Author Archives: Ashok Shah

Ashok Shah

About Ashok Shah

I work with CBM as RCS Field Coordinator Nepal since October 2012, and am based in Kathmandu. RCS stands for Representative Child Sponsorship, where I'm responsible for detailed documentation of children with disabilities and their journey towards transformation, with the support of CBM. I'm based partially at CBM Nepal Country Office (NCO) and at CBM partner 'Hospital and Rehabilitation Centre for Disabled Children' (HRDC) in Banepa, near Kathmandu. From time to time, I also do resource gathering trips to CBM projects in Nepal and India.

Six months after Nepal earthquake

Six months have passed. Looking back, it feels like just a short time ago that I was waiting to board a flight to Kathmandu – four days after a 7.8-magnitude earthquake rocked Nepal on 25th April. With its epicenter barely 100 kilometres from Kathmandu and first reports of the collapse of a nine-storey tower, I thought there’s nothing much left of the capital city. As I sat in the departure lounge, I could see the toll of dead and injured on the TV screen mounting every few minutes.

An aeroplane on the ground

First emergency assignment

As such, it was pouring and lightning outside, very unusual for an April spring, tourist season in Nepal. My heart went out to those who had lost their shelter and their loved ones, and were stranded in the hills amid ongoing aftershocks and unfathomable destruction.

In the next few hours, as I embarked upon my first emergency assignment, I was going to travel to some of the most affected areas and witness first-hand the scale of the destruction.

People with leg casts etc sitting eating

Outreach camp

On 1st May, I was part of a relief medical camp conducted by our partner HRDC (Hospital and Rehabilitation Centre for Disabled Children) in the yard of a partially-damaged house in Sipaghat in Sindhupalchowk district. Of the 133 clients, there were mostly people who had sustained severe head and spinal injuries, broken arms and ribs, and many had deep cuts all over their bodies. With minimum surgical equipment, the team sutured cuts and wounds, provided assistive devices such as cervical collars, splints and slings, and transported critical cases to Kathmandu for further treatment.

Meeting room with about 25 people

Cluster meeting Nepal earthquake 2015

The next two weeks were very crucial. As CBM joined forces with a string of partners, including local DPOs (Disabled People’s Organisations), to conduct a Rapid Need Assessment (RNA) of the overall situation, I had to travel to seven of the 14 worst-affected districts. The RNA team held long discussions with CBM partners on how they could scale-up their capacities to meet the sudden rise in patient count and related demands. I was also part of several UN Cluster meetings where CBM not just represented but played a crucial role in creating an advocacy alliance that voiced for ‘inclusive humanitarian response’.

As life was slowly getting back to normal, a second major quake measuring 7.3 on the Richter scale jolted Nepal on 12th May. What I saw at HRDC hospital that day will remain unforgettable. Fortunately, the 20 tents provided by CBM were useful, to shift all 72 in-patients from the wards into safer, open spaces. While the children stayed in the tents for a month, the medical team at HRDC continued to reach out to some of the remotest villages in Sindhupalchowk, Kavre, Dhading, Makwanpur and Chitwan districts, and provided much-needed medical services to the people.

A man presenting to a group of adults

Koshish PFA session

Over the next few months, I continued reporting about the efforts of CBM and its partners on the ground. As I travelled, I experienced and engaged in a range of activities conducted by CBM partners for people and communities impacted by the earthquake. Of all, the work of our partner ‘Koshish’ at providing psychological first aid (PFA) is of the utmost importance. I almost cried during a PFA session for schoolchildren in Bhaktapur district, as the little ones narrated their tales of trauma. Bhaktapur, with over 300 deaths and 12,000 injured, is one of the worst-hit districts. As schools reopened about two months after the earthquake, children were extremely happy to be sitting again in the classroom, but had a deep sense of fear and anxiety.

“Given the impact of disaster on the mental health of growing children, it’s important that we conduct psychological first aid sessions with schoolchildren…We have been doing such sessions in schools across Bhaktapur district after the Nepal earthquake,” explained Savitra Neupane, psychologist with Koshish. Furthrmore, with the support of CBM, Koshish went a step ahead to train teachers and social workers from other organisations on PFA and psychosocial counseling. “Sadly, there aren’t many organisations working to address the psychosocial needs of people affected by the earthquake… We’re happy to be working with CBM,” Savitra added.

