9-1-1 International: Hadassah in Nepal
At four minutes before noon on Saturday April 25, 2015, a hunk of rock nine miles under Nepal gave way to the Indian subcontinent’s constant thrust northward. Its shift triggered a blast equal to a dozen nuclear explosions. The entire Kathmandu Valley shook like a rattle and, in minutes, over 9,000 people were dead, 23,000 hurt and tens of thousands more were homeless.
One of the first international relief teams to reach quake-stricken Nepal traveled 5,000 miles to do so. On Monday morning, 30 hours after the catastrophe, a 747 airplane left Tel Aviv carrying 260 physicians, surgeons, nurses, X-ray technicians, paramedics, psychologists and physiotherapists. Its 95-ton cargo included an 80-bed field hospital with two operating rooms and four intensive-care rooms, X-ray machines, respirators, electric generators, computerized medical record systems and medications as well as bottled water, kosher food and a synagogue complete with a Torah scroll.
Israel’s aid convoy was, according to CNN, larger than all other aid efforts to Nepal combined. The State of Israel IDF Medical Corps Hospital was operational within 12 hours of landing, its launch attended by Nepal’s Prime Minister Sushil Koirala and Army Chief of Staff General Gaurav Shumsher Rana. By the time the Israelis went home two weeks later, the hospital had treated 1,600 patients, performed 90 operations and delivered 8 babies, 6 of them by C-section. They left their field hospital behind for the stricken Nepalese.
The medical team was drawn from all of Israel’s general hospitals, including the Hadassah–Hebrew University Medical Center in Jerusalem. Among the Hadassah physicians was senior anesthesiologist Dr. Yuval Meroz. Last summer, he routinely flew from Gaza with wounded Israeli soldiers, but this was his first aid mission abroad. “The needs were overwhelming,” he says. “There were many, many casualties. Most of those we treated had crush injuries. We did our best, and I believe we helped many people.”
One of them was 15-year-old Pemba Tamang, who had been trapped for five days under the rubble of the guesthouse where he was a bellboy. “I never thought I would make it out alive,” he told reporters from his bed in Israel’s field hospital. “I was eating lunch next to reception when everything started shaking. I tried to run but something fell on my head. I blacked out—I don’t know for how long. When I woke, I was buried and in complete darkness. I heard people around me screaming but I couldn’t help them. I found a jar of ghee [clarified butter] in the dark and I ate it.”
Miraculously, Tamang had no major injuries. “Like most people we treated, he was unbelievably calm and patient,” says Hadassah pediatrician Dr. Uri Ilan, another member of the team. While the majority of patients had been injured by falling walls and roofs, there were also several who presented with conditions unrelated to the earthquake. “One teenage girl came because of severe acne,” he relates. “Others turned up because they’d never been to a doctor and had heard Hadassah would give them medical attention, even though they weren’t ill. But they were only a handful among the critically hurt and gravely ill.”
A 12-year-old girl who had been found in the woods had a deep head injury. “She survived surgery, but came out of it with her left side paralyzed,” says Dr. Ilan. “Her home is in a village with no access roads and she could not go back there in her condition. Among hundreds of Israeli backpackers who flocked to our hospital to help was a trained physiotherapist. She made the youngster her project and, within a week, she had her walking.”
A young boy was diagnosed with hemolytic uremic syndrome, a food-borne illness that can lead to acute renal failure. With no dialysis equipment, Dr. Ilan contactedHadassah’s pediatric intensive care unit head, Dr. Jacques Braun, by satellite phone. Introducing himself as “today’s resident in charge at the tent hospital in Nepal,” he followed Dr. Braun’s manual dialysis directions. “It was extraordinary to get backup medical expertise in a tent in the middle of chaos and destruction,” says Dr. Ilan.
