Nepal Earthquake Experience - a life changing experience.

It has been a month since I left Kathmandu, Nepal. Coming back, my life was in such a chaos handling the work that I had left for 8 days. Exhaustion was merely an understatement as I sought the balance between my children, my work, my patients and many more decisions that required immediate attention. 1 month is perhaps a short time to resolve most issues in view of how big they were, but I am not planning to talk about all those. I want to tell you about Nepal.

My first interest in Nepal was when I was a young girl and we use to play a detective game called "Carmen Sandiago" (Yes, I am not that young anymore) - one of the cities that the thief would travel to was Kathmandu in Nepal. Nepal also hosted the highest range of mountains i.e. the Himalayas and Mount Everest. It has been a lifelong dream to see the Himalayas with my own eyes and to experience its magnificience. It is also home of many artistic cultures of Hinduism with beautiful temples and architecture marked as UNESCO heritage sites. The lovely paintings, cashmere products, beautiful literature and unique history is enough to pique my curiosity enough to agree volunteering myself for a medical relief team despite my crazy schedule.

A massive earthquake had occurred in Nepal which caused a lot of death and destruction on April 25th 2015. It was recorded at 7.8 or at peak 8.1 Richter scale Magnitude. Gorkha was hit the worst and it was estimated 8000 people died, 23,000 people injured. It was the first earthquake in more than 80 years according to the locals. Reading about it in Malaysia, I did ask my team whether are we going or not? 

So after 2 weeks they decided to send the first team and we left on the 9th of May 2015. My team consisted of 5 people with Papa Joe being the logistics coordinator, me as team leader, another male doctor and two nurses. As usual we brought medication along which luckily we had clearance from the Malaysian Nepal Embassy to bring in so there were no hiccups. It was a 4 hour flight from Kuala Lumpur but we lost 2 hours due to time zone differences. We arrived late night and by the time we went throught the visa and customs and collecting our baggage, we were out at midnight. Luckily we were welcomed by the Islamic Sangh Nepal group who facilitiated our whole stay and mission. Checking into the budget hotel provided, I was thankful that at least it had a clean bed and a proper toilet. We brought our sleeping bags just in case we need to evacuate and sleep outside.

The rendezvous point for our team was the mosque in Kathmandu. We were amongst the fourteenth or fifteenth team sent there for medical help so most of the relief works have been done. In fact most of the teams were already leaving, but it was okay. There will always be some area requiring assistance and medical attention. In my 10 years of experience vounteering for medical relief efforts, this was one of the most well coordinated effort I have ever seen. We were astounded at the amount of funds and volunteers who came in, and the amount of food and basic necessities distributed like tents and blankets. 

I spent the first day doing the official stuffs like informing the Malaysian embassy of our arrival, visiting WHO command center and getting maps to plan out our activities. We visited the health office to inform of our presence whilst my other team members followed the Pakistan group to conduct medical health checks. So I had a good look around.

Kathmandu was a beautiful city with a mix of old and new architecture. There were purple flowers growing on trees as the mark of early summer and the weather was sunny around 25 degrees day time. However, the whole city was so dusty that it was impossible to walk around without a mask. Initially I thought that it was due to the earthquake, but then I realized that they had a dry and hot weather that causes dust particles to suspend in the air longer. Coupled with on-going pollution, construction and not-so-hygienic practices it had turned this beautiful city into a dirty one. Our food choices were limited due to our own dietary restrictions but it was good enough. The mosque provides food for 500 people a day each meal time, and there were 2 shops selling Muslim food. The spices used were very different than in Malaysia, and I realized I was putting on too much weight from the lovely Biryani dishes. Another interesting dish was Momo which was something like a boiled meat dumpling and fried meatballs.

