Monday, November 07, 2005

STORIES From the Field: Doctor’s Diary

by Dr. Naseem Salahuddin

Three weeks after the earthquake struck, our team of 6 doctors- four women and two men- was in Muzaffarabad and Jhelum Valley to run a medical camp. The devastation wreaked by the monstrous upheaval was beyond belief. Driving through the city center of Muzaffarabad one saw hundreds of structures reduced to rubble. Cement blocks dangled precariously from metal rods, poised to crush the cranium of a survivor. The three stories of Hotel Sangam stood at an angle as if a giant hand had pushed it aside. Collapse was imminent. A car lay flattened like a pancake under a collapsed structure. The once crowded Combined Military Hospital was no more. Earth movers were leveling the ground which had swallowed up doctors, nurses, patients and equipment. Only the metal gate creaked to testify to its past existence. Loudspeakers were still asking for help to dig out corpses from the rubble of a men’s college where the smell of decomposed bodies pervaded the air. The substandard construction of public buildings, educational institutions and hospitals became apparent as all had folded in like a pack of cards.

Our team was organized by Indus Motors which has generously arranged for rotating groups of doctors, paramedics and boy scouts from Quetta, as well as medicines and emergency relief items for distribution to thousands of victims. The house where we were accommodated was the lone intact structure in the entire neighborhood. We were transported in cars with a convoy of three pickup trucks packed with medicines and relief goods. From Muzaffarabad we drove for two hours through rough and rocky terrain past Hattian Bala and then a further hour and a half uphill through pine forests to Bani Hafez at 7,500 feet. The road was steep, narrow, winding and often dangerously eroded and cracked. At one point a bridge had collapsed into the ravine.

We had adequate help at the Bani Hafez camp. Our arrival had been announced and scouts roved neighbouring villages bringing patients on makeshift stretchers. They had already queued up and were waiting for us in the warm pleasant sunshine under the trees. There was an abundance of medicines and material for wound management. Mattresses were laid out for those in pain or exhausted from the arduous ascent or descent.

Our medical team set to work at whatever the member felt best at. The anaesthesiologist started IV fluids on a few patients in shock from infection or simple dehydration, and injected intravenous antibiotics as needed. The ENT surgeon was best at wound debridement and dressing and attending to children with ear or throat infections or removal of foreign bodies. The young dentist busied herself with oral problems and helped in wound cleaning. The general practitioner dealt with the all too frequent complaints of muscle pain from being buried under debris, respiratory tract infections and non specific GI complaints, and the medical student gave a helping hand to any one who needed one. She was particularly good with infants and small children. My own specialty of Infectious Diseases was handy for selection of antibiotics for wound infections, pneumonias and bloody diarrheas. Tetanus immuneglobulin and toxoid were absent from our formulary but at our request were made available on the following day. Scabies was rampant. For suspected fractures we would write a request for X-ray and scouts would escort the patient in the van to the facility. Some patients required admission and were sent to Abbas Medical Center.

Over the 4 days of medical camp we treated over 500 outpatients and also acted as counselors. Each man, woman or child had a poignant tale of deaths in the family, injuries or loss of home and belongings. They vividly recounted moments of the ‘quake. Typically, one heard a strange hissing sound followed by a sensation of being thrown from one side to the other; the sky darkened from thick clouds of dust. Some escaped falling debris and others found themselves buried under the rubble or a beam or a wall. One woman scraped with her fingers to get her child out only to find that her child was dead. A school teacher sitting outside the classroom saw children buried below the neck or arms and legs sticking out of rubble. He was able to rescue at least a few students while others died screaming. When he looked in the opposite direction the other part of the building had vanished and he could see the field beyond. He thought he was dreaming until it occurred to him his own children might be dead. He ran to look for them, only to find the dead body of his only son. The four daughters and wife were home and alive. “I have just come to make my son’s grave,” he added as tears flowed and his shoulders convulsed as he wept. With the enormous number of students and teachers in school at 9 am on that fateful day, and who either died or were injured, a vacuum of that generation will exist for years to come.

One man related how he was walking on the mountain with his son when the mountain fissured and the boy disappeared into the cleft for ever. A 20 weeks pregnant woman lay under a beam for 6 hours and could not be sure of fetal movements. A 12 year old girl with a fractured arm carried her infant brother for miles. They were the sole survivors of their family in the vast, lonely world. Where would they go, what is their future? I kept swallowing that painful lump in my throat.

Twelve year old Samina could not walk to the camp from severe pain in her left hip and a wrist drop, so I clambered up the slope into her improvised hut. Her parents were alive but her brother had died. After injecting a pain killer I immobilized her wrist on to a cardboard splint. The grateful mother served me hot tea and biscuits from their meager food stock. The father rummaged under the trees and picked choice walnuts and miswak for me to take back. “These and my prayers are all I can offer”, he said.

As there is no industry for local employment majority of men work in cities or overseas, leaving behind vulnerable women and children to fend for themselves. The medical, social and psychological consequences of the calamity will be permanent for many, I am sure. Medical camps are helpful but two days at two sites each were insufficient. Continuity of care is essential and I would hope that more doctors, especially women doctors and nurses would volunteer. In any case, for the future this is the time to restructure preventive and curative health care, safe housing and employment. The villagers’ requirements are of food and shelter, not clothes which are discarded on the mountain side. One man disdainfully told me he did not want used or mismatched clothes, and another said he did not wish to carry extra weight up the mountain.

A scene that shall forever be embedded in my memory is the valley that our camp overlooked. Four villages once dotted the forested mountain side. In the few seconds that the earth shook and the mountains rose and tore apart, a massive landslide swallowed all the homes in its hungry path. And there, before my eyes was a third smaller mountain in the middle of the valley. This is the tomb of a few thousand villagers.

The views expressed in this article are those of the author and do not reflect the official policy or position of the any Institution of the Government of Pakistan.


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