ 1,000) per year, per family.

 

Challenges ahead:

25% of 30 million people of Nepal live below the poverty line and 15% of them live below $ 1.90 per day.[4] Acquisition of matching fund for the subsidized enrollment of this group of the population, will be a huge setback for the aim of pooled fund collection, stern on the already exhausted health economy. Yet another issue of concern is the limitation and efficacy of protection provided by the insurance benefits, health service equivalent to $500 -$ 1,000 for the entire family. This upper ceiling is negligible compared to actual costs of health-related expenditures incurred by an average Nepali family today where 14 – 35 % catastrophic health related expenditures occur annually.[5],[6]

This program will also face the challenge in bringing about balance between pre- existing disparities in human resource distribution, gaps across wealth quintiles and geographic location. Nepal has an overall chronic shortage in health human resources, doctors, nurses, midwives with their density less than 7 per 10,000 population.[7] The prevalence of health facility is also scarce with less than 5 hospital beds per 1,000 population and most of which are in the major cities.[8],[9] Only 68% of the population reside in areas within 30 minutes access to health institutes, with a significant urban (86%) and rural (60%) incongruity.[10] The resulting burden of this discrepancy is, as expected disproportionately felt by the poorest households who have the limited recourse to purchase quality services from private providers.

Years of poor service both in terms of availability and quality has resulted in a very high degree of mistrust among people towards public health institutes. Private health sector in Nepal is a huge industry which received 90.4% of total out-of- pocket expenditures, amounting $540 million in 2011.[11] These private sectors are based upon highly unregulated fee-for-service business model and triumph over the public sector both in terms of number and patient turnover.[12] Contextually, incorporation of these for-profit private medical sector in the scheme will pose an immense challenge if not even threaten its very own existence. A very cautious outline should be put forward by the government for their amalgamation, probably building upon issues of their social accountability and responsibility.

 

Facility Number Available beds
Public Hospitals 95 7,637
Private for-profit Hospitals 105 4,621
Medical Colleges 20 10,576
Mission Hospitals 8 612
Total 228 23,446

Source: MOHP 2010

Table 3. Comparison of number of hospitals and beds.

In addition, chronic and Non-Communicable Diseases (NCDs) have become a huge global health challenge. The requirements in today’s personalized medicine era therefore cannot be limited to and by the mere 70 drugs of the National List of Essential Drugs. Suitable recourse to consider the costlier and effective noble treatment modalities to address the chronic illnesses, NCDs must also be periodically made.

 

 

 

 

 

The Silver lining:

 

NHIP aims to generate and distribute the limited financial resources to maximum number of its citizens when a backdrop of globally estimated 100 million people are pushed into poverty annually because of their health-related expenses.[13] Establishment of the constitutional health rights, programs and high-level committee for this insurance program demonstrates the dedication, which has been key to successes of similar kind of programs in countries like Thailand and China.

 

Thailand is a remarkable example of strong dedication from the leadership in bringing about changes at very affordable costs. In a span of 10 years, by 2011 the UHC program was successfully expanded from less than one third coverage to over 98% of the 68 million population. Costs of their health scheme averages $80 per person, double to the existing $40 expenditure of Nepal. China on the other hand has the largest known expansion of insurance coverage in history. In the span of 5 years (2005 to 2011), the coverage expanded over a billion population from less than 50% to 95% citizens. Though, Nepal’s population is nowhere compared to China, however Nepal can pick up on the role of political and socio-economic backup, importance of public support, and commitment demonstrated from top leaders for such a gigantic maneuver. [14]

Nepal also needs to be meticulous on their financing strategies. The government needs to seek for options in increasing revenue, perhaps by appealing more international support or increasing tax rates. On a better approach, the government should also take steps towards the spill reduction by corruption control as in Indonesia, where the government took on policy for zero tolerance against corruption and were able to raise tax related revenue from 9.9% to 11% in just over four years.[15]  Much can be achieved in the arena of economic transparency in Nepal, where reports of Transparency International show stable corruption perception index of around 30 in the last decade, 0 being very corrupt and 100 very clean.[16]

Nepal also has different pre-existing free health benefits covering the major health issues of the country and will eventually come under the remit of this program. The government already provides free 70 essential drugs, basic laboratory services, maternal and neonatal health care at public health facilities. Ongoing public health programs for immunization, family planning, community-based integrated management of neonatal and childhood illness (CB-IMNCI), essential therapeutics for Tuberculosis, Malaria, Kala-azar, Leprosy, HIV prevention and treatment program are being distributed free of cost.

Lastly, Nepal needs to set up a clear realistic idea, aim for practically achievable targets. The program in China, for instance where the annual premium is only around $20, almost equal to $25 of Nepal, the coverage in return is merely sufficient and hence the benefits of which are often questioned. [17]

 

 

Conclusion:

 

Successful implementation of the health insurance will not only have the well-known benefit of financial protection but also health related benefits. Experiences in Costa Rica, China and Peru have demonstrated that consumers with protection against health-related financial risks have better health seeking behavior as well as service providers have a positive difference in behaviors of the towards them.[18] This scheme will again, also provide an opportunity for improvement of the existing public institutes both in terms of quality and quantity.