A young mother with baby

Ganga’s newborn baby

Another memorable moment was meeting Ganga at the field hospital of our partner ‘The Leprosy Mission Nepal (TLMN)’ in Lalitpur district. “Ganga was heavily pregnant during the second quake on 12th May. As we were living in a tent, we were really worried about Ganga’s health. Yesterday morning we brought Ganga to Anandaban (TLMN) Hospital at around 7 am. We didn’t want to take any risks of post-partum complications. But even here everything was out in the tents… Ganga delivered a boy at 7.25 am. It was a smooth delivery and everything went well,” exclaimed Ganga’s caretaker Subhadra. Amid tents filled with injured patients, Ganga was beaming with joy. “Every now and then there’re people coming to our tent to see the newborn. I think they’re surprised to see a baby born in the tents…” said Ganga looking her baby.

Both TLMN and HRDC continued with their medical outreach camps in the affected districts. Sharing his experience, Dr Bibek Banskota, medical director at HRDC, says: “Initially, we saw a lot of clients with serious injuries at the outreach camps. But over a period of weeks to months, the flow of patients started changing into more chronic type of problems coming out of lack of proper sanitation, living in open shelters, and not having access to food and clean drinking water.”

In the meantime, CBM set up a dedicated emergency response team (ERT) in Nepal, and continued to roll out a full-fledged emergency response program with nine partners working mainly in central, and parts of eastern and western Nepal. In its first phase of eight months, the ERT was directed to work with a ‘twin-track approach’ – to empower persons with disabilities to access relief and participate in response initiatives, and to ensure mainstream relief is disability inclusive.

To me, the most strategic of interventions was what CBM borrowed from its experience of working in Haiti and Philippines – called the ADFP mapping system. ADFPs, or the Ageing and Disability Focal Points, were specialized hubs set up in three most affected districts in partnership with ‘National Federation of the Disabled Nepal (NFDN)’. These focal points were tasked with mapping all service providers in a particular area, and linking them with people or families that are in need of a particular service.

A man holding a pocket radio to his ear

Communication is essential

During a visit to Sindhupalchowk district in early July, I met Tul Bahadur (who has visual impairment) and his family at their temporary hut. Asked what support has he received from the ADFPs, a joyous Tul Bahadur explains: “I’m receiving their help since I got my disability identity card… After earthquake, they have provided me with a temporary shelter. In addition, I got 20 kg rice, two liters oil and two packets of salt. I’m happy that they provided me a radio. Now, I get all important information to cope with the post-quake situation. I even listen to music to heal my pain.”

Six months on, CBM has touched the lives of over 21,000 people from across all 14 affected districts in Nepal. Through outreach camps in remote, inaccessible villages, our partners have provided medical services to 14,800 people. Thanks to our partner Koshish, more than 2,700 people including schoolchildren have received psychosocial counseling through classroom sessions and psychiatric clinics. Through the focal points, more than 3000 people and 70 organisations have been ‘mapped’, and more than 900 referrals made. Besides, CBM has also held workshops with government officials, NGO and civil society members on accessibility and building inclusive structures. We’re also working with the Ministry of Health and Population in Nepal to provide injury management training to community health workers in 14 quake-hit districts. A campaign on accessible media information on relief and recovery work is underway; and CBM together with ‘HelpAge International’ is carrying out an operational research to analyse the impact of disasters on people with disabilities and older people, among other long-term initiatives.

However, this month as I visited Sindhupalchowk, on the way I could see children studying in an open, makeshift classroom right next to the highway – with just a tarpaulin sheet as a roof over their heads and shield from the noise of vehicles passing just inches away. I felt extremely sorry for the little ones. Indeed there’s so much to do. We have a long, long way to go… People continue to live in temporary shacks and struggle for basic needs and healthcare. October end marks the onset of winter in Nepal and temperature in the remote hills of Sindhupalchowk can drop to –5 degrees Celsius.

This week as I return to my hometown in the plains, the first time after the April 25 earthquake, my thoughts and prayers are with the hapless survivors battling winter chills up in the hills. While the rest of the country is celebrating the ten-day Dashain festival, the survivors must be missing their loved ones, must be remembering how things were during Dashain last year. But I know the tides will turn, and I look forward to being part of it, to doing more together!