The second day we were sent to a remote area northwest of Kathmandu at the Tamang area inside district Nuwakot. Tamang are the rural folk of Nepal who live in mountains and valleys. We literally crossed 3 huge mountains, crossed a river and travelled 3 hours in a car that occasionally required us to get off and push it out of a ditch or mud. Yes, it was fun. The people were happy to see us. I met one of the UNICEF photography groups who were stationed there for a week. Pity I forgot to take their contact information. It would be nice to see their work. On the way back, it rained and thunder was clashing as we went down the mountain back to our hotel.

The third day, we were stationed nearby at a place called Sitapaila. Sita is the goddess Sita (Hindu beliefs) who was thought to be the daughter of the goddess of earth, Bhumi. She is the central female character in the Hindu epic Ramayana and was married to Rama. She is revered as the epitome for all Hindu women and is known for her devotion, self-sacrifice, courage and purity. Paila in Nepal means slipper or shoe. The village is about 10km from Kathmandu. Being in the outskirts portray more of the womenfolk who tends to the wheat fields. Whilst in the city, I could not help but notice the more male to female ratio of people walking around.

We were about to start our mobile clinic when we heard a commotion. I turned around and everyone had left the building we were in, and I heard someone shout, "Run, run, quick". We ran outside to realize an earthquake had just occurred lasting for maybe a few seconds or minutes. (I was disorientated at that time because it was my first experience).The ground shook and then it stopped. Everyone was quiet. Then in the distance I saw one building collapse, then another one, and another one. I sucked in a deep breath and said a prayer. Subsequently there were a few aftershocks not as strong as the first but no one dared go indoors. My colleague suggested we do a quick scout survey of the area to see if anyone was injured, so with 2 motorcycles we were pillions checking on the schools, and surrounding area. Luckily none were severly injured, just a few cuts and bruises. After that, we continued the clinic and we only returned to base in the evening. It was only then did we realize the magnitude of the quake. It was a 7.3 richter arising from Sindhulpalchowk in the northeast side, extending through Kathmandu, with an aftershock of 6.8 richter occurring minutes after the first (Yes, I felt both). A building in Thamel district collapsed to rubble and a few buildings cracked. At least 117 people died and 2500 people injured this time. They were more prepared due to the first episode of quake, and most people have only started to return to their homes. Subsequently, there were a few more quakes occuring on the next days we were there.

Perhaps the worst was the one that occurred at night when we were sleeping. The whole building shook and I jumped out of bed to run downstairs. It was 2 am local time. Just as we went back to our rooms, another one occurred, less strong but significant enough to make everyone hang around outside. In the morning we were informed that the quake was 6.8 richter and that Japan had an eathquake too soon after what we felt. I couldn't sleep after the quakes. I was thinking about my babies back home. How would they survive without me? I count my blessings every day that I am alive. The subsequent days we were sent nearby to Bhaktapur (south) and the last one was at Nagarkot located east of Kathmandu. Nagarkot was at a mountain district that allowed you to see the Himalayas on good days. We were lucky, we managed to see the Himalayas although Mount Everest was covered by clouds.

Experiencing the quakes was really life changing. Some people would chide that it was just tremors, but then again, what if a building toppled on top of you or you didn't realize because you were asleep? What if the tremors were signs of bigger ones to come? The Earth is changing and we are seeing more and more disasters happening. Maybe the level of pollution and ravage that we humans have done has reached a point where the Earth needs to evolve again to cope. Maybe it is the start of the end of the world.

To the people of Nepal, I enjoyed your hospitality. They were very receptive and welcoming the help we were giving. My only qualm is the cleanliness, which I hope they will improve on after this. Regardless, I will definitely come back and hopefully in much better times as a tourist, to embass in the beauty of the old city and its treasures.

Doctors' Unity and Saying No to Dispensing Separation.

Its been awhile since I've had time to sit and write my blog. Part of it was work, part of it was keeping my mind quiet enough to focus. Despite my silence and perhaps appearance of inactivity on my social medias, I have been keeping myself up to date with issues transpiring in this country.

