Dr Elena Hazelgrove-Planel
GP trainee for medical charity PHASE Nepal, six weeks, as part of an out of programme experience (OOPE) year between ST2 and ST3 in Severn Deanery.
I sit up in bed with a cup of hot sweet ginger tea, enjoying a lie in on this one day off in the Nepalese working week.
I’m working for the charity PHASE Nepal, supervising the Auxiliary Nurse Midwives (ANMs) it employs who have just 18 months of healthcare training to work for six- to 12-month periods in remote rural villages.
I pull the blanket around me and cradle the hot tin mug – the nights are cool in this Himalayan village. It is my third day at this health post, where I have come to spend a week with ANMs Anita, Randjana and Namrata.
The ANMs and I are sitting on the floor, reading and chatting after a relaxed morning meal of lentils, rice and vegetable curry, when I hear a great rumbling sound. At first I think it must be rats again, running between the walls and the protective tarpauling sheeting, but within seconds I realise that this is something far more threatening.
Dropping everything we’re holding, we run out of the house, jumping down over a stone wall into the potato terrace as the ground sways and judders under our feet. In our socks, we half crouch among the potato plants to keep our balance, holding onto each other, watching walls crumble and hearing rocks falling on the mountain sides around us. Time seems to have stopped but I learn afterwards that that first shake lasted just under two minutes.
When the ground stills, we see and taste that the air is filled with dust. Fearing further tremors we climb out of the terrace, grabbing some essentials from the house. Along with other villagers we climb to greater security in open terraces at the top of the village. From there we watch the devastation around us as the ground continues to shake every 15-20 minutes, setting off new landslides with every tremor. Amazingly at this point there is still some phone network reception, and we manage to get word out to the PHASE office that we are safe but expecting casualties.
The ANMs and I gather on the terrace in front of our PHASE clinic, which was an old government health building.
The two-roomed building has been seriously damaged. Two walls have collapsed. The medicine cupboards have fallen over, so equipment and debris strew the floor.
Some of the local men take the risk to retrieve some essential medicines for us – we now have some bandages, suture kits, IV fluids and cannulas, oral paracetamol, ibuprofen and tramadol and both oral and IV antibiotics.
A steady stream of patients arrives throughout the afternoon, some walking, others carried by friends and family by piggy-back or in woven baskets.
The ANMs and I work closely together. Over the past three weeks I have managed to pick up some useful Nepalese phrases but my language skills are still very basic and I rely heavily on the ANMs to translate for me.
Namrata calls me over to see a six-year-old girl held in her father’s arms. She is conscious and crying and I see that her left foot is wrapped in a blood stained scarf. Namrata unwraps the makeshift bandage, revealing that the foot is attached by only a one centimetre strip of tissue to the ankle. The bones and muscle have been cleanly sliced through by a falling slate.
I wish I could call 999 for a blue flashing ambulance, but instead we hesitate, discussing whether to amputate, knowing we have only a razor blade. Part of our problem is not knowing if, or when, we will get outside help. We know that there has been significant damage to the rest of the country, and the radio is regularly announcing an increasing death toll in Kathmandu.
After conferring we decide that amputating the girl’s foot at this point will create more risk than benefit, so Namrata washes out the wound with saline and iodine and we bandage it up.
As well as tramadol, our strongest antalgic, I give her some diazepam. We only have 2mg adult tablets so we ask her parents to use their teeth to break them up. We continue to give her tramadol and diazepam at regular intervals over the next 48 hours, until our first evacuation helicopter comes on Monday afternoon.
A woman is carried to us on a home-made bamboo stretcher with a retained placenta, having given birth 36 hours ago. We unsuccessfully try simple techniques to remove it, including breast feeding and cord traction, so Randjana prepares to perform a manual removal of placenta instead. Luckily the ANMs have managed to retrieve the intact PHASE emergency delivery rucksack.
As for most GP trainees, I have limited practical obstetric experience and I’m relieved to hand over to Randjana’s skill and experience. We have a syntocinon infusion and sterile equipment but as I hold the patient’s thighs steady on our concrete veranda floor I picture the anaesthetised sterile theatre where this procedure would be carried out in England.
Night has now fallen and the electricity supply went with the earthquake. We have some assistance from the glow of the full moon but we still have to rely on torchlight to treat the woman successfully.
I hadn’t even thought about where we could sleep for the night when Anita translates that the villagers have erected a tarpaulin shelter. I am moved that despite their own problems and worries they have kept a space for us health workers. Someone has even found and cooked us some instant noodles.
Amazingly, another person lends me their phone and I cry for the first time as I call home to England.
Dawn brings with it a clear, dry morning. Relief floods over me as I walk out from the tarpaulin, grateful to be alive, taking stock of the damage and mentally trying to prepare for whatever might come next.