Friday, May 1, 2015

MGH physician recounts days following devastating earthquake

Salas at Everest Base Camp five days before the earthquake

Renee Salas, MD, of the MGH Wilderness Medicine Fellowship Program in the Department of Emergency Medicine, was in Nepal at the time of the earthquake. Salas was uninjured and remains in-country providing medical care with the Himalayan Rescue Association Nepal (HRA) in Pheriche, near the Mount Everest Base Camp. On April 28, she described the situation in an email to the MGH:

Where were you and what were you doing when the earthquake struck?
It was just after noon, and my colleagues and I were in the living space of the HRA clinic. As the realization set in to the events that were occurring, we ran outside to see nearly all of the buildings of the small village of Pheriche crumbling, at least partly. About a third were completely destroyed. In the midst of screams and dust clouds, we quickly circled the village after the earthquake vibrations had settled to see if there were any injured. Amazingly, the only injury was one small head laceration. If this disaster had occurred at night, I fear the injury rate would have been much higher. The village came together as everyone comforted one another and assisted those who had completely lost their houses. Some even began rebuilding their stones walls after the initial waves of aftershocks.

What did you experience/think at the time?
This was my first experience with an earthquake, and the severity of the earth’s movement was astounding. I felt as if I was on a boat at sea. The immediate thoughts and concerns were to the status of the families of the Nepali workers here and to our HRA colleagues in Everest Base Camp and Manang. Unfortunately, we had few means to gain credible information. We had been without Internet contact for the few preceding days, and this remained inoperable. We attempted to reach Everest Base Camp with the radio system we had in place but were also unsuccessful. Through conversations my Nepali friends had with family and the HRA headquarters in Kathmandu, we learned that it had affected the city but had no understanding of the severity. We then began to assess the damage to the clinic, which had thankfully affected only a portion of the living quarters and left the patient treatment area unaffected. The numerous aftershocks we experienced caused the village to remain outside for a good portion of the day. Unfortunately, it was snowing with moderate winds, which made this situation more difficult.

What have you been doing since?
The first patients from Everest Base Camp were two climbing Sherpas who arrived about nine hours after the earthquake, as they had immediately descended via foot and by horse. We saw and treated them – one moderately injured who was admitted overnight and one minor who was treated and released. We began to understand the gravity of what had occurred at Everest Base Camp as they recounted their experiences. We initially remained awake believing that more would be arriving late that evening but soon retreated to the sunroom (a separate free-standing building across from the clinic) to sleep given the continued aftershocks.

We were awoken the next morning a little before 6 am to the sounds of helicopter traffic heading up the valley. We received word that they would be evacuating all of the critically ill and wounded from Everest Base Camp to our facility and quickly began preparing for the possibility of significant patient volume. This is exactly the type of mass casualty situation that my emergency medicine and wilderness medicine training prepared me for. We received approximately 10 critically ill patients first and placed them in the clinic and sunroom – many on makeshift beds placed on the floor. In total, we saw and evacuated an estimated 73 patients including many “walking wounded.” Our resources here included intravenous fluids, medications and an ultrasound. However, we are a remote post without access to blood products or the ability to perform subspeciality procedures that many patients required. Luckily the weather cleared, and we were able to arrange further evacuation to a hospital in Lukla, which had increased resources. Numerous helicopters, including an MI-17 that could hold 16 to 18 patients, made numerous trips as all patients were evacuated over a five-hour time period.

The local and international community here in the region came together in a way unlike anything I have experienced. Locals from the village and neighboring town of Dingboche assisted with patient transportation, arranging supplies, and giving patients and volunteers
tea and food. International trekkers with nonmedical backgrounds who were in the region assisted selflessly with patient transport and donated first aid supplies and materials. We had numerous international physicians, nurses and EMTs who spontaneously arrived and quickly set to work seeing patients, checking vital signs and administering medications.

When the last patient was evacuated, the nearly 100 to 200 people who had assisted all cheered and hugged one another for the amazing team effort, and then people dispersed back to their villages while many international trekkers continued their descent to lower villages.

What do you think is important for others to know now about the situation there?
This is a country full of loving people and the innately welcoming culture has created a collaborative and selfless post-disaster environment here in the Khumbu Valley. However, this a country with very limited resources. The situation in Kathmandu sounds grave, as medical facilities have been quickly overwhelmed and they have struggled to take care of patients in buildings in the continued wake of aftershocks. The situation in the more remote outlying villages is also unknown. As food and water resources dwindle and the lack of sanitation grows, the risk of epidemics is high, which will turn an already dire situation into a nightmare. The country will require basic needs such as food, water and medical and infrastructure personnel and supplies. Any assistance, depending on your resources and abilities, would be greatly appreciated – including prayers. 

Read what the MGH is doing to help Nepal.

Read more articles from the 05/01/15 Hotline issue.


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