When an earthquake struck Nepal on Saturday, April 25, two Brigham and Women’s Hospital faculty members were in Achham District, in the far west of Nepal, about 200 miles from the epicenter. Duncan Maru, MD, PhD, and Dan Schwarz, MD, MPH, both of the BWH Division of Global Health Equity, were in Nepal working for Possible, a partner program of the Division of Global Health Equity based in Achham District. The staff at Possible felt the earthquake’s powerful tremors and aftershocks, but fortunately all are safe. As lines of communication were re-established later in the weekend, Possible’s staff members communicated with family and friends in other parts of Nepal, all of whom were thankfully safe. While Achham District gracefully sustained itself through the earthquake with no reported loss of life, buildings, or farmland, the same cannot be said for the rest of the country.
The death toll now stands at over 5,000 and more than 10,000 have been injured in this country of 30 million. These numbers will climb in the coming days as rescue teams reach the more rural districts closer to the earthquake’s epicenter. These areas were already marginalized prior to the earthquake, and the media has paid little attention to them so far. Preliminary reports on social media and from various local organizations indicate that up to 80-90% of homes and buildings have been destroyed in some communities in Gorkha, Lamjung, and Sindhupalchowk Districts, among others. The scope of the devastation is astounding.
In the capital city of Kathmandu, centuries-old historical sites have been reduced to rubble, hospitals are triaging patients in the roads, and families have to make the difficult choice between sleeping outside in tents under heavy rain, or staying inside unstable buildings prone to more aftershocks. The Tribhuvan International Airport in Kathmandu is open and accepting relief flights and cargo planes into Nepal, yet air traffic is congested as this is the only major international airport in the country. At Dhulikhel Hospital, orthopedic surgeon Dr. Dipak Shrestha operated on 36 patients in a 24 hour period. Nick Simons Institute, a Possible partner, continues to make inroads in collaboration with the Government of Nepal to address the enormous needs for medical care, shelter, and food. Uplifting stories exist, but the damage to this country is unmistakable.
On Monday, both Dr. Maru and Dr. Schwarz arrived in Kathmandu to work with Possible’s partners, including the Government of Nepal, various public and private hospitals, and other non-governmental organizations, to help coordinate the relief effort most effectively. The bulk of funding for the relief effort is coming from official development aid sources. As was seen in the relief effort following the earthquake in Haiti in January 2010, much of that aid from those sources fails to reach either the government or local institutions on the ground[i][ii].
The Nepal earthquake was over 16 times greater in magnitude than Haiti, which coupled with the geographically challenging terrain and remote setting make coordinating the relief effort an enormous challenge. Dr. Maru and Dr. Schwarz are also using this opportunity to play an advocacy role to support the government to “build back better” and develop durable relationships favoring health systems strengthening, governance, and disaster preparedness. Although the immediate relief effort is an immense challenge, the rebuilding effort after the official development aid sources leave is perhaps a larger one.
In Achham, Possible’s healthcare team continues the daily work of treating Nepal’s chronic maladies: chronic obstructive pulmonary disease, malnutrition, fractures, and more. As a team committed to delivering high quality healthcare to our patients, they struggle to somehow translate deep loss and sadness into a way forward. After the emergency is patched up by the heroic efforts of those working on it, the remarkable resilience of the Nepali people will shine through, as it already has. Possible and its staff are committed to honoring their responsibility to Nepal’s people by walking this road together and building back better. They continue to be deeply committed to this task, and will be supporting the Nepali government to build more robust, expansive healthcare systems in the wake of this tragedy.