Two years on, disability continues to stalk 2015 earthquake survivors

Kathmandu, April 23

The day after Nepal was struck by a devastating earthquake, Samrat Basnet opened his doors to the wounded as hospitals overwhelmed with thousands of victims had to send away those without life-threatening injuries.

Two years on, Basnet is still caring for a handful of the 22,000 Nepalis injured in the disaster, many left with preventable disabilities after slipping through the cracks of a woeful healthcare system.

With just seven health workers for every 10,000 people, the country was grossly ill-equipped when the massive 7.8-magnitude earthquake struck on April 25, 2015, levelling whole villages and killing 9,000.

Small, impromptu clinics like Basnet’s picked up the slack. As patients were discharged from hospitals to clear beds, Basnet tended to their injuries on mattresses in his cramped office in Kathmandu. But the hospital engineer never imagined he would still be their carer two years on.

“There are hundreds of times I thought I could have stopped this, I could have gone back to my normal life,” he said. “But when I see these patients, I cannot do that.”

After the earthquake, a seemingly endless stream of injured poured into Kathmandu needing treatment.

Once patched up, the hospitals sent the injured away. Many had nowhere to go or were sent back to damaged homes where they could not receive necessary follow up care.

“In the districts, there were not any rehabilitation or surgery facilities, so the people who required rehabilitation didn’t get it,” said Sunil Pokhrel, a physiotherapist with the charity Handicap International.

“That’s why they have developed the stiffness of the joint, infections in the wounds.” There is a lack of data on the number of people who have been left permanently disabled by the earthquake, but some estimates say it could be as high as 3,000.

A report released last year by the United Nations Development Programme said a significant proportion of disabilities in Nepal were preventable, caused by avoidable complications and a lack of follow-up care like physiotherapy.

Krishna Hari Pudasani, 28, used to work as a trekking guide but today is paralysed, bedridden by tetanus from a small cut to his ankle. “I am feeling very bad, because he used to work hard and earn and now he is in this condition,” said Pudasani’s father Lilanath, as he fed his son via a feeding tube.

Basnet’s first patient was a woman he found in an alleyway with severe head injuries. She had been patched up at a hospital then discharged but needed ongoing care, so Basnet brought her home where he had medical equipment on hand.

Soon overwhelmed doctors and nurses were on the phone, asking if he could take a few more. Within a few days, every room in Basnet’s office was full as he tended to around 25 patients.

Today he still cares for six people injured in the earthquake, most of whom have required repeated follow up surgeries. Basnet ferries them to the hospitals for appointments and his team of five nurses and one physiotherapist provide the post-surgical care they otherwise would not receive.

“They (the hospitals) have to discharge them as soon as possible, as soon as they are operated on, within two, three days. This is the problem of our healthcare system,” Basnet said.

The World Health Organisation recommends a minimum of 34.5 skilled healthcare professionals per 10,000 people — nearly five times the number available throughout the country right now.

The shortage almost robbed Sarita Tamang of her ability to walk and care for herself after her right hip was crushed in the earthquake. She lay trapped for hours under the rubble of a collapsed wall that killed her husband and for months relied on crutches to walk and her son-in-law to help her use the toilet.

Tamang’s mother, as she watched her daughter struggle to walk, wondered if she would have been better off meeting her husband’s fate.

But after months of physiotherapy in a tented clinic run by Handicap International in Chautara, a town 107 kilometres (66 miles) east of the earthquake’s epicentre, Tamang now walks unaided with a barely detectable limp.

The 32-year-old still needs one final surgery to remove a metal rod in her leg before she can put the disaster behind her for good. “Then it will be better, like it was before,” she said.