Steve Mannion, a Consultant Orthopaedic Surgeon and Head of the Department of Conflict & Catastrophe Medicine at St George's, describes the impact of the earthquake in Nepal and how he became involved in the crisis.

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He writes: "A 7.8 magnitude earthquake hit Nepal at 11:56 (Nepal time) on the morning of the 25th of April 2015. With an epicentre in Gorkha District, 120 km North-West of the capital, Kathmandu, the earthquake resulted in over 8,000 deaths,  16,000 injuries and over 300,000 homes destroyed or damaged. Recognizing the scale of the disaster, the UK Government’s Department For International Development (DFID) mobilised the United Kingdom International Emergency Trauma Register (UKIETR) in order to provide UK healthcare professionals to assist in the response to the crisis."

He was was the clinical lead of the team of 20 clinicians who were mobilized under a project hosted by Save The Children (UK).

Having previously visited Nepal several times with St George’s Health Partnership Nepal (HPN) project, once in country, Steve immediately made contact with Nepali clinicians at Nepal Medical College (NMC), an 800 bed teaching hospital in metropolitan Kathmandu with which St George's is linked.

NMC had suffered major roofing damage in the earthquake, with 80% of the hospital rendered unsafe due to the possibility of unstable, falling masonry. The hospital was functioning with only one, 80 bed, ward, located in what had been an underground car park and one improvised operating theatre, in the Emergency Department. Furthermore, disruption to the water supply due to the earthquake had led to major disruption to NMCs waste management systems.

Elements of the UK clinical team were able to integrate with Nepali colleagues at NMC and assist in the treatment of earthquake victims, the majority of which had suffered orthopaedic injury. Via DFID, the team made contact with the United Kingdom International Search and Rescue Team (UKISAR), a team composed mostly of firemen, who were able to stabilize and render safe the NMC roofing, allowing the main wards and complex of 6 operating theatres to reopen and thereby greatly increasing the clinical capacity to treat the surge of patients injured in the earthquake.

The team also facilitated the repair and reconstruction of NMCs waste management system, utilizing Save the Children’s WASH ( Water, Sanitation and Hygiene) expertise and were able to donate theatre equipment and medical consumables to assist in patient treatment.

Via connections with NMC, secondary care elements of the UKIETR team (anaesthetists, orthopaedic surgeons, plastic surgeons, ODPs and theatre nurses)  were able to offer assistance and increase capacity at several hospitals in Kathmandu. Meanwhile, the primary care / pre-hospital members of the UK team (paramedics, GPs) were tasked to  conduct healthcare assessments by road and helicopter to the more remote rural areas  where the impact of the earthquake had been most severe.

When patients were identified who would benefit from hospital-based care, their evacuation to Kathmandu was facilitated by the team. Although after 2-3 weeks most of the UK clinicians withdrew from Nepal there remained an ongoing support project to the Nepal Spinal Injuries Centre in Kathmandu. This involves specialist UK spinal injuries nurses and physiotherapists who are assisting in treating the excess of over 200 spinal injuries which have resulted from the earthquake.  There is a also an ongoing primary healthcare project hosted by Save the Children(UK) aimed at re-establishing primary health services in the areas that were devastated by the earthquake.

Notes:

Health Partnership Nepal (HPN) www.hpnepal.org  is a largely student run initiative at St George's. Founded in 2007, activities typically involve an annual project visit by students and doctors from St George's to Nepal Medical College in Kathmandu. In conjunction with NMC colleagues surgical outreach camps have been run in the more remote areas of Nepal and St George's consultants have run specialist medical courses at NMC.  In the wake of the recent earthquake HPN, and the St George's students have been fund-raising for the relief effort, and partners of HPN have already set up a medical camp in Nuwakot District of rural Nepal which has already treated over 400 patients. As the priority in treatment shifts from care of acute injuries to shelter, water & sanitation, food and restoration of primary healthcare services, HPN is committing to long term fund-raising and involvement in the reconstruction effort.

The United Kingdom International Emergency Trauma Register (UKIETR) is a database of clinicians prepared to assist in the wake of natural disasters anywhere in the world.  It is hoped that prospective arrangements with employing NHS Trusts will allow timely release of such volunteers for future disasters, with back-filling funding to cover the cost of absence. More details can be found on the website www.uk-med.org

St George’s students interested in humanitarian relief in the wake of natural disasters might wish to consider studying the intercalated BSc module Conflict and Catastrophe Medicine ( GH1800)