On 25th April 2015 a devastating earthquake struck Nepal killing nearly 9,000 people and injuring nearly 22,000. Entire villages were destroyed in many districts across the country and hundreds of thousands of Nepalese were left homeless.
Five years on, Dr Binod Dangal (Nyaya Health Nepal’s Health Care Director for Dolakha) recalls the moment the earthquake struck Dolakha (one of the epicenters) and talks about how different healthcare is now in the district.
At that very moment the earthquake struck Dr Binod was working in Gaurishankar General Hospital performing a C-section on a 42-week pregnant lady with obstructed labor. Dr Binod was in the theatre with his staff and patient when the ground started vibrating. Groaning, rumbling sounds erupted around him. The building shook, the lights went out and everyone was plunged into darkness. ‘I remember the sounds of people screaming around me, clangs of metal as equipment and oxygen tanks fell to the floor. Panic seized my breath and I had a profound sense of foreboding. As I pulled myself off the floor, sensations and images swarmed my mind. My first concern was for my patient on whom I was operating and my colleagues who were supporting the operation.’
Similarly, the mayor of Bhimeshwor Municipality Bharat KC recalls the scene he saw from his house top that day.
“When the earthquake hit us, with tremors, I could only see the cloud of dust going up. It looked like it was a war time and all of the communities were bombed. Such a devastation!” On the rebuilding work, Mayor KC says “nearly 90% work has been completed. Rebuilding work of the Integrated communities and heritage is still going on.”
Regarding the health system, Dolakha was already under-resourced and ill equipped to deal with basic healthcare needs. The community lacked surgical capacity as well as the capacity to train and teach more medical staff. There was a huge gap in the provision of mental health services - something that would be desperately needed in the wake of the earthquake. Health indicators for the district showed high home delivery rates that contributed to high maternal and neonatal mortality rates.
In the initial aftermath of the disaster, surviving staff from private and government hospitals were in a position to support less critical patients. Patients with serious injuries and disabilities were evacuated from the district army barracks to Kathmandu hospitals. Many of the health facilities in Dolakha were destroyed or badly damaged so what remained was very basic. Additionally, the supply chain to deal with the survivors was severely limited and the ability to transport urgently needed medical supplies to Dolakha was hampered. Although supplies started to arrive within a week, much life was compromised due to the initial lack of medical supplies and staff. Coordinating care was a challenge as Government facilities and the community lacked the resources to deal with the immediate aftermath and manage care delivery.
A week after the earthquake, humanitarian support began to trickle into the area. Within three weeks, many INGOs and NGO’s arrived with disaster relief programs of food, sanitation, medical management and temporary shelter for those who had been made homeless. This help was followed by medical staff who arrived to support the care being provided at facilities like Charikot public hospital.
Nyaya Health Nepal (NHN)’s support in Dolakha commenced out of this tragedy. SP Kalaunee, the Executive Director of NHN shares the experience of how NHN expanded service in Dolakha:
“Had it not been for the earthquake, we’d probably not have expanded our services in Dolakha. Following a request from the Ministry of Health and Population, I remember my first visit to Dolakha post earthquake, driving through all the collapsed buildings on the right and left sides of the road. It was heartbreaking! At the same time, we received the warmth of the people, their representatives, and government officials for support. In the last five years, we have rebuilt 18 health posts and handed them over to the government, and have provided direct care to over 274,000 people through Charikot hospital. We are blessed to be able to contribute in strengthening the public sector healthcare system.”
Within months NHN was providing high-quality free medical support through Charikot hospital. The model as “a holistic concept using post-disaster reconstruction and recovery as an opportunity to improve a community's physical, social, environmental and economic conditions to create a more resilient community in an effective and efficient way.” says Dr Binod.
After the earthquake, trauma and the incidents of mental health illness increased. There were many more incidents of depression, anxiety, alcohol abuse, psychosis, post traumatic stress disorder (PTSD) etc. as many had lost their relatives and homes. While treating the injured it NHN also provided mental health care using their collaborative care model.
NHN trained a cadre of Community Health Workers to serve in the communities supported by Charikot hospital. This integrated healthcare model in partnership with the government continues today. The partnership provides significant value in the form of enhanced quality of services, reduced costs, increased productivity, improved leverage of limited governmental resources, and risk-sharing distributed across private and public-sector partners.
The stakeholders in the district are appreciative of the work NHN has done.The parliamentarian from the district Honorable Pashupati Chaulagain says: “I appreciate not only the health care service NHN has provided but also the confidence the hospital has built among the people in the community. I can’t imagine what we would have done in this global pandemic had we not upgraded the hospital under the PPP model with NHN.”
On that fateful night in April 2015, Dr Binod and his staff not only saved the life of that mother and her unborn child but treated and saved countless others. Five years on in the face of Covid-19, Dr Binod feels the lessons learned from the 2015 earthquake and the integrated model now in place will be invaluable in the fight against the pandemic. Thanks to its integrated care model, NHN can provide holistic care at the facility and in the community. NHN’s community health workers ensure home-based care to over 96,000 beneficiaries to ensure timely case identification, appropriate treatment, counseling or referrals, and follow-up. The patient's healthcare records (recorded on a digital system) provide NHN with a good map of the healthcare landscape in the region and this will help when planning to reduce the impact Covid-19 is likely to inflict on the region.
Find out what Dr Binod and his colleagues are doing in the fight against Covid-19 in Nepal and how you can help here.