The toughest challenge for doctors and nurses in a disaster zone such as the Nepal earthquake area is making swift diagnosis and treatment decisions with very little information, says Stuart Harris, MD, MFA, chief of the Division of Wilderness Medicine, which is part of the Mass General Department of Emergency Medicine.
“You don’t have access to the usual array of tests and scans,” Dr. Harris says. That means emergency responders in disaster zones must be highly trained and mentally prepared to make prompt decisions with scant information, relying on physical exams, signs, symptoms and verbal descriptions from patients.
The Division of Wilderness Medicine, which had two physicians on the ground in Nepal when the 7.8 magnitude earthquake struck on April 25, 2015, provides such training in the art and science of “resource limited medicine under austere conditions,” Dr. Harris says.
The two physicians were soon joined by seven experienced Mass General doctors and nurses from Global Disaster Response at the MGH Center for Global Health who will work in collaboration with the International Medical Corps. Another group of six is also deploying. The clinicians are working in teams in village areas outside the city of Katmandu, where access to medical facilities is lacking.
The death toll from the Nepal earthquake has surpassed 7,500, more than 14,500 people have been injured and thousands more are without homes.
Every Disaster Different
No matter how well-trained a disaster response team is before arriving, unpredictable elements always arise.
“Every disaster is different,” says Dr. Harris who responded to the earthquake and tsunami in Indonesia in 2004 and again to the earthquake and tsunami in Japan in 2011. Despite the similarities, he says, the temperature of the water made a major difference in the type of medical care needed. The warm water in Indonesia meant that there were many survivors who had been battered by debris and waves and needed treatment for injuries. But in Japan the water was cold, causing hypothermia. There were almost no survivors among the many who had been swept into the water.
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In Nepal and other underdeveloped countries, it is crucial for the medical teams to be completely self sufficient, carrying their own food, water and shelter, so as not to burden the local population. They must also be meticulous about avoiding contaminated water or food so as not to become ill themselves, Dr. Harris says. “The fastest way to lose a medical team is through gastrointestinal distress,” he adds.
The Nepal earthquake patients treated by the MGH medical team have a combination of injuries from falling debris and infection. At the same time, Dr. Harris says, the MGH team will help maintain normal, ongoing treatment for people with chronic disease, like high blood pressure or kidney disease, whose regular treatment has been disrupted by the Nepal earthquake.
Altitude Sickness a Threat
Altitude sickness may be another issue facing the MGH medical team. The two MGH doctors who were in Nepal when the earthquake occurred have had time to acclimate to the high altitude. But those who arriving more recently may experience some symptoms such as headaches or even dangerous swelling known as edema.
Katmandu sits at an altitude of nearly one mile, like Denver. But as the teams make their way to higher villages, they could get as high as 8,000 to 12,000 feet. That’s not very high in a country that holds the roof of the world within its borders—Mount Everest stands at 29,029 feet—but high enough for people who ordinarily live at sea level in Boston to feel some effects.
Another challenge of disaster response can be cultural barriers, says Dr. Harris, who was one of few Americans who went to Japan after the earthquake and tsunami in 2011.
Another challenge of disaster response can be cultural barriers, says Dr. Harris, who was one of few Americans who went to Japan after the earthquake and tsunami in 2011. With previous experience working in the area where the tsunami hit, he knew that some Japanese are reluctant to speak openly about problems.
He recalls meeting a 91-year-old woman in a village of seaweed farmers that had been almost completely swept away. The woman repeatedly offered help and assistance to the visiting doctors. It wasn’t until a day later that he learned from a neighbor that the woman had lost her daughter in the disaster—a fact she kept completely hidden while helping the doctors. “It was a testament to the inner strength of these people,” he says.
Nepal Earthquake and Cultural Differences
In Nepal, the people are warm and welcoming, says Dr. Harris who has visited several times. But certain ethnic groups, such as the Sherpa people who often work as guides in the high peaks, are known for being self-contained and less communicative—possibly posing challenges to American clinicians asking patients to describe their symptoms or other problems.
The Mass General responders serving in Nepal include the wilderness medicine physicians who were there when the earthquake struck, Renee Salas, MD, and Lara Phillips, MD. They were joined by a team led by Miriam Aschkenasy, MD, deputy director, Global Disaster Response at the MGH Center for Global Health, with Bijay Acharya, MD, Grace Deveney, RN, Annekathryn Goodman, MD, Kevin Murphy, RN, Jacquelyn Nally, RN, and Sheila Preece, NP. A second is also working there led by Paul Biddinger, MD, chief of MGH Emergency Medicine’s Division of Emergency Preparedness with Russell DeMailly, RN, Hasmukh Patel, Lindsey Martin, NP, Monica Staples, RN, and Nicholas Merry, RN.
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