As Beth Israel Team Deploys to Nepal, Challenges Mount

"There is a tremendous amount of death," says program leader Meg Femino.


Photo via AP

On Wednesday afternoon approximately a dozen clinicians from Beth Israel Deaconess Medical Center will deploy to Nepal, where they’ll help deliver emergency medical care amid a worsening humanitarian crisis. The team of doctors and nurses, most of who are associated with the Boston hospital’s fellowship in disaster medicine, will fly from New York to New Delhi, India, and then work their way to Sheer Adventist Hospital in Nepal’s Kavrepalanchok District, an area facing untold devastation after a 7.8 magnitude earthquake this past weekend.

“There is a tremendous amount of death,” said Meg Femino, who leads Beth Israel’s emergency management program and is among those traveling to Nepal. “It’s an austere environment. Communication is spotty—I don’t think there’s a complete picture yet.”

The death toll creeps higher each hour, topping 5,000 as of Wednesday. Understaffed hospitals and clinics have been overwhelmed by thousands of patients in need of trauma and wound care. Once Femino and the Beth Israel team reach the country, they’ll coordinate with a cluster of United Nations agencies that is supporting the medical response and get to work.

Among Femino’s concerns is that medical supplies, drugs, food, and water are diminishing as existing stocks are put to use and impassable roads and damaged infrastructure choke the supply chain. “We’re going over there with suitcases and bags full of wound-care supplies, antibiotics, pharmaceuticals, but these supplies will be scarce until things open up,” she says.

This advanced team is expected to spend approximately 12 days in Nepal, though it is likely that some members will return for extended stints.

At this point, it seems impossible to grasp the long-term needs that will emerge. Yet it is critical for the international community to act deliberately and think holistically as it responds to this disaster, says Dan Schwarz, a global health equity resident at Brigham and Women’s Hospital, who has worked in Nepal for years and was there with a healthcare nonprofit called Possible when the earthquake hit.

“We are already working closely with our partners in the Ministry of Health and central government, [and we are] in discussions about how to direct aid efforts in the short term, and in the longer term, how to build back better,” Schwarz wrote in an email to Boston. “In other recent tragedies—such as Port au Prince, 2010—we learned the sad lessons of poorly coordinated and poorly regulated aid efforts, with only miniscule percentages of aid money strengthening the public sector, and much of the money never accounted for at all…We hope that the international community will learn from past failures in disaster relief, and both allow and support the Nepali government to use the money to strengthen its systems for the future.”

Schwarz and his colleagues, most of whom are Nepali and have family members in Kathmandu, work in the far western region of the country. They felt a few rumbles from the earthquake but were spared physical damage. Emotional distress, however, runs deep, and many are torn between rushing to provide disaster relief or staying put to ensure the remote communities they work in continue to have access to medical care. It is a morally daunting decision.

“Despite the overwhelming scope of this disaster, to leave our own communities would mean that these communities would have no doctors, that they would have no nurses, no medications. Each day, for example, our orthopedic surgeon—who is one of the only orthopedic surgeons working in the public sector throughout all of Nepal—sees no less than 15 to 20 fractures or other orthopedic trauma patients,” Schwarz wrote. “Were she to go to serve the disaster relief efforts—while a very worthy cause in and of itself—those patients in our community would have no recourse to care.”

Despite a limited healthcare workforce and pervasive poverty, Nepal has made notable public health gains in recent years. Nafisa Halim, a professor at Boston University’s School of Public Health, described the country as a “positive outlier,” noting that it hit a United Nations’ goal of lowering the number of mothers who die as a result of pregnancy or childbirth ahead of schedule.

The destruction of Saturday’s earthquake threatens to reverse years of progress and presents entirely new burdens, especially with regard to mental health and women’s health. Halim has concerns that violence against women could increase as displacement camps are established. “Overall, violence against women is quite prevalent in Nepal…And violence against women and children appears to increase in disaster situations,” she says.

Femino and the Beth Israel team are acutely aware of these complex challenges and have no illusions that there’s a quick fix.

“It will take years to recover from this; children have lost parents, parents have lost children. The stress of not knowing where your loved one is—there will be a great need for mental health care,” Femino said. “Recovery is the longest piece of the emergency management cycle. Look at big events like the earthquake in Haiti or Hurricane Katrina. Those areas are still recovering.”