Six Days in Nepal

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A boy sits inside a tent after a deadly earthquake in Nepal on April 29, 2015. | Reuters/Adnan Abidi

Stanford Medicine professor and physician Paul Auerbach flew to Nepal to aid victims of the recent earthquake, which has claimed the lives of more than 7,000 people. The Stanford GSB alumnus (MSx ’89) wrote this account of his time there. It has been edited for length. Read the full account at Stanford Medicine’s Scope.

Under the auspices of International Medical Corps, I joined a team to help meet the needs of Nepal following the recent devastating earthquake. It wasn’t easy to fly in. The airport had a single main runway, which wasn’t large enough to park many large aircraft, and there were a great number of relief flights from all around the globe bringing people, equipment, and supplies. Our commercial flight was largely occupied by responders, including an official Japanese search-and-rescue team, as well as concerned and courageous people of Nepal returning to be with their families.

The scene was somewhat reminiscent of what we encountered five years ago in Haiti, with the main exception being that there is much more of a structured healthcare system in Nepal, so the national medical response has been significantly more robust. Still, there were more than 4,000 known victims, likely many more to be discovered in the difficult-to-reach areas surrounding Kathmandu, and at least quadruple that number of persons with significant injuries.

Having been to Kathmandu a few times on my way to the majestic Himalaya mountains to trek, including to Everest Base Camp, it was very sad to see the collapse of buildings — indeed, large portions of certain neighborhoods — as well as ancient temples and iconic structures. Soon after leaving the airport, I witnessed resilient citizens sheltering under tents because their homes were destroyed or rendered structurally unstable. They were enduring a fierce rainstorm with sheets of hail that caused some streets to flood and emphasized the risk for spread of infectious disease such as cholera.

The local medical community responded aggressively, and the health professionals were working around the clock to tend to patients. The overall community led by volunteers assessed its capabilities to support shelter, hygiene, provision of safe water and food, and integration of its capabilities with those who are coming in relief. The government worked to integrate its efforts with non-governmental agencies, other countries, and generous donors.

The Long Road to Recovery

My second day in Kathmandu was quite different from the first. The city sprung back remarkably. Although its citizens continue to face enormous challenges, the streets were nearly full with traffic, rubble was actively being cleared from obstructing piles, and people were walking and resuming commerce.

There are an estimated 16 camps within the boundaries of Kathmandu, where people were either forced to seek housing or prefer to remain, certainly for sleeping at night, until homes can be replaced or cleared with respect to structural integrity. The camps were orderly and treated with dignity by the occupants and passers-by.

We visited one that afternoon, examining patients who wished to see a physician. Because the hospitals in Kathmandu received the injured soon after the earthquake, we mostly served people with “routine” medical ailments.

There will be increasing focus on the communities outside Kathmandu, where there is sparse medical care and distances to hospitals mean walks of hours. Some of these will need to be approached by helicopter because of distances, mud- and rockslides caused by the earthquakes that have obstructed roadways, and calls for urgent assistance. It’s anticipated that some teams may need to trek for days to reach certain villages. Much of the coming days’ and weeks’ activities will be intended to avoid the spread of infectious diseases.

We have heard tales of miraculous survival, sadly juxtaposed against the grief of many lost family members and friends. Driving through the city past enormous mounds of rubble that last week were sacred temples and monuments, it was striking to think about how much there is to be done worldwide to prepare for cataclysmic natural events. There will be many lessons learned from this catastrophe, and we should take them to heart. One of them is how much better is a world focused on mutual aid and skillful compassion than upon dominance and conflict.

An Unsettled Nepal

The days I spent in Nepal were action-packed, and but after a week there, my time was coming to a close. As an emergency physician, my skills would soon be much less needed than those of orthopedic and plastic surgeons, and primary care and infectious disease specialists. Because of the incredible outpouring of active interest from people, many healthcare professionals had arrived, and more are still on the way. The government of Nepal recommended that all persons, particularly those in large groups or teams, wishing to come to Nepal to help do so under the auspices of a government-approved organization. This is important to maintain an effective response and deploy resources where they are most needed.

It was a bit unnerving to experience three significant aftershocks over the days I spent in Nepal. Each was accompanied by a jolt or shaking of the ground or building and rumbling noise, followed by silence, followed by the sounds of commotion as people fled their dwellings. Fortunately, none of the aftershocks were prolonged or destructive, but they served as a reminder of what happened, and what will undoubtedly happen again sometime in the future. The cycle for a major earthquake in this country in modern times is approximately every 75 years.

On one of my final days there, we traveled to Hatia, a community close to Dhading, to assess need and provide care. We were greeted by approximately 100 residents with earthquake-related illnesses and injuries. Nearly all of them were displaced from their homes. With monsoon season beginning the end of this month or early in June, combined with the number of persons requiring new shelter, the timetable is set for an aggressive attempt to provide adequate housing, essential public health education, and water-sanitation-hygiene programs. More victims of the earthquake will undoubtedly be found as helicopters are deployed to approach very difficult-to-reach areas.

I have witnessed many acts of selflessness. From a personal perspective, I’m impressed by the number of participants in response that have come from the wilderness medicine community. Many people came to help, and behind every person there are dozens at home supporting their efforts.

The staff of International Medical Corps and all of the volunteers have been terrific. The amazing people of Nepal and many of its citizens, such as Om Rajbhandary and a great number of other inexhaustible business leaders in Kathmandu; the Nepal Ambulance Service; and incredible doctors and health professionals in hospitals and clinics across the country are working ever so hard to find an equilibrium and begin to simultaneously manage this crisis while beginning to recover and restore. I wish them all well, and every ounce of good fortune to be successful in their time of need.

Read more of Auerbach’s experiences.