Surgeons help with recovery after earthquake in Nepal

Dr. Katz speaking with patient S.R. (Photo by Patrick Reddish.)

Dr. Katz speaking with patient S.R. (Photo by Patrick Reddish.)

In the operating theater at Manmohan Hospital, performing wound debridement for B.K. (Photo by Micah Katz)

In the operating theater at Manmohan Hospital, performing wound debridement for B.K. (Photo by Micah Katz)

Swayambhunath, a famous religious site near Manmohan, demonstrates the destruction of the earthquake (Photo by Micah Katz)

Swayambhunath, a famous religious site near Manmohan, demonstrates the destruction of the earthquake (Photo by Micah Katz)

Homeless children near Dunche posing for a picture with Dr. Russell (Photo by Micah Katz)

Homeless children near Dunche posing for a picture with Dr. Russell (Photo by Micah Katz)

Dr. White assessing a chest X ray before rib plating (Photo by Katie Russell)

Dr. White assessing a chest X ray before rib plating (Photo by Katie Russell)

Chest tube in fracture patient (Photo by Katie Russell)

Chest tube in fracture patient (Photo by Katie Russell)

Preoperative planning for rib plating (Photo by Katie Russell)

Preoperative planning for rib plating (Photo by Katie Russell)

Preoperative chest X ray for K.T. (Photo by Katie Russell)

Preoperative chest X ray for K.T. (Photo by Katie Russell)

Postoperative chest X ray for K.T. (Photo by Katie Russell)

Postoperative chest X ray for K.T. (Photo by Katie Russell)

Earthquake victim observing rounds (Photo by Patrick Reddish)

Earthquake victim observing rounds (Photo by Patrick Reddish)

Dr. Katz holding patient S.R.’s hand (Photo by Patrick Reddish)

Dr. Katz holding patient S.R.’s hand (Photo by Patrick Reddish)

Collapsed buildings blocks from Manmohan Hospital. (Photo by Patrick Reddish.)

Collapsed buildings blocks from Manmohan Hospital. (Photo by Patrick Reddish.)

The international team after rib plating surgery. Seated, from left: Dr. Nirajan Subedi and Dr. Tej Dabadi, orthopaedic surgeons; Dr. Saroj Yadav, general surgeon; Dr. Prashanta Paudel, chief anesthesiologist; Dr. Russell; Dr. White; and Dr. Shrestha. Standing: Prahlad, operating theater (OT) technician; Sharmila, OT nurse; Shobha, OT nurse; Kavita, OT nurse in-charge. (Photo by Patrick Reddish)

The international team after rib plating surgery. Seated, from left: Dr. Nirajan Subedi and Dr. Tej Dabadi, orthopaedic surgeons; Dr. Saroj Yadav, general surgeon; Dr. Prashanta Paudel, chief anesthesiologist; Dr. Russell; Dr. White; and Dr. Shrestha. Standing: Prahlad, operating theater (OT) technician; Sharmila, OT nurse; Shobha, OT nurse; Kavita, OT nurse in-charge. (Photo by Patrick Reddish)


After the Nepal earthquake on April 25, the authors decided to join our friends in the area and lend a hand in the recovery effort. Our group included four surgeons/surgical residents from Intermountain Medical Center, Murray, UT, and the University of Utah, Salt Lake City. The physicians were joined by Dean Cardinale, founder and president of Human Outreach Project, a not-for-profit humanitarian organization, and World Wide Trekking, its sister organization, both based in Salt Lake City. This collaboration gave us the ability to be self-sufficient in terms of shelter, food, and water, as the availability of these resources in Kathmandu, Nepal’s capital, was likely to be very limited. Furthermore, the Nepalese staff members of these two organizations provided guidance and local perspective, which proved to be invaluable to our mission.

The American College of Surgeons (ACS) also supplied our team with a letter verifying that we were traveling in an official capacity under the ACS Operation Giving Back program. The College’s support was especially helpful during the registration process with the U.S. Department of State, the World Health Organization (WHO), and the International Medical Corps, allowing us to avoid any unexpected problems as we entered Nepal.