Read about CBM and partners’ response

Download six month report (PDF, ~ 1.1MB)

 

The second quake – an unforgettable experience

A young boy on a bed, being hugged by a young woman

Denish, who was waiting for surgery when the second major earthquake hit

On 12th May I was at CBM partner HRDC (Hospital and Rehabilitation Centre for Disabled Children) to document our response to the first earthquake on April 25, and to record the journey of a child client from an affected district who’s now receiving free treatment. As Tuesday (and Wednesday) are surgical days here, I could find quite a few children who were injured during the quake and were on the list for surgical intervention. With the help of the nurses, I decided to make the story of Denish (who is 4), from Gorkha district, who sustained severe injuries to his right leg. (As their shelter collapsed, both the boy and his mother were buried in the debris. His mother later succumbed to her injuries… the boy was brought in an army hospital to Kathmandu.)

It was around 12 noon, I finished both the tasks and was waiting to have a word with the hospital management about the relief camps in the three CBM supported CBR districts. I had just entered the director’s room when a massive quake, almost of the same intensity as the April 25th, struck Nepal. Unlike the ongoing aftershocks, this one made an unusual noise. With me there were three other members in the room and within seconds all of us were out in the open. The tremors continued for more than 15 seconds…

Chaos

Suddenly, my mind went to four-year-old Denish whose story I had just recorded. Earlier, as I was speaking to Denish’s caretaker, the boy – who was waiting to receive a minor surgery – had fallen asleep in his bed in the medical ward. Before leaving them, I had asked his caretaker Sabina (who is herself only 19) to wait for the nurse’s call to take the boy inside the operation theatre). As I stood there, I don’t know why I thought I should check if Denish is still sleeping the ward. Instinctively, I rushed for the medical ward amidst a crowd of bellowing children and patients. As I ran, I could feel the ground was still shaking… there were patients being pulled out on their stretchers. As I entered the ward, there was no-one inside, little Denish lay there in his bed, oblivious of what was happening outside. I quickly picked him up and rushed outside. After a brief look at the chaos around, Denish went back to sleep in his caretaker’s arms…

By then, the four patients inside the operation theatre had also been evacuated. They were somehow rolled out by the nurses, with drip still inserted in their hand. Their caretakers came crying and screaming as their wards were brought out of the theatre. Mothers hugged their children and cried as they tried to wake them up. Fortunately, there was no patient with a major surgery during the time of the earthquake. As the crowd settled, there was yet another massive aftershock and the hospital immersed in a roar of cries and prayers. I had never experienced something like this before…

Shelter

A large tent with many people inside, some with plaster casts and crutches

Tents, donated by CBM, set up in open spaces

HRDC staff brought the tents that CBM had provided as relief materials. The staff team pitched 10 of them, one after the other, in the open spaces within the hospital premises. Soon, all 72 patients and their caretakers were accommodated and given refreshment. Nurses attended to those who were still on intravenous drip and counselled the parents not to worry about anything. Gradually, mats were taken out of the medical and rehab wards to make preparations for all children and caretakers to sleep in the tents at night. Soon, a decision was taken to cancel all surgeries scheduled for the next day.

At 5 pm, a pall of silence descended on the hospital. As I left, I was reminded of how a fresh quake rattled the country that day. However, after the first earthquake and a series of aftershocks, we had gathered requisite resources and were better prepared to deal with the situation… I hope we continue to exhibit the same spirit and preparedness for future quakes.

Read about my visit to one of our relief camps

 

My first relief camp – in the aftermath of Nepal earthquake

It’s 7. 30 am, and I’m outside CBM partner Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Banepa, 22 km east of capital Kathmandu. Around me is a stream of vehicles waiting to depart for the second day of the ‘Disability Relief Camp’ scheduled at a remote village called in Sindhupalchowk – the district which has one of the highest number of casualties – after a 7.8 magnitude earthquake struck Nepal on April 25, 2015. The death toll in this district alone has crossed 1300, while that of the country slowly inches toward 7,000, with more than 14,000 injured.

