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Today, April 25, is a somber moment, the three-year memorial of the earthquake. Over 9,000 people lost their lives, another 22,000 were severely injured, and nearly 3 million people were thrust into a humanitarian crisis. The damages amounted to over 50% of the country’s annual gross domestic product.
That day, Mark Arnoldy, Possible CEO, and I were together with Possible team members in Achham, and the subsequent hours were filled with uncertainty, aftershocks, mourning of a national tragedy unfolding and unknowable in scope. In Achham, we are acculturated to a certain isolation; when I had first travelled there just after the civil war as a medical student, the only way to call home to check in on my dying grandfather was by pestering this one guy in town with a VSAT phone at 6 in the morning. But there was nothing like those hours after we heard the initial news – many buildings had fallen, including the iconic Dharahara tower, and all the lines went dead. It was by far the longest of the long trips back from Achham I have taken over the last decade.
Reaching KTM there was a strange desolation to many of the streets, almost like during some of the holiday periods when, for a brief moment of annual religious ritual, the direction of movement was from urban to rural and the horns were silent. Yet behind the illusory quiet of Kathmandu, an entire country, it seemed, had mobilized on a shared purpose, not in the loud and chaotic protests that toppled a king, but similar in the rarity of humanity coming together for a singular purpose. Thus this divided valley, came together, following the loss of 9,000 souls in an instant, in a sort of focused hope. Even the ever-under-resourced Ministry of Health and its much-maligned bureaucrats, operating out of its temporary Emergency Ops modular units, stepped up into an efficient focus. My surgeon friends at the corporate hospitals waived fees and turned none away; they stepped up and, in many ways, protected national sovereignty and patient rights as over 99% of emergency surgeries in the aftermath were performed by Nepalis. As those days turned into weeks, then months, now years, I think some of us long for that time of hopeful focus. There is a straightforwardness to search-and-rescue, to setting fractures and stabilizing spines, to helicopter evacuations and sending trucks of relief supplies, that is in a strange way enviable to the terrible complexities of the world outside of disaster zones.
The term triage took root in the English language during World War I; in some ways, triage serves as much for the necessary focusing of resources as it is to the survival of the triaged’ caregivers. In Nepal, for a moment, the complexities of the chronic public health crises, of undernutrition and overnutrition, of smoking addiction and hypertension, of emphysema and HIV, of spiraling urban private healthcare costs and rural neglect, were triaged away, to save lives, give blood, and fix broken femurs.
Re-reading an op-ed in the Washington Post I wrote with the then-Health Secretary, we too felt this hope that this focus would translate into “building back better”. I’m not sure much of those aspirations were realized, but, nevertheless, I remain both hopeful and grateful for what health we do enjoy and the communities that make health possible.
Duncan Maru, MD, PHD is an assistant professor of global health at Harvard Medical School and Brigham and Women’s Hospital, and co-founder of Possible, a healthcare organization in Nepal with whom he has collaborated for over 12 years.
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