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The earthquake in Nepal in 2015 proved to be a challenging and serious global disaster that led to deaths and injuries of a great number of people. Moreover, this natural crisis caused massive destruction of the country. The national and international response involved immediate rescue, search support and personnel, medical support and teams, and emergency relief issues as well as the assets from aircrafts to deliver aid to other machinery and equipment providing people with some help. Owing to their massive support for the victims, healthcare providers played a crucial role under those circumstances. Therefore, Nepal earthquake is a bright example of a natural disaster where healthcare providers, particularly nurses, play a critical role in providing victims with medical assistance.
National and International Response
In 2015 a great earthquake happened in Nepal, which was followed by a number of aftershocks. This event led to the deaths of more than 8500 people, damage to 85500 houses, and injuries to 17600 people (Cook, Shrestha, & Htet, 2016, p.2). That event impacted the social services, livelihoods, and infrastructure of the state. Despite institutional and structural weaknesses of Nepal, the government reacted fast. The earthquake happened on Saturday, which was the only day off when all offices were closed. The national institutions reacted according to their abilities and immediately activated the National Emergency Operation Center (NEOC) and mobilized Nepali Armed Forces and Nepali Red Cross. Due to the aftershocks and the affected distinct areas, the government mobilized full logistical capacity involving helicopters to deploy national personnel in the remote areas (Grünewald & Burlat, 2016). Apart from this, Nepali Red Cross Society (NRCS) activated Emergency Operation Center and own resources involving many volunteers in the district branches (Grünewald & Burlat, 2016). Hence, the national agency’s response was fast.
The healthcare professionals mobilized immediately and reached stations in different health institutions. The response in Kathmandu valley was different from the rural district’s response because the preparedness level of healthcare providers was worse. The government insisted on paying for medical care during the emergency state. However, this information did not reach each area and many injured people stayed at home due to the fear that they might need to pay for the expensive medical care (Grünewald & Burlat, 2016). Mass causality and injury management in Kathmandu were provided in a clear way, which brought positive results in such areas as wound care, surgery, triage, rescue, and first aid. Less successful results were seen in the case of continuity of care beyond discharge, involving early rehabilitation. The situation in rural areas was more difficult where health facilities were completely or partly ruined (Grünewald & Burlat, 2016). Thus, most of the emergency cases were moved to Kathmandu within the first six days.
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This event also generated a strong reaction and a fast response from the international community. The United Nations Resident and Humanitarian Coordinator (UNRC-HC) promoted UN agencies to act outside Kathmandu, where the help was strongly needed. Numerous USAR teams with different influence and efficiency came in several days after the earthquake. Depending on the disaster type, self-sufficient, mobile, and light SAR teams acted better in comparison to the INSRAG registered heavy teams (Grünewald & Burlat, 2016). The WHO demanded further assistance, so many organizations and states sent Foreign Medical Teams (FMTO) to help Nepal with such medical services as psychiatry, obstetrics, gynecology, orthopedics, mobile clinics, and surgery. Moreover, “the Foreign Medical Teams Coordination Cell (FMTCC) was provided and coordinated by HEOC to control the activities and presence of 142 FTM from 123 organizations following the OSOC model” (Grünewald & Burlat, 2016). The Red Crescent system and Red Cross mobilized Health Emergency Response Units. What is more, field hospitals and clinics were provided. They were self-sufficient for one month and can operate up to 4 months with supplies and a multidisciplinary team from ten to twenty aid workers. They provided surgical care and other healthcare services involving child and mother care, psychological support, and community health services (Grünewald & Burlat, 2016). Thus, healthcare providers played a crucial role in supporting victims of the environmental catastrophe.
In general, social exclusion became the serious issue during the earthquake in Nepal because most of the affected people were from marginalized groups. In particular, twenty-three percent of people were seniors, twenty-six percent – single females, and forty-one percent belonged to the indigenous and Dalit communities (Amnesty International, 2015). These groups were not adequately represented and mixed with both national and international responders, which led to discrimination in access to relief. Thus, during the earthquake, the discrimination can be seen among people called Dalits and among Janajati groups (Amnesty International, 2015). Other groups of people that can be distinguished were elderly and women. They were denied in assistance, which can be the case as the nearest road to seek help is a long trek down the mountain. It means that people with disabilities, elderly, and single women with children would find it extremely difficult to pass. Another issue is the adequate housing because a huge number of people were left without houses in poverty (Amnesty International, 2015). People in urban and rural areas were living outside homes in informal and formal displacement sites under tarpaulins established by international and national organizations and the Nepal government. However, there were cases when parliamentarians took tents intended for disaster victims. Such complaints were also noticed on the local level.
