Memories need to be recorded. What we did during the last 6 weeks was just not imaginable. The amount of courage and the driving desire to do something for our people was evident in the actions of our health workers at Kathmandu Medical College (KMC).
It started with a shock and unbelief on what was happening on April the 25th 2015. The continuous tremors were enough to rock even the boldest of the hearts. Even though nothing significant happened to the hospital's buildings which houses our patients, it appeared very dangerous to stay inside and consequently all the patients except for the neurosurgical patients in the 1st floor Neurosurgical ICU (NICU), were vacated to the parking outside on the very first day with only 1 tent! As all other ICU patients were transferred to NICU it was clogged to its limit. Fortunately there was no damage to NICU due to the care taken during installation of monitors and equipments and light frame walls as a preparation for earthquake during its inception. But as the after-shocks kept on coming with increasing frequency, for the safety of patients, on the second day all NICU patients were shifted to Emergency department and rest of the patients were either discharged or relocated to the parking area. Patients were flocking in not only from nearby areas but also brought from distant places like Dolakha, Sindhupalchowk and Everest base camp following the avalanche. Referral to other centers, we realized was like dumping patients to death, as all the facilities in Kathmandu were in same state. With the barest minimum, we had the challenge to deliver. To avoid being overworked, we the faculties and staff started working in shifts with the provision of buffer to cater for intermittent influx of heavy patient load.
Strangely almost 10% of all the patients managed in Kathmandu medical college had head injury and of them the 10% had skull base fractures or compound depressed fractures with pneumocephalus. Such scenarios demand urgent surgical intervention, however with no operating rooms outside our complex, it was almost next to impossible to operate. Severe head injuries were ventilated and measures taken to decrease the Intracranial pressure. Options like operating in the makeshift OT in the container placed in APF ground as well as the Indian Army camp was explored but found to be not practical owing to non existing facility of good light, microscope, drills lest not for a good ventilator. During this preparation, we lost 1 patient due to infection and 2 were developing meningitis. As 72 hours passed after the first shake, visual inspection assured us mere cosmetic damage to our physical structure and with consent of the patients and staff, we opened our 1st floor NICU and OT after mak-ing an emergency escape route and provision for relocation to PN Pant building. Since then NICU worked in full strength throughout and consequently we started performing surgeries. With the help of our anaesthetic team, we operated on 35 patients during this disaster, of which 22 were major craniotomies and spinal injuries. Our OT was also used by orthopaedics department, and serious patients kept in the Neurosurgical ICU. Of the 2 patients who developed meningitis, 1 died after 5 days. 2 patients with scalp lacerations developed wound infections while staying in the parking area. With no visible damage to the building it was highly inappropriate to stay out of the building owing to the increasing risk of infections. The rains during evenings and nights and scorching sun and dust during daytime was making the life staying outside increasingly miserable. With the willingness of the patients and attendants, we moved in. Tremors kept on coming and a major shake caught us again on May the 12th, while we were operating on 2 patients simultaneously. We stayed with the patient as the only mishap to avoid then was avoiding them to fall and ensure continuous ventilatory support. Such courage and involvement in patient care is unprecedented and the whole team stood firm in alliance.
After the first 2 weeks, we saw patients coming with hemorrhagic strokes. Even though not related to physical injury, history revealed emotional trauma suffered due to loss of home and beloved ones. Pattern of injuries sustained during this disaster revealed that most injuries were due to falls during trying to escape during the panic. Hence earthquake drills with emphasis on drop, cover and hold were administered to the team and the patient attendants to avoid being hurt.
At the end of the hospital's disaster debriefing, we conducted the debriefing in our department and listened to the concerns and suggestions of the team members. The Department drafted its own protocol of preparedness, response and post disaster recovery and plans to update and merge with the institute protocol in future.
We had our share of happiness to see almost 99% patients going home safe and recovered after all this terrorising disaster from the neurosurgical wards. It is very satisfying and encouraging to see the whole team work like a force, disciplined and committed. I am personally very thankful to all the team members not excluding our OT staff and didis who worked without thinking about their life with just one desire, to help others. Our management team had been very helpful and participated in the whole action as their own. We thank God the almighty to have saved us for a reason and helped us to deliver what we know the best. The whole team of KMC stood as one and contributed from their end not just labor but also a part of their salary for the relief work.
But as a critic, I should admit there is lot of scope to improve. We are health workers and it is our duty to deliver the services in these testing times. Disaster is by definition is overwhelming but we shall try convert the disaster management from a one dipped in fear and despair due to unpreparedness to one of hope and efficient by being prepared and organised! Every skill counts and every help should be offered not as a charity but as a duty!
Recorded: 17 June, 2015
