Opinion

Photo story: A nurse's diary of the Nepal earthquake

Photo story: A nurse's diary of the Nepal earthquake

Prasuna Kadel, medical rescue team co-ordinator and vice-president of the Nepalese Nursing Association UK, flew to Nepal from London in the aftermath of the April 2015 earthquake. This is her diary.

27 April 2015. Flight to Nepal

Leading the earthquake disaster relief team of the Nepalese Nursing Association (NNA) UK was a huge responsibility. The magnitude 7.8 earthquake, which struck central Nepal on April 25, killed more than 8,800 people and injured more than 23,000. The earthquake (also known as the Gorkha earthquake) was followed by violent aftershocks, destroying much of the country’s infrastructure. 

I flew from London to Delhi in the knowledge that there were no flights to Nepal from Delhi airport. However, after waiting several hours in Delhi, I was fortunate to get a flight to Nepal. The plane was not able to land at Tribhuwan International Airport for about five hours, which gave me plenty of time to survey the scale of the devastation from my seat on the plane. It was especially widespread in ancient Kathmandu, where several buildings in the centre of the capital were destroyed, including centuries-old temples.

On arrival, my first stop with fellow nurse Jyoti Tiwari, was to the tallest tower in Nepal, a major tourist attraction. The nine-story Dharahara Tower is one of Kathmandu’s iconic landmarks, built by royal rulers as a watchtower in the 1800s, and a UNESCO-recognised historical monument. The earthquake completely destroyed the tower, and about 180 of its inhabitants. The smell of dead bodies emanated from underneath the rubble. Passers-by covered their noses with their hands, some wore masks, while others just walked by, accepting and inhaling the reality.

April 30 2015. Jyamdi Mandan village development committee (VDC), Kavrepalanchowk district

Three nurses from NNA UK’s rescue team, as well as a doctor, a paramedic, a volunteer and two drivers, reached Jyamdi Mandan VDC in Kavrepalanchowk district. This was one of the worst affected centers ­­– some 200 houses had been destroyed leaving families without food, clothes and shelter. Our team provided emergency treatment for wounds, head injuries, leg injuries, acute coughs and colds, diarrhoea, dysentery, eye infection, skin rashes, acute onset of asthma due to dust, and more.

Two days at Kavrepalanchowk provided us with a complete picture of the types of emergencies and health issues survivors may be experiencing in other areas. I was keen to move on and visit other places – I went to Bhaktapur, Lalitpur district, and various other locations in Kathmandu. Liaising with local teams, I witnessed first-hand the heart-breaking devastation caused by the earthquake, not only to human lives but to world heritage natural sites.

Before the second group of NNA UK arrived, I ensured all the paperwork and permissions were in order, a requirement of the Nepalese Ministry of Health. This would allow the government to monitor the number of rescue teams visiting the country and collect data from the affected areas. 

May 3 2015. Meeting at Action Works Nepal

The second group of nurses arrived from the UK. We had a meeting with Action Works Nepal’s founder and president Radha Paudel, who advised us on ordering logistic materials. We nominated sub-coordinators for the worst affected areas: Ajita Simkhada for Dhading, Rajendra Pudashaini for Nuwakot, Babita Lama for Sindupalchowk, Kamala Pandey for Gorkha, and me as team co-ordinator. I was responsible for logistics, liaising with area co-ordinators, communicating with the NNA UK team at home, as well as media reporting. We also met with Britain Nepal Medical Trust director Shobhana Gurung, who kindly provided two vehicles for our Dhading trip. Once we had our plan in place, we divided ourselves into groups according to allocation. 

May 5-6 2015. Psychosocial counselling

Our group visited the Bhaktapur district and Daman in Makwanpur district. For the three days we spent there we focused primarily on treating minor injuries, referrals to hospital and providing health advice and psychosocial counselling. Severe anxiety, panic attacks, depression, dysphonia, hypertension, shaking, and loss of appetite appeared as major health issues following the quake.

May 8 2015. Dhading

In the early hours of the morning our team of 14 rescuers headed to Dhading. Ajita Simkhada was already there, supporting earthquake victims at Ratmate VDC. Our group was allocated Marpark VDC, a remote, poor, and severely damaged area in Dhading. We drove in darkness for nearly six hours on treacherous roads. The lack of phone signal, fear of looters, landslides and losing our way made our journey extremely challenging. We finally reached Marpark before midnight; everyone was tired and hungry but we received a wonderfully warm welcome from the villagers, who cooked rice and gundruk (dried spinach leaves) for us, despite the fact that they were surviving in the open land without any food and shelter. 