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There were several healthcare service barriers. One of the difficulties was the communication problem with affected populations. Lack of information provoked poor decisions in deploying medical teams to affected parts of the country. Gaining healthcare information on the affected areas within the districts was a problematic issue due to the limited communication with several district health offices. Another barrier was the remote placement of some areas. Healthcare providers simply were not able to arrive physically in some rural areas due to the high level of destruction (Cook, Shrestha, & Htet, 2016). Furthermore, local healthcare providers experienced a lack of efficient planning and protocols for similar cases that made their work more chaotic. For instance, these medical workers did not develop a prioritizing list for victims, which had a negative effect on transporting victims from rural areas to the urban parts with greater medical capacities (Cook, Shrestha, & Htet, 2016). Another issue relates to poor transportation alternatives that forced volunteer and response groups to walk several hours per day to reach the remote areas that needed help.
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Moreover, hospitals, including central level and tertiary care hospitals, had a problem with surgical and medical supplies needed to handle the great number of trauma cases. Main stores in the states faced a lack of the needed surgical supplies and while several FMTs are self-sustained and have some supplies to assist patients, most of them provide human resource services only (Cook, Shrestha, & Htet, 2016). In addition to this, there was a problem with a lack of specialists in physiotherapy, post-surgical and post-disaster rehabilitating, and mental health. Therefore, these issues posed serious challenges to the healthcare service providers in the response to the earthquake in Nepal. Other challenges included culture and cultural norms in healthcare delivery. The medical team from the Israel Defense Force stated that culture plays a critical role in providing healthcare in Nepal, especially in case of end-of-life and surgery decision (Cook, Shrestha, & Htet, 2016). It was crucial to provide proper communication with families and patients in order to gain mutual respect and trust for healthcare treatment. International medical teams have to organize the local medical culture issues and work efficiently with nurses and physicians from the host state.
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The role of international and altruistic organizations in providing healthcare services was extremely significant. The WHO played a paramount role, responding immediately to health needs of affected people. The organization sent supplies and medicine to cover the needs of 120,000 people for three months’ period, just as the surgical and trauma kits (WHO, 2017). Shortly afterwards, it assisted technical experts from WHH-leaded foreign medical teams. They helped in the treatment of a huge number of victims. Moreover, the WHO helped with the Health Emergency Operations Center. It is worth mentioning that many other organizations have also provided their support. Without their assistance, it would be impossible to help such a vast number of people. Moreover, despite a prompt response of local government, there were not enough financial, technical, healthcare, and logistic resources (WHO, 2017). The greatest contribution was made in the healthcare area, because the Nepal government did not have a sufficient number of specialized healthcare providers, medical instruments, and medicines. Hence, the role of the international organizations in critical situations cannot be overestimated.
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Role of Nurses
The role of nurses in case of disasters is crucial. They provide trauma care as well as emergency and first aid with limited resources. Nurses provide patients with food and clean water. They offer not only the physical support but also the emotional one (Bonito & Minami, 2017). In particular, they support victims’ families and represent mental health counseling and emotional support for post-traumatic stress. The nurses’ work is guided by “such two frameworks as an ICN Framework of Disaster Nursing Competencies and the Asia Pacific Emergency and Disaster Nursing Network Ecological Framework” (Bonito & Minami, 2017). Owing to these frameworks, nurses are focused on effective management of recovery and rehabilitation, response, preparedness, prevention, and mitigation. Moreover, these medical workers play a crucial role in the crisis response, because they have to work in different healthcare fields (Bonito & Minami, 2017). The help of nurses as healthcare providers is extremely important as they assist victims effectively.
In conclusion, the earthquake in Nepal was a serious natural disaster that took lives of many people and provoked multiple injuries and terrible destruction. The national and international response was immediate and as efficient as possible in those conditions. Healthcare providers played a pivotal role in that case. In particular, nurses had to provide patients both with physical and psychological assistance under difficult circumstances. Thus, healthcare providers are a critical success factor in helping disaster victims.
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