How Doctors In Nepal Are Getting on

Creative To Cope With The
Onslaught Of Earthquake Victims
Gynecologists setting bones. Splints made of T-
shirts. As Nepal begins the rebuilding process
by rebuilding its injured citizens, its beleaguered
medical infrastructure is responding in
innovative, resilient ways.



In the earthquake's aftermath, broken bones
have become one of the most common ailments
in Kathmandu. The city’s hospitals have become
inundated with fractured limbs and bandage-
wrapped heads, in scenes that evoke the
disarray of wartime. The streets are no different:
limpers of all ages go about their business,
albeit slower than usual, while a motorcyclist
with a pair of steel crutches under his arm has
become an everyday sight.
After the devastating 7.8-magnitude earthquake
on April 25 that killed 7,500 people and injured
at least 14,500, what doctors call "crush injuries"
have dramatically shot up in number, mostly
involving the spine, legs, arms, and heads. The
impoverished country’s medical infrastructure is
struggling to cope: according to Nepali press this
week, doctors in the capital have carried out
almost 1,000 orthopedic surgeries since the
quake.
In Kathmandu’s Model Hospital, the injured lie
supine on its dirty stone floors. Surgical resident
Kovid Nepal dashes from one patient to another,
his doctor’s coat becoming a white blur. "We’re
seeing so many lower limb and spinal fractures,
but we’re trying to manage," he says. Though
not trained as an orthopedic surgeon, the
earthquake has forced him to become as close
to one as possible. Doctors are setting bones
with remarkable speed and using innovative,
jerry-rigged methods. In the Model Hospital’s
corridor, a man on a thin mattress shows off his
rudimentary split, made from jagged pieces of
wood and tied together with an old T-shirt. In
another Kathmandu hospital, ropes weighed
down with bottles of water help apply traction to
a young girl’s leg fractures.
In the sleek, newly-built Kirtipur Hospital, just
south of Kathmandu, obstetrician and
gynecologist Ganesh Dangal is assisting with,
and sometimes carrying out, surgeries on broken
limbs. His tall stature and thick mustache belie
his gentle manner, and he never stops smiling. "I
never once imagined that I would need to do this
work," he says while doing the rounds. A young
woman named Komal is awaiting bone-setting
surgery. She lays in a rudimentary bed, her right
leg encased in orange plaster. Wincing with pain,
her relatives explain how Komal had watched
their house fall around her. "I am lucky," she
says dozily, her eyes half-closed. Across from
her is a middle-aged woman with a head wound
and several fractured limbs.
To give a scale of the need, the country’s
premier Orthopedic Hospital has performed
double the amount of surgeries—121 on 97
patients—than was usual before the earthquake.
"There’s a waiting list of 60 more patients, it’s
more than we can handle," says its medical
director, Saju Pradhan. It is a situation repeated
in hospitals across Kathmandu.
Medical professionals say time is of the
essence: thousands of people are hurt, mostly
from being crushed by rubble, and of these,
many need surgery. The surgeries must take
place over the next two to four weeks in order to
make sure those in need are saved from
disfigurement or handicap, says Dr. Shankar
Man Rai, a burns specialist and Kiritpur
Hospital’s director. "Instead of having more
orthopedic surgeons, we can help instead," Rai
says. According to the British Bone and Joint
Journal , 2% to 5% of earthquake crush injuries
can turn into crush syndrome, a dangerous
condition that brings with it the likelihood of
amputation.
To speed things up, workers cleared land behind
the hospital for a helipad to bring in the critically
injured from the remote, hard-to-reach areas
near the epicenter. The Nepalese Army, which
oversees a massive relief effort, ferries them in
on military helicopters.
Hundreds of international aid and medical
professionals have descended on Kathmandu in
recent days, replacing the swarms of foreign
journalists who have moved on to their next big
story. Aid relief workers have complained that
the government is too slow and chaotic to
coordinate properly. Nepal is ill-equipped to
handle a country full of medical emergencies,
and medical workers are desperately needed.
But the situation is so unorganized that some
people on the ground believe that they could do
more harm than good.
On Sunday, the government barred large planes
from entering its airport, saying cargo and
military jets had damaged its tiny runway, in a
move likely to further hinder aid efforts. As a
water crisis and the likelihood of a food
shortage grow, Nepalis are growing increasingly
angry at their government. Huge crowds have
protested outside parliament in Kathmandu, and
mobs of men have stopped aid trucks going to
rural areas, arguing the supplies are not nearly
enough.
Amit Aryal, a U.S.-trained engineer who is an
advisor to the Ministry of Health, frustratedly
described the current situation as a
"clusterfuck." "We’re trying to deploy people
according to their specialties, but there is no
coordination. This is the worst emergency we’ve
ever had to handle," he says under a large red
canopy in the ministry’s front yard. Foreign and
Nepali medical teams buzz around energetically,
preparing first aid kits and sterilizing needles
and surgical instruments before heading out to
rural areas. "We’re over-saturated with
specialists.

By Amie Ferris-Rotman MAY 8, 2015 | 6:00 AM