There were also basic public health issues to address. The partial collapse of Nepal’s largest private orphanage, Bal Mandir, had left 100 children homeless and suffering severe diarrhea. “I asked whether the kids were using soap to wash their hands—something that’s understandably neglected when you have been in an earthquake and lost your home,” says Dr. Ilan. “Strict rules about hand-washing with soap were imposed, and the situation improved rapidly.”
Improbably, Hadassah also contributed a Nepalese physician to the rescue team. Dr. Shree Krishna Kashichawa is at Hadassah for advanced orthopedic training. “I come from Bhaktapur in the Kathmandu Valley,” he says. “My parents and five sisters and brothers all live in the area affected by the quake. I managed to speak to them hours after it happened. None of them, fortunately, was home when the five-story building where they lived collapsed, and they were all alive and unhurt. I asked my department head, Dr. Meir Liebergall, to help me join the delegation.”
Red tape needed slashing—Dr. Kashichawa does not serve in the Israel Defense Forces and could not, therefore, be recruited as a medical military reservist—so he arrived a day later than his colleagues. He spent two weeks at the IDF field hospital, treating some 200 quake victims. Then, before heading back to Israel, he set out to find his homeless family, taking with him a sturdy military tent. “I spent a few hours with my family and felt so much better for that and for leaving them with shelter,” he says. “They know they are among the lucky ones. A neighbor lost his wife, mother and daughter that day.”
Three days after Israel opened its field hospital, the therapeutic clowns showed up, courtesy of the Dream Doctors Project. “Clowns have a unique role in disaster situations,” says medical clown David Barashi, aka Dush, a 13-year veteran who was part of Israel’s aid to post-earthquake Haiti and post-tsunami Thailand. “Clowns act in ways you don’t expect and address topics that are taboo, for reasons of fear or propriety. We were open about the earthquake and how terrifying it was. We made people laugh, and their laughter put them back in touch with themselves…. It helped them begin to let go of the trauma and start the healing process.”
Israel has blazed a trail in professionalizing clown therapy, with 110 clowns currently working in 29 Israeli hospitals. The five who went to Nepal last spring are all trained for disaster situations.
“In Israel, we work in a protected environment with a common language,” says Dush. “In Nepal, we went back to clowning roots that emphasize street performance and used lots of gadgets and props—harmonica, balloons, bubbles, blow up dolls, finger puppets, beach balls, nail polish, stickers. And bereaved children with broken legs and bandaged heads clapped and laughed.”
One heavily bandaged little boy, however, stared impassively from his stretcher in the surgery tent. He had been trapped under his home for several days, and his injured foot had been amputated.
“I looked at the boy till eventually he looked glassily back at me,” recalls Dush. “He noticed that I was a bit different from the medical personnel, with my red clown’s nose and funny hair. I smiled and approached him slowly. He gave me a surprised smile. Then I burst a balloon on the butt of a passing doctor. The boy laughed. Soon, we were squirting each other with water from medical syringes. Then we got into wheelchairs and had a race.”
Dr. Ilan works with Dush at Hadassah Hospital. “Research shows what doctors sense—clowns’ [positive] impact on pain relief, stress reduction and boosting immunity,” Dr. Ilan says. “I have come to depend on them in many situations. In those weeks in Nepal, we learned something else about their role: They were important not only to the patients, but to the medical team as well. They helped us take a breath in the midst of long hours, terrible injuries and human grief, and to function better for it. We hope to make them an automatic part of future medical missions.”
Israel’s medical delegation to Nepal is the 24th it has sent to 22 countries in the past 30 years. “There was an extraordinary sense of cooperation and resourcefulness among the team,” notes Dr. Meroz. “You are working in the field, where you rely on what you know, your intuition and your colleagues.”
“People told me I would come back from Nepal a different person,” says Dr. Ilan. “I was skeptical. I work in a tertiary care hospital and I am a military doctor, so I have seen a lot. But I did change. I came back with a new pride in Hadassah’s long tradition of serving abroad, and a new perspective on how to deliver medical care to society.”