May 9 2015. Helping the wounded

The majority of villagers were treated for minor cuts, skin infections, acute asthma, ENT problems, diarrhoea and dysentery, infected wounds, anxiety and depression. About 950 houses had been damaged or completely destroyed by the earthquake, so families needed food supplies, clothes, tents and medicine. After the successful medical camp and relief aid distribution at Marpark, we headed back to Kathmandu because we had run out of medicines and relief materials.

May 10 2015. Kathmandu

The team gathered for a debrief and strategy meeting. Our next plan was to visit Sindhupalchowk. We decided to split into two groups, enabling us to visit two different locations ­­– Bhotang VDC and Jalbirae VDC. I was getting hundreds of phone calls, text messages and facebook messages from all over the country. People were asking us for help or recommending places to go; others wanted to volunteer, while some wanted to support us. It was encouraging to receive such positive messages from well-wishers around the world.   

There was a shortage of supplies and relief materials in Kathmandu valley. We had to order supplies from a number of different places ­– especially tents and blankets – which were taking time to arrive.

May 11-12 2015. Fresh supplies and an earthquake

Armed with fresh supplies, we were ready for our next move, which was to one of the hardest hit regions of Nepal, Sindupalchowk. We set off on our journey but it wasn’t long before a 7.3 magnitude earthquake struck. The vehicle we were in shook badly and I could see the driver was not able to control the steering. It was one of the scariest experiences of my life. Minutes later, a second 6.3 magnitude earthquake struck. We witnessed houses falling and dust covering a whole village. All our mobile phones stopped working, people were running and screaming in fear. We stopped for the night at Zero Kilo because there were a number of landslides on the way to Sindupalchowk.

May 12 2015. Casualties

Overnight we received information that there were a huge number of casualties in Dolakha – an area where no medical help had managed to reach. Contrary to advice from the police, local communities, as well as families and friends, we boldly continued our journey in the direction of Dolakha. Our professional ethics, determination and feeling of solidarity impelled us to carry on. As we drove through Araniko highway we could see the results of recent landslides, which made the journey very scary indeed.

Overcoming all the hurdles we reached Charikot, a sleepy Himalayan mountain resort close to the epicentre of the earthquake. The Nepalese Army and the Indian Army were already there, rescuing casualties by helicopter. As we didn’t have permission from the government to visit the region, I immediately started liaising with the district health office and district hospital while the other nurses in our party began working with army rescuers. We were told that the Ministry of Health in Kathmandu had granted us authority, but we were allocated to set up camp at Putalighat – a four-hour drive away.

It was upsetting and disappointing when we were asked to leave Dolakha and travel elsewhere. We could see casualties lying on the ground needing immediate assistance but we had to follow instructions from the authorities. Despite frequent earthquake tremors, we travelled to Putalighat. After driving for three hours we started to encounter landslides. It was getting late, night was approaching and there was no way we could proceed any further. I managed to speak with the authority head who suggested that we set up camp wherever we were. It was frustrating, and admittedly scary, because we didn’t know where we were, we had no security, and it was a remote and dangerous location. We found some local people who were clearing the road and they advised us on what our best options would be for the night. We managed to get some local volunteers to help us set up our camp. We chose a site just above the riverbank on the paddy field, away from hills to avoid landslides. 

May 13 2015. Overwhelmed

As soon as word spread among the local community that we were there, hundreds of people gathered asking for food and tents. We divided ourselves into two groups – ­a health group and a materials distribution group. However, as the evening progressed, the crowd became uncontrollable. Halfway through the distribution some drunken locals began to threaten us. Distribution was stopped until the next morning. It was extremely frustrating. With the help of local volunteers, I managed to speak to the local police, who helped me recruit volunteers from the village to provide security overnight. Volunteers stayed awake monitoring the relief aid as there was the risk of looting. Our group was exhausted. We'd had nothing to eat all day apart from some light snacks in the morning. Out of nowhere, some older villagers came to the camp carrying cooking utensils and started cooking a meal for the group. People often respond to disaster with self-sacrifice and humanity, and the kindness people showed to us that night made all the difference. 

That night we experienced a number of aftershocks and a thunderstorm but the solidarity among the team of medics and volunteers gave us strength and carried us through.

May 14 2015. At the district general hospital

By 5am a big crowd of people had already gathered waiting for food, tents, and medicine. In total, we treated 115 acute and chronic cases, but we didn’t feel safe to stay there for more than a couple of days. We were more fearful for our personal security than any earthquake. It was understandable why villagers were frustrated – they had lost everything and had no food, shelter and no prospects for making a living. We were the first relief group to arrive and provided a ray of hope for the community.

