A shield against disaster
By Rajan Subedi, DIPECHO Manager
When on April 25 a massive earthquake struck Nepal, Lokendra Paudel, PHCC (Primary Health Care Center) Incharge of Changunarayan village development committee in Bhaktapur found himself in a health camp not far from his station. He rushed to the centre, and found that many injured had already lined up for treatment. "Initially I was confused," remembers the young, energetic doctor, "but I gradually took command. My trained team started to work the way we learned in the simulation. We were able to handle the situation without any assistance from a hospital, and some critical patients were referred. We were able to save many lives. The plans, training and simulation had built our confidence, and we became able to respond effectively. We are very lucky that the project was implemented in our health centre.”
The April 2015 earthquake proved to be a touchstone for Oxfam's Disaster Risk Reduction and Climate Change Adaptation programme. For years the programme had supported communities and health facilities to be better prepared for disasters. The outcome, as Paudel's experience shows, was positive. The preparedness paid off, and many lives could be saved.
Increased frequencies of disaster have made Nepal a major disaster hotspot area in the world. Featuring among the world’s twenty poorest countries, Nepal ranks fourth in terms of climate change impact, eleventh in terms of earthquake risk and thirtieth in terms of flood risk. The earthquake risk in the urban areas of Nepal has increased with urban densification, poorly designed buildings and inadequate public knowledge on preparedness.
Out of 21 most seismic vulnerable cities in the world, Kathmandu, the capital city of Nepal, is at highest risk in terms of impacts to people. Rapidly expanding settlements, non-compliance to building codes, excessive water extraction, encroachment of public land and inadequate government’s monitoring have increased the vulnerability at significant rate.
On April 25, 2015, a 7.6 magnitude earthquake struck Nepal affecting eight million population and killing 8,790 people, mostly due to building collapse. Out of 75 districts, 14 districts were declared as hard hit districts, including Kathmandu.
Preparing for the Big One
Government and development agencies started to work jointly on disaster preparedness in Nepal in 2008. The initiatives included participation and commitment in Hyogo Framework of Action, preparation of National Strategy for Disaster Risk Reduction and other Disaster Risk Reduction guidelines. Among them, specific health sector disaster preparedness initiatives have been taken in the Kathmandu Valley with the aim to minimize a possible catastrophe after the occurrence of a disaster.
Oxfam in Nepal has been the part of health sector disaster preparedness since 2009 through DIPECHO (Disaster Preparedness ECHO). This project is a joint initiative of the World Health Organization (WHO) Consortium with the Ministry of Health and Population, with the financial support of European Commission’s Humanitarian Aid Department ECHO. The consortium members include Oxfam, Save the Children and Handicap International. ENPHO and Lumanti are Oxfam’s implementing partners.
The programme aims to enhance the response capacity of health authorities, health institutions and community to provide medical service during and immediately after a disaster as well as strengthen health response system. The programme also aims to reduce the preventable mortality, morbidity and disease associated with the mass casualty incidents in Kathmandu, Bhaktapur and Lalitpur districts of Kathmandu Valley.
Oxfam focuses on community and health institution’s health disaster preparedness by including these institutions are the direct partners to guarantee ownership of the program. The assessment of Emergency Water Sanitation and Hygiene (E-WASH), preposition of essential items, training on planning, and formulation of the Operation and Management plans and guidelines and simulation exercises were rolled out in 2011 targeting Primary Health Centers (PHC), the major health service-providing center after disasters.
One of the PHCs targeted was Paudel's station in Changunarayan VDC. The project assessed required E-WASH items, identified gaps through a series of discussion, prepared E-WASH plan and build the capacity of PHC Staff for the proper use of the prepositioned items. Assessments were carried out in health facilitates as per the questionnaire prepared followed by a detailed observation and data collection on the measurement of water pipelines, discharge calculation, etc. This was carried out with staff from administration, maintenance, housekeeping and technical staff like nurses and public health promoters.
For the simulation, a worst scenario after an 8 magnitude earthquake was created. The simulated scenario included 20 dead, 100 injured, no electricity, no water and a big crowd making a lot of noise. Equipped Red Cross volunteers and an ambulance helped to make the scenario more real.
After a half-day simulation, the major achievements and gaps were identified and listed. It provided an opportunity to understand the capacity of the PHC to handle a disaster situation. Furthermore, it guided to improve on Incident Command System, Mass Casualty Management Plan and Operation and Management Guidelines.
The real deal
On April 25, 2015, Changunarayan was highly affected by the earthquake. More than 60% of the houses were destroyed and over 100 people got injured in the area.
During the April 25 Nepal earthquake, Dr Ritesh Thapaliya found himself in the zonal hospital of Chautara, headquarters of Sindhupalchowk district, one of the worst affected districts. “As soon as the quake struck, hundreds of victims were brought to the Chautara hospital,” recalls Thapaliya. “It was hard to handle the situation. I treated people as much as I could. There were some medicines, but we did not have water, electricity and other essential WASH items. If I had received a preparedness training and stocked emergency WASH items, I could have treated the victims in a systematic way.”
In comparison, the small Changunarayan PHC effectively respondedto 40 victims in the hours after the quake. Five staff trained under DIPECHO on E-WASH Planning, Incident Command System, Mass Casualty Management plan and efficient use of E-WASH items were ready to respond effectively to the victims of Chagunarayan along with injured of adjoining VDCs. They were able to prepare the treatment place in the open space which enabled them to classify the types of injuries. A proper coordination mechanism for referral was also activated in coordination with Bhaktapur Hospital.
When Dr Thapaliya was transferred to the Public Health Centre in Changunarayan later on that fatal day, the health professional was able to see the difference between a prepared and unprepared health facility. He says, “I now realise the project has helped to save many lives. It was amazing to see that the centre responded better than the zonal hospital. I believe that if such preparations are to be made in every hospital and Public Health Centre, the victims of any disaster will receive rapid and effective treatment in a systematic manner.”
The preposition of E-WASH items along with enhanced staff and institutional capacity all are crucial factors for this success. The project’s strategic approach has supported to save the lives of thousands of people. It is safe to assume that also in the future the ownership of the government and related stakeholders on updating stockpiles, DRR plans and conducting regular simulation activities will shield communities against disaster risks.