A bus outside 'Hospital & Rehabilitation Centre for Disabled Children

Waiting to depart

As I board the bus, I can see boxes of plaster supplies, stacks of orthopaedic appliances, drinking water, medical equipment, relief supplies and so much more. There are about 20 members in the bus, including two orthopaedic surgeons, two physiotherapists and three nurses among other paramedical and support staff, ready of the mission. As we set off, I’m reminded of the ordeal we had to go through last Saturday when the massive earthquake hit, followed by strong aftershocks lasting for several days. I’m also reminded of how my entire family slept in a hall on the ground floor, waking up several times at night to run out to the street. Then I was at my hometown Rajbiraj, about 450 km from Kathmandu.

Taking part in emergency response

Although there was no major damage to lives and property, I’ve never experienced anything so horrifying in my life. Nevertheless, I’m glad that a week later, I’m part of an emergency relief camp that aims to provide much-needed medical care and attention to the people in the remote hilly villages of Sindhupalchowk district.

Damaged buildings; people walking past, carrying bags

Damaged buildings

Two hours later, we are at Sipaghat, a village of about 1000-odd population, situated on the bank of Indravati river. All along, I can see mud houses reduced to rubble, with pieces of broken windows and doors strewn around. Sometimes, the areas smelled of decayed flesh. The devastation caused by the quake is much more than I could imagine. People here are in dire need of relief services.

 

Relief

Soon after, as we park the bus in the village and begin to take the tarps out, a huge crowd gathers to know if we have brought relief supplies for distribution. However, they are equally relieved to know we have come to provide free medical care for those who suffered injuries during the earthquake. While we are just setting up the venue and opening the supply boxes, three severely injured victims have already been brought to the camp.

The first client is Deepa, a young woman with a spinal injury and an arm fracture. She has been carried from a village across the river on a makeshift stretcher, waiting for medical attention since last Saturday.

“I thought I had managed to leave the house when the roof came crushing down on me. I fell on the ground, unconscious… Later, my mother came to pull me out of the debris…” recounts Deepa with a heavy voice. “I have been waiting for medical care since then….” she adds as tears run down her face.

Her house has collapsed completely and she had to stay in a tent with all her injuries for the last six days. The earthquake triggered landslides which cut off the only way to her village. It was only on Thursday, April 30th, a rescue team managed to land a helicopter in the village and provided her a spinal belt to hold the backbone in position. At the camp, the doctors decide to transfer Deepa in an ambulance to a private hospital in Kathmandu, where she will be given free treatment.

More people arrive

As the medical team continues to attend to clients at the venue, the HRDC bus is sent out to bring more patients from the nearby villages. There isn’t a moment the medical and support staff can have rest as more and more clients keep coming in. There are patients of all age groups, with broken arms and ribs, severe head and spinal injuries, and many with deep cuts to their heads and other body parts. With minimum surgical equipment, the doctors are also able to suture cuts and wounds – relieving the victims of the burden of travelling to the nearest hospital. There are also people suffering from diarrhea, fever, cold and other communicable diseases. All of these clients are given free medicines – and a relief pack comprising of biscuits and energy drinks, which the support staff have tirelessly packed the previous night.

People sitting eating; one girl has plaster cast on leg

Children with broken limbs, who were provided plaster casts, have been asked to come to HRDC for a follow-up after a week

By the end of the day, a total of 133 clients from 10 neighbouring villages have been treated at the relief camp, including 13 severe cases who are transported to Kathmandu in an HRDC ambulance. Also, five children with broken limbs, who were provided plaster casts, have been asked to come to HRDC for a follow-up after a week. And just like the camp, they would be treated there free of charge.

“I’m so happy that we could serve as many as 133 cases today, who would otherwise have been left in the lurch. I’m very thankful to all the support staff and volunteers who went out to bring patients from the nearby villages…” says Dr Bibek Banskota, medical director at HRDC. “I believe there are more people injured by the earthquake and are waiting for medical services… I think we need to plan more relief camps in this district.”

Hope

It’s 6 pm, and the sun is coming down slowly on the hills of Sindhupalchowk. A district that is barely 100 kilometres from Kathmandu had to bear the burnt of the violent earthquake. Nonetheless, with a caring organization like HRDC in the neighbourhood, there is definitely some hope for the affected communities. All in all, it was an immensely fulfilling day… although I’m exhausted and ready to drop, I’m happy that I could do my bit to support fellow humans in need.

Thanks to CBM and HRDC.

Read more about Nepal earthquake