May 17 2015. Landslides

It took nearly the whole day to drive along a dangerous dusty road, crossing more than 20 landslides on the way. It was one of the scariest journeys we experienced. Huge boulders were falling nonstop from the hills. It was almost 9pm when we reached Dhunche and we couldn't go any further so we stayed there for the night. Dhunche is located at an altitude of 2,030 metres and we could feel the cold. We managed to find a hotel and the owner kindly cooked us a meal.

May 18 2015. Setting up camp

We couldn’t go much further because the road was completely blocked so we decided to set up camp at Syfrubesi. The principle of Ghatlang School spoke to the local community and arranged for everyone to gather where we had set up camp. Within an hour, we could see a huge number of local people arriving for treatment and relief aid collection. We treated 123 people, the majority of whom had minor cuts and injury, infected wounds, eye infections, skin rashes, diarrhoea, dysentery, vomiting, general malaise, headache, fever, sprains, acute asthma, anxiety and depression. We provided health information to each patient and explained the risks of living with poor hygiene. I met the health professional in charge, passed on the information about the cases we had treated and handed over medicines and dressing materials. We emphasised the importance of hygiene among local communities, a matter that needed high priority to reduce the risk of skin infection and other communicable disease. There was a high volume of patients. Relief aid distribution was started – food, clothes and tents for 450 houses were provided. We could see that the little help we were able to provide brought a smile to people’s faces. On the way back we handed over a few boxes of IV antibiotic, medicines, dressing materials and medical equipment to Nuwakot District General Hospital, which was our pre-planned task. 

May 19 2015. Back together again

We all got together and shared our experience of the rescue and relief camps. Remembering those days brings tears to my eyes. The NNA team was very grateful to my parents who supported our journey from beginning to end. Like everyone else in Nepal, my mum and dad were living and adjusting to their new life outside in the garden. Without their support, the NNA UK team would not have been as efficient as they were.

May 22 2015. Homeward bound

I flew back to the UK today with a heavy heart. My friend and fellow nurse Bhawana and I were strong enough to hide our emotions at the airport, but we burst into tears once the plane took off. We hugged each other and cried and said prayers for Nepal to rise again. 

Summary

We visited ten areas badly affected by the Nepal earthquake. It was extremely tough to see the devastating effects of the earthquake – villages destroyed, dead bodies, and the psychological impact on survivors. The scariest moments were experiencing the numerous aftershocks and having to carry on with our duties. These moments make me proud to be a nurse.

The earthquake destroyed national heritage sites and thousands of homes were wiped out. Survivors were living through aftershocks and tremors. Each aftershock was testing their resilience. It was not just houses and lives that were affected, but also people’s ability to cope physically and psychologically. While I was in the relief camps, I asked people what they have been eating since the earthquake. A woman replied: ‘Everything has been buried in the house; we have no food, no money. We have been eating the grass. We boil and drink like soup, we have nothing left.’

The earthquake, fear of aftershocks and the insufficient relief and aid delivery were a tough test for anyone’s spirit, but the earthquake brought people together from all corners of the globe. Nepal witnessed the generosity and solidarity of the world as life-saving aid and rescuers poured into the country. It felt Nepal had a reason to breathe again. But the true heroes of this tragedy were the people of Nepal themselves who showed their humanity, love and kindness as they banded together to help one another.

With thanks

The NNA UK earthquake disaster medical rescue and relief campaign was successful. As a co-ordinator of the rescue and relief team, I would like to thank all the nurses, doctors and volunteers who were with me in the field, those who were in the field with other teams and those who helped individually.

NNA UK is really proud of its nurses: Tuka Sandwell, Ajita Simkhada, Kamala Pandey, Hira Shrestha, Saroja Aryal, Monika Lama, Kushum Rai, Laxmi Limbu, Shovita Karki Silwal, Jyoti Tiwari, Babi Lama, Apshara Khulal, Uma Dahal, Purnima Guring, Rajendra Pudashaini and many more nurses who were in the field. Special thanks to Radha Paudel, Action Works Nepal, Basant Kumar Chaudhary, BC Foundation and Gillian from Britain-Nepal Medical Trust for all the support. Thank you Nepal Embassy UK, the media and every individual who supported us from around the world. Huge thanks goes to NNA UK president Sushila Karki, general secretary Binodbikash Simkhada, treasurer Rashmita Dharlami, the executive committee board and all members.