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Nepal: preparing Kathmandu for “The Big One”

All hospital beds and tables have been chained to the walls, to avoid congestion of hallways in case of an earthquake.

All hospital beds and tables have been chained to the walls, to avoid congestion of hallways in case of an earthquake.

20/12/2012 – Sitting dangerously close to a major fault line dividing the Indo and Asian plates, the congested city of Kathmandu faces the threat of being struck by a massive earthquake at any time. As experts say, “it is not a question of if, but when” the Nepali capital will have to cope with a natural disaster of catastrophic proportions. A frightening prospect, which has prompted ECHO to fund an urban disaster preparedness project, with a special emphasis on enhancing the emergency health response capacities of the city.

The last time a major earthquake hit Kathmandu, in 1934, it left 8000 people dead and 60% of the buildings destroyed. Since then, the city’s population has grown fifteen-fold, transforming what was a provincial town into a sprawling metropolis. If the same quake of 8,1 magnitude was to hit tomorrow, conservative estimates therefore anticipate a minimum of 100 000 casualties, 300 000 injuries requiring medical care, one million people displaced, and 60% of schools destroyed.

The airport’s single runway would probably also be considerably damaged, and since it is anyway connected to the city by a series of bridges that would not withstand the shock, chances are Kathmandu would be unaccessible for several days. A nightmare scenario, which implies that the initial response to the disaster would inevitably have to come from within. And it could happen any time as, according to experts, major seismic activity in the region is historically overdue: over the last eight centuries, the Kathmandu valley has witnessed a major earthquake approximately every 75 years.

In order to prepare for the worst, ECHO has been funding a consortium of partners under its Disaster Preparedness programme (Dipecho) in order to enhance the capacity of the medical community to cope with a mass casualty situation. Focussing on three public hospitals and two rehabilitation centers in order to create a replicable model, the project covers seismic assessment and non-structural retrofitting of buildings, stockpiling of fuel and surgical kits, digging a 250 meter deep tubewell in the Tribhuvan University Teaching Hospital (TUTH) – to make sure water will be available in the operation theatres if the regular supply breaks down – and, most importantly, training and organising of the medical staff.

“This country has 300 qualified surgeons and 6500 nurses, 80% of whom are in Kathmandu itself, explains Florent Milesi from Handicap International. But until now there was no organised response mechanism in case of a major disaster, a gap which would lead to total chaos in an emergency situation as professionnals would not know where to go or what to do if communications and transport were down”. The first step was therefore to create a roster, in order to ensure an early deployment plan of health professionnals, according to which each doctor and nurse in the valley now knows where to go in case they can’t reach their normal workplace. “The idea is to be able to rely on processes rather than people, making sure that everyone is replaceable so that emergency capacities are not hindered by the absence of this or that person”, explains Luc Verna, ECHO’s Disaster Risk Reduction Coordinator for South Asia.

Each hospital has also put in place a referral system to track patients easily, and a Mass Casualty Management Plan in order to reorganize the premises to cope with a potential huge influx of patients and dead bodies. Finally, 420 doctors were trained on specific interventions, such as operating on complex fractures or spinal chord injuries. “Not only are we better prepared for a major disaster, but whether it is the training of doctors or the links created between the hospital and the rehabilitation centers, this initiative is already helping to save lives on a day-to-day basis, in regular circumstances”, says Dr. Pradeep Vaidya, Head of the Surgery Department at TUTH.

“The best part of this project is that both the medical community and the government have taken keen interest, and have now actually taken the lead in pushing this effort forward”, adds Dr. Arun Mallik from the World Health Organization. Indeed, Nepal’s Ministry of Health is on the verge of adopting three new medical protocols – for amputations, spinal chord injuries and complex fractures -, giving a national outreach to what was originally a localised project. A National Mass Casualty Management Plan is also in the pipeline, and a coordinating agency dedicated to the health sector will be added to the existing National Emergency Operation Center. Mechanisms which will undoubtebly help save lives when the unavoidable happens.

By Pierre Prakash,
Regional Information Officer for South Asia

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