Isolated

The emergency room at the hospital in Gorkha in March. Litle is known yet how the hospital or its patients have fared since Saturday’s earthquake that has claimed more than 4,000 lives so far. PHOTO: MARGARET TROMP

Hundreds of thousands of Nepalis slept outdoors last night—some because their homes have been destroyed, others because they fear their homes will entomb them as they sleep. More than 4,000 are dead after the deadliest earthquake the nation has endured in 80 years. There are likely many more casualties. Landslides have shredded communications, electricity and road networks in this rugged, mountainous region, making it impossible to know the true measure of the devastation.

Picton physicians Margaret Tromp and David Beach returned from Nepal just three weeks ago, after spending a month in Gorkha, very near the epicentre of the quake, and one the hardest-hit regions.

They were in the region training medical students.

The reports they are getting from Gorkha remain sketchy, but they have been told the medical students and physicians are safe. However, they know little else, not even the condition of the hospital in which they served.

Rural hospitals in Nepal are understaffed. Some don’t have any doctors at all,” explains Dr. Tromp.

Five years ago, a medical school was established in Kathmandu, specifically to train doctors to work in the rural towns and villages of Nepal.

“In their fifth year they spend six months in a rural hospital,” says Dr. Tromp, working though the Society of Rural Physicians of Canada. “Because there are so few doctors available, they have arranged for Canadian doctors to work with these trainees in these remote settings.”

Drs. Tromp and Beach got to know the country a little bit. They know the challenges their colleagues are surely grappling with as they care for a devastated and fearful community.

Dr. Margaret Tromp (fourth from left) with students and faculty from the rural medical school in Nepal. PHOTO: DAVID BEACH

The Nepali people regularly face the harder edges of nature.

“Most of Nepal is on the side of a mountain,” says Dr. Tromp. “When everything is mountainous, things slide down a lot. Floodwater. Snow. Mud. Rock.”

About 1,000 Nepalis are killed each year by floods alone. Rural communities are particularly hard hit, often cut off for days or weeks. It is why the Nepali government is predicting the death toll from Saturday’s earthquake will likely top 10,000.

Building standards are poor. Rickety additions are erected upon rickety buildings. Streets are narrow, often with upper floors encroaching into the street, some nearly touching at the top.

“So even running out into the streets isn’t safe,” says Dr. Tromp. “People don’t die from shaking—they die from things falling on their heads. There is no place to go to get away. People are aware that another earthquake is a risk. But without the money to build a stronger house, they build what they can.”

Drs. Tromp and Beach are eager to return—though they fear for the rural medical school program and the communities it serves. Disasters tend to focus resources on the wounds and damage the world can see. Rural communities get overlooked because their pain and devastation is too often beyond our view.

“I was set to go back in September,” says Dr. Tromp. “What will happen with the program now is uncertain. If there is something useful for me to do, I will go back.

Medical students are still going through the program and likely still need some help with the teaching. If they need us, yes.”

Until then, they will anxiously await news from Gorkha.

rick@wellingtontimes.ca