Gynecologists setting bones. Splints made of T-shirts. As Nepal begins the rebuilding process by rebuilding its injured citizens, its beleaguered medical infrastructure is responding in innovative, resilient ways.
In the earthquake’s aftermath, broken bones have become one of the most common ailments in Kathmandu. The city’s hospitals have become inundated with fractured limbs and bandage-wrapped heads, in scenes that evoke the disarray of wartime. The streets are no different: limpers of all ages go about their business, albeit slower than usual, while a motorcyclist with a pair of steel crutches under his arm has become an everyday sight.
After the devastating 7.8-magnitude earthquake on April 25 that killed 7,500 people and injured at least 14,500, what doctors call “crush injuries” have dramatically shot up in number, mostly involving the spine, legs, arms, and heads. The impoverished country’s medical infrastructure is struggling to cope: according to Nepali press this week, doctors in the capital have carried out almost 1,000 orthopedic surgeries since the quake.
In Kathmandu’s Model Hospital, the injured lie supine on its dirty stone floors. Surgical resident Kovid Nepal dashes from one patient to another, his doctor’s coat becoming a white blur. “We’re seeing so many lower limb and spinal fractures, but we’re trying to manage,” he says. Though not trained as an orthopedic surgeon, the earthquake has forced him to become as close to one as possible. Doctors are setting bones with remarkable speed and using innovative, jerry-rigged methods. In the Model Hospital’s corridor, a man on a thin mattress shows off his rudimentary split, made from jagged pieces of wood and tied together with an old T-shirt. In another Kathmandu hospital, ropes weighed down with bottles of water help apply traction to a young girl’s leg fractures.
In the sleek, newly-built Kirtipur Hospital, just south of Kathmandu, obstetrician and gynecologist Ganesh Dangal is assisting with, and sometimes carrying out, surgeries on broken limbs. His tall stature and thick mustache belie his gentle manner, and he never stops smiling. “I never once imagined that I would need to do this work,” he says while doing the rounds. A young woman named Komal is awaiting bone-setting surgery. She lays in a rudimentary bed, her right leg encased in orange plaster. Wincing with pain, her relatives explain how Komal had watched their house fall around her. “I am lucky,” she says dozily, her eyes half-closed. Across from her is a middle-aged woman with a head wound and several fractured limbs.
To give a scale of the need, the country’s premier Orthopedic Hospital has performed double the amount of surgeries—121 on 97 patients—than was usual before the earthquake. “There’s a waiting list of 60 more patients, it’s more than we can handle,” says its medical director, Saju Pradhan. It is a situation repeated in hospitals across Kathmandu.
Medical professionals say time is of the essence: thousands of people are hurt, mostly from being crushed by rubble, and of these, many need surgery. The surgeries must take place over the next two to four weeks in order to make sure those in need are saved from disfigurement or handicap, says Dr. Shankar Man Rai, a burns specialist and Kiritpur Hospital’s director. “Instead of having more orthopedic surgeons, we can help instead,” Rai says. According to the British Bone and Joint Journal, 2% to 5% of earthquake crush injuries can turn into crush syndrome, a dangerous condition that brings with it the likelihood of amputation.
To speed things up, workers cleared land behind the hospital for a helipad to bring in the critically injured from the remote, hard-to-reach areas near the epicenter. The Nepalese Army, which oversees a massive relief effort, ferries them in on military helicopters.
Hundreds of international aid and medical professionals have descended on Kathmandu in recent days, replacing the swarms of foreign journalists who have moved on to their next big story. Aid relief workers have complained that the government is too slow and chaotic to coordinate properly. Nepal is ill-equipped to handle a country full of medical emergencies, and medical workers are desperately needed. But the situation is so unorganized that some people on the ground believe that they could do more harm than good.
On Sunday, the government barred large planes from entering its airport, saying cargo and military jets had damaged its tiny runway, in a move likely to further hinder aid efforts. As a water crisis and the likelihood of a food shortage grow, Nepalis are growing increasingly angry at their government. Huge crowds have protested outside parliament in Kathmandu, and mobs of men have stopped aid trucks going to rural areas, arguing the supplies are not nearly enough.
Amit Aryal, a U.S.-trained engineer who is an advisor to the Ministry of Health, frustratedly described the current situation as a “clusterfuck.” “We’re trying to deploy people according to their specialties, but there is no coordination. This is the worst emergency we’ve ever had to handle,” he says under a large red canopy in the ministry’s front yard. Foreign and Nepali medical teams buzz around energetically, preparing first aid kits and sterilizing needles and surgical instruments before heading out to rural areas. “We’re over-saturated with specialists. We just need people to mend broken bones.”
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