How Preparedness Saved Lives in Nepal

Nepal Quarterly Newsletter, April-June 2015

For years, Dr. Pradeep Vaidya, Director of the Department of Information and Technology at the Tribhuvan University Teaching Hospital in Nepal, has been a staunch supporter of disaster-preparedness. A graduate of the USAID-supported Program for the Enhancement of Emergency Response (PEER), his planning and foresight helped ensure the hospital had a disaster plan in place, and was prepared to accommodate the large number of patients that needed care after the magnitude 7.8 earthquake on April 25, 2015.

We recently met to hear about his experience, learn from his methods, and gain insight into how investing in hospital staff’s disaster preparedness can have a ripple effect across an organization, across a country.

Before beginning his presentation Dr. Pradeep excuses himself and asks someone about their family, answers a staff question, and takes a quick phone call. He firmly shakes the hand of a student, and carefully takes time to provide insight into a chart a nurse hands him. He exudes calm, despite the many agenda items he is working with this morning—a trait which undoubtedly shone during April 25th and the following weeks.

He begins, and informatively walks through Tribhuvan University Teaching Hospital’s Disaster Preparedness Plan, which he helped develop, illustrating the measures the hospital would take in the case of a disaster. He then transitions into how and why the plan worked following the earthquake.

He stops for a moment. The room is quiet. Participants seemingly begin reflecting on the events of April 25th.

“A lot of people were saved because of this plan,” he says.

And he continues the presentation.

He tells us that the Hospital Preparedness for Emergencies (HOPE) project prepares hospitals for mass casualty incidents. Before the HOPE program began, hospitals were without comprehensive disaster plans. Since the HOPE course, 11 hospitals now have a disaster plan, with Tribhuvan University Teaching Hospital being one such hospital. With more than 24 areas of specialized treatment, Tribhuvan University Teaching Hospital is Nepal’s largest medical facility, making it strategically positioned to assist in the event of a disaster.

And the HOPE course is less than two decades old.

Since 1998, USAID’s Office of U.S. Foreign Disaster Assistance (USAID/ OFDA) has supported PEER to promote disaster preparedness through the development of national and regional cadres of professional emergency response instructors. PEER aims to assist local, regional, and national disaster management agencies in organizing and conducting standardized training in medical first response, community action for disaster response, collapsed structure search and rescue, and HOPE.

As Dr. Pradeep learned, during a disaster, healthcare centers can often become incapacitated due to infrastructural damage and overwhelmed facilities.

Enter the HOPE training course, which consists of 26 interactive lectures and seven exercises, targeted at medical professionals, teaching them how to handle emergencies involving mass casualties—such as those sustained in disasters.

HOPE graduates are able to design facility-specific plans to maximize their ability to manage emergency situations. The course includes but is not limited to instruction in hospital emergency incident command systems, hospital disaster planning, hospital evacuation, and management of the deceased. And Dr. Pradeep worked to implement these skills, back at his hospital.

With these safeguards against an emergency in place, the 300-bed Tribhuvan Teaching Hospital remained fully operational throughout the crisis. During the first 24 hours after the disaster, doctors and nurses treated approximately 700 patients and performed 300 surgeries at the hospital.

Dr. Pradeep looks at his watch, and gets up quickly—it’s time to visit a patient. We follow him through the halls, outside, and into another building where we stop to check in at a nurses’ station.

He pauses for a moment and points into a supply closet—“Not one of those glass medicine bottles fell during the earthquake,” he smiles, and a nurse nods in agreement.

To prepare for a natural disaster like the magnitude 7.8 earthquake, Tribhuvan University Teaching Hospital improved its physical infrastructure and resiliency by fastening furniture to walls, laminating windows, and stockpiling supplies in strategic locations. These simple steps helped the hospital remain safe and functional after the earthquake. They also inspired many healthcare workers to take similar steps in their own homes.

Dr. Pradeep introduces us to Urmila, a head nurse at the hospital. She sees us looking in the supply closet, and excitedly tells us how she had implemented in her own home the structural safety practices she learned from Dr. Pradeep. In a typical Nepali home, there are often several large wooden cupboards and chests that contain various family heirlooms. She reinforced these in her home by securing the furniture to the walls. And when the earthquake finally struck, she was prepared. Not one of them fell.

Many other hospital staff made similar structural reinforcements in their own homes—at Dr. Pradeep’s encouragement.

We walk over to a large grey building, with a plaque on the outside crediting support of the construction to the U.S. Government. The building, Dr. Pradeep explains, houses the hospital’s seismic-proof blood bank. Finished in 2014, it was vital during the earthquake, collecting over 700 pints of blood, and distributing blood to other hospitals. Upon entering the building, Dr. Pradeep mentions to us that the administrative team is now housed in the same building as the blood bank. As administrative offices sustained damage during the earthquake, the finance department and other support staff quickly moved into the blood bank building so they could continue their administrative tasks and ensure operations ran smoothly. “Earthquake heroes, all of them,” he said, stopping to shake hands and offer words of encouragement.

Even as reconstruction begins, Dr. Pradeep has not stopped spreading the word about the value of the HOPE Course, and the overall PEER program. Before the earthquake, he had taught its principles in several countries. After the earthquake, he is being asked to present on the hospital’s disaster-preparedness model and emergency response at conferences.

As Nepal looks to recovery efforts, strengthening health systems by establishing emergency response and disaster plans will only help boost its future resiliency.

Just ask Dr. Pradeep—or any of his staff.

To read the complete photo story on USAID’s Exposure site: https://usaidpubs.exposure.co/one-doctors-story-of-hope