PakMediNet Discussion Forum

Update by a Pakistani American Surgeon

This is a personal account of a surgeon who recently returned from Earthquake-affected areas.

"I have just returned to Rawalpindi from Garhi Dupatta in Azad Kashmir. I think that is important to know what is going on up there and what can be done to truly help.

THE SITUATION IN ISLAMABAD:
First of all, with each passing day, hundreds are dying. I was invited to work at PIMS, so I spent a few hours there on Monday. There appears to be no sense of urgency there. To me, it seemed like just another day at a government hospital. Loads of patients in the hallways. Dozens of school kids in uniform running around, medical students involved in heavy duty poondi, junior resident level doctors sitting around in their respective offices, no attendings in sight and absolutely nothing being accomplished. There was one wound being debrided in the operating room. The CEO (or equivalent therof) asked me to relax and rest for a couple of days! The chief of surgery happened to drop by for a meeting. I offered my services and he was quite offended by my remarks that not much appeared to be going on. I was told that in the preceeding 8 days, they had placed 12 chest tubes and had performed 1 splenectomy. He was proud of their achievement. Tens of thousands dead, uncountable others injured - quite an achievement indeed. The ICU had nine patients in it. Nine. On our insistence, they agreed to send us to Mansehra.

MANSEHRA:
Drove to Mansehra. The destruction becomes evident past Abbottabad. You can see the images on TV. The smell of death, however has to be experienced.The government degree college in Mansehra is now a makeshift hospital. 2nd year med-students were dealing with infected open fractures, using
diclofenac as pain medication. I spoke with the Swiss orthopedic surgeon running the outfit. He offered us positions as floor nurses.Literally. When I insisted that we had much more to offer, he quite unpolitely
asked us to leave. Balakot is about two hours from Mansehra. There is no building left standing. There are hundreds still decaying in the open. After dark, every vehicle is looted by the desperate locals. It is hell on earth. We chose not to stay.

MUZAFFARABAD:
We received an offer by PIMA (Pak Islamic Medical Assoc) to man their field hospital in M'abad. I reached there Tuesday morning. The roads are extremely tenuous. There is a sea of tents of various outfits from all over the country. These are manned by a variety of people, from house officers and medical students, to high school kids. No
attendings. The hospital needed a surgoen. There is not a single qualified surgeon in the whole city. Not one. No buildings are standing. There no clean water and little electricity. Cell phones do not work. We kept moving on.

GARHI DUPATTA:
I finally rendevouzed with the group from George Washington University that I had originally planned to go with. ------- had been in touch with --------'s wife in DC and somehow got me their whereabouts via satellite phone. They had reached there a few hours before we did. I helped set up the field hospital. Check the map. This place is 20 miles from the LOC. It is the farthest medical facility out there. First contact point. Over the next four days, we saw about 1500 patients. We set up a two table OR and various examination stations. The major abdominal/thoracic injuries are now dead. What we saw were heavily infected wounds. Open fractures. Gross osteo. I lost count of the number of the number of guillotine amputations needed. Florid tetanus. Meningitis. Sepsis. Pelvic fractures. Numerous paraplegics and quads. People with jelly for spines. Brain exuding from open skull fractures. Ruptured bladders with urinomas in the thigh. The fascinating thing is that these people were still alive this far out. Natural selection, I guess. The fittest survive. With two surgeons, including myself, one anesthesiologist and numerous internists, cardiologists and pulmonologists, we were still busy from 0600 to midnight. The army arrived the day after we did and set up a helipad and a unit next to us. We were able to evacuate about 40-50 patients each day after stabilizing them. Unfortunately, I knew what awaited them in Islamabad. We were choppered out today. We have left a fully functiong hospital to some docs from DOW. They'll be there until next week. Then a surgeon will arrive from New Jersey. Teams from Canada, Belgium and Australia have since arrived and set up in-patient facilities proximal to our hospital. Again, family practitioners, but no surgeons. We were able to send some relatively stable patients there, so as to avoid flooding Islamabad.

ASSIGNING CREDIT/POINTING FINGERS:
The US choppers are flying non-stop. Hats off to them. No nonsense. Efficient. Courteous. They flew over us to distal points, dropped some supplies, returned the remaining to be stored at Garhi Dupatta and evacuated our most critical patients out. This went on during all daylight hours. The Aga Khan foundation has acquired Swiss helicopters and were also working in a similar fashion. No evacuations, however.
The pakistani army is another story, unfortunately. There were about 300 soldiers twiddling their thumbs as we we struggling to get something done. In my view, they should have been sending out teams with tents and supplies to find the countless up in the mountains who are unable to make it down. Instead, there are grand plans to make tent cities, where people are expected to come down and settle. Nuts. Every patient had the same story. Two or three kids dead. Parents dead. Siblings dead. A wife and a couple of kids injured, but still alive and lying in the open. They had to make the choice - bring the child that they thought would survive. The average trek was four days one way.

WHAT YOU CAN DO:
Don't just send money to random sites. There is enough there already that needs to be distributed. Send Tents to specific people that you know will distribute them to the people still up there. Tents. Tents. Tents. Did I mention that they need tents? Clothes are a-plenty. They just need to be distributed. Once again, they need to reach the people who will wear them. The best thing you can do, however is go yourself. Find a week or ten days. Go to Garhi Dupatta. Rough it out. Do some wound care. Deliver a few babies. Treat some infections. Just do it. Do it now. The contact person is ---------. He is a cardiac surgeon at GW. Find him on the web. He'll point you in the right direction. If tickets are in issue, tell me. I'll give the contact for the Disaster Relief Network. They'll pay for airline tickets and incidentals. Sponsors are out there. What they need is your time and effort. Once I have caught up with my sleep, I'll give you more details.

Nauman Jahangir, MD
Cardiovascular & Thoracic Surgeons of Nevada
Las Vegas, NV 89121"

[Edited by rqayyum on 03-11-2005 at 08:36 PM GMT]

Posted by: rqayyumPosts: 199 :: 03-11-2005 :: | Reply to this Message

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