To conclude, merely formatting a policy and distribution of health insurance cards will not suffice this low-income nation to achieve its health targets. This health insurance policy should be taken as a nation’s top priority health policy and convert all its challenges to opportunities. Nepal must learn from other countries, examine experiences of both successes and failures, make necessary policy innovations, timely amendments and with a multi sectoral approach implement them, make this National Health Insurance Program implementation a story of success worth remembering .

References:

[1] Ministry of Health and Population Nepal, Partnership for Maternal, Newborn & Child Health, WHO, World Bank and Alliance for Health Policy and Systems Research. Success factors for women’s and children’s health: Nepal. Geneva: World Health Organization; 2014.

 

[2] World Bank. 2010. Nepal – Second Health Nutrition and Population (HNP) and HIV/AIDS Project. Washington, DC: World Bank. http://documents.worldbank.org/curated/en/964991468291002895/Nepal-Second-Health-Nutrition-and-Population-HNP-and-HIV-AIDS-Project (Accessed November 22, 2017)

 

[3] Government of Nepal. Ministry of Health and Population. Nepal Health Sector Strategy 2015-2020: Unofficial translation. Kathmandu: MoHP; 2015

http://nhsp.org.np/wp-content/uploads/2016/03/NHSS-English-Book-Insidefinal.pdf

(Accessed November 25, 2017)

 

[4] UNDP. Human Development Report Nepal 2016. http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/NPL.pdf (Accessed November 25, 2017)

 

[5] Eiko et al. Catastrophic household expenditure on health in Nepal: a cross-sectional survey.World Health Organ 2014;92:760–767 | doi: http://dx.doi.org/10.2471/BLT.13.126615

 

[6] Sanjay et al. Multidimensional poverty and catastrophic health spending in the mountainous regions of Myanmar, Nepal and India. The International Journal for Equity in Health.https://doi.org/10.1186/s12939-016-0514-6

 

[7] WHO Global Atlas of the Health Workforce, 2010. http://apps.who.int/globalatlas/dataQuery/default.asp (Accessed November 25, 2017)

 

[8]The world bank data.  https://data.worldbank.org/indicator/SH.MED.BEDS.ZS?end=2006&locations=NP&start=1960&view=chart (Accessed November 15, 2017)

 

[9] Global Health Workforce Alliance. Towards building a comprehensive and costed HRH plan through the CCF process in Nepal http://www.who.int/workforcealliance/countries/ccf/CCF_poster_Nepal.pdf

(Accessed November 15, 2017)

 

[10] CBS Nepal, 2006. Nepal living standards survey (1995/96 and 2003/04). Government of Nepal. National Planning Commission Secretariat. Central Bureau of Statistics. March 2006.

 

[11] World Bank Development Indicators database, accessed in November 2017.

 

[12] MOHP- DoHS 2010. Annual report.

http://dohs.gov.np/wp-content/uploads/2014/04/Annual_report_2067_68_final.pdf (Accessed November 25, 2017)

 

[13] WHO. WHO Global Health Expenditure Atlas September 2014.

http://www.who.int/health-accounts/atlas2014.pdf (Accessed November 25, 2017)

 

[14] Simone et al. Fair choices in universal health coverage in Thailand. The Lancet.

DOI: http://dx.doi.org/10.1016/S0140-6736(16)31608-7

 

[15] Hao Yu. Universal health insurance coverage for 1.3 billion people: What accounts for China’s success? http://dx.doi.org/10.1016/j.healthpol.2015.07.008

[16] Corruption Perceptions Index 2016. Transparency International. http://www.transparency.org/cpi2016 (Accessed November 30, 2017)

 

[17] Hao Yu. Universal health insurance coverage for 1.3 billion people: What accounts for China’s success? http://dx.doi.org/10.1016/j.healthpol.2015.07.008

 

[18] Maria et al. Impact of health insurance in low- and middle-income countries. Brookings Institution Press

Washington, DC. https://www.brookings.edu/wp-content/uploads/2016/07/theimpactofhealthinsurance_fulltext.pdf (Accessed on November 16, 2017)

Shifting hospital from tents to indoors.

Shifting hospital from tents to indoors..

Shifting hospital from tents to indoors.

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.

The strike

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.

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Our pharmacy building turning into rubbles just as the earthquake was happening.

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.

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Counselling room for patients and discussion room for doctors and sisters.
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Pharmacy and guest room.

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.

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Our makeshift hospital. Sincere gratitude to all the donor agencies for the tents and supplies. In this picture is our OPDs, Inpatient ward with 18 beds, Post op tent with 3 beds, and a Emergency tent plus a duty room.

The Rebuidling

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.

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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.

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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.

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First time mother of one day along with her baby leaves the hospital early morn on a bamboo basket carried by the father. Their home is six hours away for a normal person without a bagpack. I wonder how and when they might have made home.

3 thoughts on “Shifting hospital from tents to indoors.”

  1. Please contact us for 10 by 14 temporary shelters good enough to last at least a year or two. It’s very live able safe and sound

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