Kathmandu

Upon our arrival in Kathmandu, we registered with the WHO and the Nepalese Ministry of Health and then departed for Manmohan Memorial Community Hospital. Ram Shrestha, MD, chief of surgery at Manmohan Memorial Teaching Hospital, greeted us at the 100-bed community hospital, which provides medical, surgical, and diagnostic services, mostly to indigent patients. We learned that all urgent trauma victims had been well managed by the hospital staff, but these health care professionals and their supplies were near exhaustion. We participated in daily rounds at three times their normal capacity, exchanging ideas and observing the excellent care provided to patients. On rounds, our team witnessed the devastation of the earthquake and heard the heart-wrenching stories of the patients.

We met scared but stoic B.K., a five-year-old boy who suffered a traumatic amputation of his left lower leg after his home had been destroyed. Fortunately, the rest of his family was spared, and B.K. was receiving treatment for his injuries. We assisted the local physicians in debriding and cleaning his wounds in the operating room while working with nursing staff to optimize his wound care. Another patient, S.R., is a 75-year-old woman who sustained a superficial wound to her right hand in the collapse of the building that killed her husband of 55 years. Although her wounds appeared healthy and did not require our care, we were able to sit with her, hand-in-hand, listen to her story, and offer comfort.

We also had the privilege of introducing rib plating to Nepalese health care professionals. This operation was performed on S.N. and K.T., 35 and 59 years old, respectively, who were both trapped under rubble after the earthquake. They presented to the hospital with respiratory distress. Four days after the earthquake, they remained on oxygen and exhibited the need to exert significant effort to breathe, abnormal breathing mechanics due to flail segments, and considerable discomfort and pain. With donated instruments, our team assisted the local physicians and taught them how to perform rib plating for these two patients. The cases went smoothly, and the surgeons had little difficulty learning these techniques. Both patients responded well, and the improvement in breathing mechanics for S.N. was particularly impressive. We are especially proud of this “first ascent”—a mountain climbing term referring to the first time a group or an individual has successful completed a route—and the surgeons at Manmohan Hospital have since performed rib plating in other trauma patients with much success.

Dunche and Khumbu Valley

Our team was then dispatched to a village two hours from Kathmandu, near Navapati. We met with local military officials who reported minor injuries that they were able to manage on their own.

Our next assignment from the Ministry of Health was in Dunche, a central hub for the heavily damaged Langtang Valley. While planning our departure for this region, we encountered U.S. Special Forces who had been working in the area. They suggested that there was likely little need for medical care in the Langtang Valley, as most patients had either died, been evacuated, or had suffered only minor injuries. After chartering a helicopter, we found their assessment had, indeed, been accurate.

In Dunche, we met a well-staffed Canadian Red Cross team who were seeing only one to two patients per day. After returning to Kathmandu, we were told there might be need in Pokhara. Dr. Shrestha contacted the Director of Health of the district along with his colleagues at hospitals in that area. Similar to the situation in the Langtang Valley, many deaths but few injuries were reported, with no urgent need for our medical skills.

Ongoing recovery

A recurring theme during our time in Nepal was a lack of reliable information regarding where medical help was needed, which might be common to natural disasters in developing countries. The insights of the local team of the Human Outreach Project were invaluable, but we still made several trips where we found fewer injured patients than reported. Ultimately, we were relieved that people were not as badly injured as we had anticipated and that the local hospitals and other aid groups were able to care for the earthquake victims. The patients and providers we met along the way were extraordinarily resilient, and we admired how they had managed the crisis and had started to rebuild their lives after the earthquake.

Although the acute need was less than we expected, our trip helped in the assessment for the ongoing recovery in Nepal. While in the Khumbu, the surgeons on this trip visited the Namche Dental Clinic, which had been supported by the Human Outreach Project in the past. We toured their previous facility, which was in ruins, while Mr. Cardinale collaborated with the staff regarding their needs for rebuilding. Recognizing the public health concern regarding communicable disease with the upcoming monsoon season, the Human Outreach Project purchased and delivered hundreds of toilet tents to the areas we visited.

We are thankful to the organizations that supported our trip and provided thousands of dollars of medical supplies, including the Huntsman Cancer Institute, Mountain Star Medical, Direct Relief, and Mammoth Medical Missions. Throughout our travels we donated duffel bags of medications and bandages, along with sterile supplies to replenish the stores of inundated clinics we encountered. We are very thankful for Mr. Cardinale and the support team from the Human Outreach Project for managing our trip. We also thank Operation Giving Back for supporting our effort and for its continued interest in Nepal’s recovery.

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