Perhaps the most pressing issue for the medical society at this point of time is the issue of 'Dispensing Separation'. The pharmacies are pushing for dispensing separation. What it simply means is that when you are sick and you go to the clinic, the doctor will only give you a prescription and then you have to go to the pharmacy and buy the drugs yourself. You will have to pay the doctors consultation fee, then go to the pharmacy and buy the medicine prescribed. This is being practiced in a lot of developed countries in the world and may seem to be an ideal system, EXCEPT, are Malaysians really ready to go through with this system? And are the people ready to pay two separate fees at two different locations just to receive treatment?

My personal experience of doing relief works in Phillippines and Indonesia has made me seen how difficult it was for the people. Half the time after disaster, they do not have enough money for even food, let alone two separate consultations for illness. So in turn, they just try their best to nurse the sick at home, until hopefully some NGO like mine detects them. Drug wise, some just get checked but have no money to purchase medication. Most just buy stuff off pharmacies without a prescription. Correct me if I'm wrong but how does this translate to a better health care?

Most every doctor in this country is against this new policy. For us, we feel that this will burden the patient and will cause patients to default follow-up especially in relation to chronic diseases. As it is, we already have a good healthcare system which is ranked top 5 in the world. It is very strange to change something that is good. But like everything else in this country, suddenly there is a bill out pending for parlimen to approve as an Act without the people realizing the full implications or the rationale behind it. (Examples : SOCSO Act, Personal Data Protection Act, etc). Inquisitive in nature I always question the rationale of the new acts to the officers-in-charge and most of the time they are unable to give me a logic and satisfactory answer. Most of the time, the answer would be that it was a directive from above and hence they have to follow. 

Yesterday, there was a meeting between our top doctor associations and the pharmacy associations and Health Ministry in Putrajaya. My kudos to my bethren who unitely walked out of the meeting because the pharmacy side failed to produce the bill for the doctors to scrutinize through. Fair enough, if you want to implement something that will affect a few parties, there should be total transparency of what you are implementing. But the stakeholders for this act are not happy. What they thought would be a smooth drive is now having an obstacle from professional bodies that for years have been silent. 

For the first time in so long, we see doctors uniting for a common cause. It is definitely exhilarating. For years, doctors have been victims of external parties taking advantage of our disunity. Doctors have been disrespected and humiliated by not only authorities but even the public. Too many bogus doctors walking around the street and selling 'god-knows-what' miracle cures and are accepted by public and undisturbed by enforcers, when doctors are constantly under scrutiny.

But we brought this upon ourselves. Due to the lack of unity. Doctors do not defend colleagues. Doctors attack their own colleagues. Most of the complaints and raids done on other doctors are complaints arising from another doctor (but done anonymously). Why do we as professionals, and supposed to be the top creme de la creme of the country act in such a juvenile manner? Why the bad-mouthing, backlashing, and degradation of our own fellow colleagues? 

We must learn to respect each other regardless of where they graduated from, or years of experience. Whether they are senior or junior. Whether they are a specialist or just a doctor. Whether they are in government or in private practice. Whether they choose to go into business or administration or become a public figure or politician. Each and everyone of us has the capability to do the best for our patient. We took a serious vow on the first day, to do no harm and save lives. There are many ways to save lives, so we should respect whatever our colleagues choose to do. We should indulge in healthy competition among peers, by competing on our best skill and not by degrading our colleagues. We should spread our knowledge and share our experiences and help correct our colleagues who were mistaken instead of condemning them. We have a third vow to share our medical knowledge to our peers for the continuity of medical care. Have we all forgotten these three vows?

These few weeks there will be a lot of debate on the dispensing separation bill, and my prayers go to those representing the medical fraternity of doctors. Personally, I really wish that our medical associations can unite and make us as strong as the lawyer's bar council. I envy they unity they have in keeping the interests of the professional body in tact over time. With the recent events, perhaps there is still hope for a more united fraternity.