Saturday, May 16, 2015

Back from Nepal

I’ve been back in DRC for almost a week.  I spent a couple of week in Nepal, assisting with the earthquake relief effort.  It was a good experience.  Nepal is a fascinating, bewildering, bizarre experience, even without an eartquake.  The earthquake has devastated this poor country and it was my privilege to go and try to help. 

Preparing for surgery
I would like to make a couple of observations.  Firstly, the “news” does not present an accurate picture.  I before arriving in Kathmandu, I had read about the situation.  It sounded like the city of Kathmandu had been flattened, the hospitals completely overwhelmed and the infrastructure totally destroyed.  This was not the case.  I landed in the airport with the other medical teams and the search and rescue squads.  There were cracks here and there, but things were functioning ok.  I was met outside of the airport by a van from the hotel.  On the trip to the hotel I looked for signs of destruction but I didn’t see much.  There were houses here and there which were damaged.  Some of the buildings looked a little crooked, but in Kathmandu a lot of things look crooked.  Most of the destroyed structures were older building make out of brick.  The more modern buildings seemed ok.  I’m not trying to make light of the situation; what happened was terrible.  Don’t believe the news, however.  The stories always make the situation sound worse and more dramatic than the reality.  A dramatic story captivates us, it grabs our attention.  It sells newspapers (do they still exist?).  Anyway, I think it is helpful to view the news as a product and not a completely accurate reflection of the situation.

Lance (R), fearless leader of medical team
The country of Nepal was certainly inundated with foreign medical teams.  Did they have needs for supplies and assistance?  Certainly, but they didn’t need all the doctors who showed up.  As a matter of fact, the Ministry of Health had a big job trying to coordinate and direct the foreign medical teams.  The military was quite effective in evacuating wounded patients to hospitals in Kathmandu.  These hospitals were quite adamant about not needing the assistance of foreign doctors.  Was there pride involved?  Was there a degree of posturing?  I believe there was.  Were there patients whose care was delayed due to inadequacies of the medical system?  Certainly.  Nevertheless, I confess that I was impressed by the general competence and efficiency of the Nepali medical system.  Many of the foreign medical teams ended up in more remote areas, vying to stake their claim and struggling to find something useful to do.  There are huge medical needs in Nepal and there is much that needs to be done to rebuild the health sector, especially in outlying rural areas.  There are incredibly remote areas which are cut off and need basic medical care. 
A typical scene of destruction

Anandaban OR
Did they need me there?  Not really.  It’s hard to say this, but I did not feel especially useful.  I mostly worked at Anandaban Hospital.  This is a smallish hospital on the outskirts of Kathmandu.  It functions as a center for the care for patients with leprosy, but they also do a fair amount of orthopedic surgery.  Obviously the leprosy work was on hold for the two weeks following the earthquake.  There was a steady, but not overwhelming caseload of orthopedic cases.  The cases were what you would generally expect in an earthquake: crush wounds, lacertations, open and closed fractures.  Most of the injuries involved the lower extremities.  We put a lot of bits of metal to fix broken bones.  It was actually a good learning experience for me, as I was able to work with some very competent orthopedic surgeons.  I learned a lot, and this felt like a real luxury.  In Congo I am forced to muddle through on my own, with inadequate materials.  In Nepal I worked with three orthopedic surgeons.  We had access to decent materials, we had good x-rays, a c-arm, good anesthesia, adequate supplies, etc.  I didn’t quite succeed in saving the world, but I learned a lot, and I enjoyed my time.  In these situations, you really don’t know what you’re going to find until you get there.

Dr. Tul, an old friend from Tansen
As always, the stories are heartbreaking.  I spoke with people who had lost half of their family in a matter of seconds.  They lost lifestock and posessions.  I spoke to one man who was in his late 90’s.  He had survived the last big earthquake in Nepal, the one in 1934.  In this earthquake he lost his wife, a son and two grandchildren.  He lost his buffalo and several goats.  I think that it is a privilege to offer help to people who have suffered so much.  When you multiply this level of several of suffering by the number of people who were affected it can be truly overwhelming.  The wonderful thing about medicine is that you have the ability to provide tangible physical care to individual people.  One woman with a fractured femur is a drop in the bucket in one sense, but in another it is the most important thing.  We put a rod in that broken bone.  It helped her pain and it got her up walking and back home to what remained of her family.   

Parked in the wrong place!
Dr.s McClusky and Tul

Nepal will continue to have overwhelming needs.  They need food, clean water, adequate sanitation and shelter.  This need for shelter will become even more pressing as the monsoon approaches.  It was my privilege to work with the Samaritan’s Purse team and I was impressed to see the level of competence and compassion that they manifested.  It was also great to see the commitment to sharing the gospel and working alongside the local Church in a culturally appropriate manner.  In a disaster situation, people need physical help, but I believe that even in this situation, people have a spiritual need.  They have questions, doubts and fears.  They need prayer, kindness and the good news.  It makes me proud to see that Samaritan’s Purse acknowledges these spiritual needs, even in the acute disaster situation. 

I’m back at Nyankunde, and truth be told, I’m far busier here.  Today we had a conference (topic: sickle cell disease), operated on a ectopic pregnancy, a prostatectomy, removed a fish bone from the esophagus of a lady (that was my most challenging case), chiseled away the outer part of the skull on a girl with a huge scalp wound, did three c-sections, an umbilical hernia on a child, several major debridements,  and treated a soldier who had been shot through the femur.  There may have been a couple of other case I forgot about.  We saw a bunch of outpatients as well.  This is my ongoing chronic disaster situation.  It may not be in the news, there may not be relief organizations rushing to help, money pouring in…but it keeps me busy.

Mostly I’m happy to be back home with my family.  I missed Lindsey and Emmanuel.  I love it all: our evening walk, my struggle to feed an active little boy, our evening winding-down rituals.  I love to see the new things he is doing, to feel his little tooth which is coming in.  All these things are valuable to me.  Yesterday was our 5 year anniversary, and our first as a family.   It gives me pause to consider the incredible blessings of this life.  I have a beautiful wife who loves me despite all the ways I drive her crazy, we have a child who is an incredible gift and a joy to us.  We have work that is challenging and meaningful.  We feel that God has called us to be here in this time. 

Thanks so much to everyone who has supported us and prayed for us.  I was especially touched by so many who prayed for us during the time we were apart.   You are an integral part of our ministry here and we can’t thank you enough.

Warren



Happy Boy




My coffee plantation- expecting a bumper crop!
Nyankunde from a drone



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