Conference

1. 2015 Earthquake: a “PRIVATE”
Hospital Experience
Prof. Dr. J L Baidya
FRCS(Ed.),FRCS(Eng.),FCPS(Pak.)

2. Were we prepared?
7.9 Richter = 500 atomic bombs dropped in Nagasaki & Hiroshima

3. •Regular Disaster Drills
•Staff Training, Triage Systems
•Primary Trauma Care Courses
•Evacuation Plan
•Fuel and Electricity Contingency Plan
•Open Shelter, Tents etc. ??

4. Set up of “TENT WARDS” for patients

5. •Mortuary full !
•Oxygen depleted !
•Electricity Inadequate !
•Tents Inadequate !
•Telephones not working !
•WHAT ODDS DID WE HAVE TO WORK AGAINST?

6. 114 casualties were attended on the first day
itself, many with serious open injuries

7. Door triage and observation tents were set up for any victim
requiring hospital services

8. •Outdoor life-saving surgery had to be performed
while major aftershocks were in progress
•A proper hospital tent was still a far-cry!!

9. Regular appraisal of work being done and challenges
faced, was shared with visiting government officials

10. Triage Summary B&B: 507 patients
Door Triage - 50
Registered Triage: 457
1st Disaster - 422
2nd Disaster - 35
0
50
100
150
200
250
1st Disaster 2nd Disaster
232
17
190
18
1st vs. 2nd Disaster
Female
Male
Female
(249)
54%
Male
(208)
46%
Sex Classification
Average Age: 42 Years

11. 114
49
19 20
28 29
53
39
25
17
8
30
26
0
20
40
60
80
100
120
25-Apr 26-Apr 27-Apr 28-Apr 29-Apr 30-Apr 1-May 2-May 3-May 4-May 5-May to
11-May
12-May After 12-
May
Triage Patient Flow

12. District-wise Triage Summary
Total Districts- 29
Total Patients - 457
Others: Makwanpur, Okhaldhunga, Dolakha, Bara, Tanahu, Bhojpur, Jhapa, Kaski,
Sunsari, Dhanusha, Gorkha, Kailali, Mahotari, Ramechhap, Taplejung, Panchthar,
Sindhuli, Siraha, Solukhumbu, Syangja, Nawalparasi
Lalitpur
(186)
41%
Kathmandu
(76)
17%
Sindhupalchok
(63)
14%
Bhaktapur
(31)
7%
Nuwakot
(23)
5%
Kavre
(21)
4%
Dhading
(14)
3%
Rasuwa
(7)
1%
Others
(36)
8%

13. Admission Summary (Total = 228)
B&B = 198
HRDC = 30
Admission at B&B : 198
Children Admission at HRDC : 30
Total: 228
1st Disaster Admission at B&B - 189
2nd Disaster Admission at B&B - 9
Children Admission at HRDC - 30
0
20
40
60
80
100
120
1st Disaster 2nd Disaster
103
4
86
5
1st vs 2nd Disaster
Female
Male
Female
(107)
54%
Male
(91)
46%
Average Age: 47 Years

14. 15
25
3 3
16
12
34
26
18
15
5
6
20
0
5
10
15
20
25
30
35
40
25-Apr 26-Apr 27-Apr 28-Apr 29-Apr 30-Apr 1-May 2-May 3-May 4-May 5-May to
11 May
12-May After 12-
May
Admission Patient Flow B&B

15. District-wise Admission
Total Districts- 15
Others: (1 Admission each)
Dhanusha, Mahotari, Makawanpur, Okhaldhunga, Tanahu, Bara
Lalitpur
(43)
22%
Kathmandu
(42)
21%
Sindhupalchok
(50)
25%
Nuwakot
(16)
8%
Bhaktapur
(12)
6%
Kavre
(14)
7%
Dhading
(7)
4%
Rasuwa
(6)
3%
Dolakha
(2)
1%
Others
(6)
3%

16. Surgery Summary
Surgery at B & B Hospital: 389
Pediatric Surgeries at HRDC: 30
Total Surgeries Performed: 419
Major Surgeries
(226)
54%
Major Pediatric
Surgeries
(30)
7%
Debridements
(164)
39%
Operated Patients at B & B Hospital: 166
Operated Patients at HRDC : 30
Total Operated Patients: 196

17. Surgical Procedure Flow
3
28 25
15
15
25
31
22
30
37
29
21
15 13
1
10
2
68
0
10
20
30
40
50
60
70
80
Outcome Female Male Total
Dead on Arrival 9 2
11
Inpatient Death 2 5
7
Total 11 7
18
Mortality

18. Hospital Expenses
Before Tax (Rs)
Pharmacy Expenses
(Rs)
1,75,87,002.00 52,15,666.00
Total 2,28,02,668.00
till 25 June 2015
Expenditure (B&B Hospital)

19. Emergency Surveillance and Response (ESAR)
Free Health & Relief Camps
Completed Camps: 54
Total Patients seen so far: 27,816
•Launched on the 1st of May by B&B Hospital and HRDC
•Aim to identify and treat victims (comprehensive medical
and surgical treatment) and distribute relief materials
including food, clothing, medications and dignity kits

20. B&B/ HRDC ESAR free health & Relief camp

21. Banskharka, Sindhupalchowk
Sipaghat, Sindhupalchowk

22. Januka was seen at ESAR Dhading camp
Was airlifted to B&B Hospital with the help of Nepal Army
Had florid Necrotizing Fasciitis with systemic disturbances
Radical Debridement in OT same night
Multiple debridements , IV Antibiotics and STSG

23. Way to Banskharka, Sindhupalchowk
Way to Bhotechaur, Sindhupalchowk

24. Destroyed Local Health Post &
School
Sangachowk, Sindhupalchowk

25. Sangachowk, Sindhupalchowk
Baruwa, Sindhupalchowk

26. 80 year old man hit by a
landslide stone on 25th April
Open wound had received no
treatment
Bhotechaur camp,
Sindhupalchowk

27. Substantive evaluation or dogmatic assumptions???
Incentives to perform….If not, AT LEAST some appreciation!!

28. In Summary…
• Since 25th April 2015:
– 419 surgical interventions between B&B Hospital (389) and
HRDC (30)
• The ESAR health and relief camps since 1st May 2015:
– Over 27,000 earthquake victims have been beneficiaries of
basic and comprehensive medical and surgical care and
relief items (food, clothing, dignity kits etc.)
– 54 camps have been completed in the worst hit areas of
Sindhupalchowk, Kavre, Dhading, Nuwakot & Lalitpur

29. Points for Discussion
• How can we be better prepared?
• The important role that “PRIVATE” institutions can (and have) played
• What is the states responsibility apart from delivering ultimatums
and criticism!!
• Who is responsible for SUBSTANTIVE EVALUATION of work being
done?
• Is it right to group an institution as “private” without differentiating
the amount and quality of contribution made?

30. “the woods are lovely, dark and deep
But I have promises to keep
miles to go before I sleep
miles to go before I sleep….”
- Robert Frost