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Nepal Earthquake: April 25, 2015

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Nepal Earthquake Rescue DogJust this past Saturday (April 25, 2015), the country of Nepal has experienced what has been deemed the worst natural disaster in Nepal’s history for more than 80 years. The Nepal earthquake was a 7.8 magnitude quake that has, so far, resulted in 5,000 deaths and over 9,000 injuries. Eight million have been affected by this disaster, so its effects are dramatic and far reaching. The earthquake has resulted in several offshoot disasters, including aftershocks, landslides and the well-publicized Mt. Everest avalanche. As tragedy strikes, 16 nations have hurried in to come to Nepal’s aid, including India, China, and Israel. The United States has sent several disaster relief teams as well as provided $10 million in assistance.

Nepal Earthquake Mt Everest Avalanche

Despite these international efforts, barriers remain to providing relief to Nepal and surrounding areas devastated by the earthquake. Barriers include unreliable means of communication, the terrain, badly damaged roads, weather (heavy rains), lack of supplies (food, drinking water, electricity, gas, etc.), unsanitary conditions and a continually rising number of injured. Hospitals in Nepal are overflowing with patients and healthcare professionals are running low on medications and surgical supplies. The relief efforts are ongoing for the country of Nepal at this time. They continue to require international assistance as they continue searching for survivors and cleaning up the rubble. The country of Nepal is dependent on income from tourism so this disaster will greatly affect their economic status.

Nepal Earthquake Relief Effort

I can’t even begin to fathom what it would be like to be a healthcare provider during this crisis. The overwhelming number of those affected and the destruction of homes and buildings is difficult to imagine. I have yet to participate in a disaster effort, let alone one of this magnitude, but it is essential that we learn from this disaster to better prepare for future disasters. Previous earthquakes and other international disasters have better equipped the world for more efficient and effective response to save lives and minimize devastation. With each new disaster, new obstacles are encountered and hopefully overcame and/or provided a learning experience that will improve the world’s preparedness for the next disaster.

References

Watson, I., Mullen, J., and Smith-Spark, L. (2015). Nepal earthquake: Death toll passes 4,800 as rescuers face challenges. Cable News Network. Retrieved from http://www.cnn.com/2015/04/28/asia/nepal-earthquake/

Shapiro, E. (2015). Nepal earthquake resucue teams en route in wake of devastation. Good Morning America. Retrieved from http://abcnews.go.com/International/nepal-earthquake-rescue-teams-en-route-wake-devastation/story?id=30609810

Mai-Duc C. (2015). Nepal earthquake: 8 million affected, 4 Americans dead; how to help. Los Angeles Times. Retrieved from http://www.latimes.com/world/asia/la-fg-asia-nepal-earthquake-what-you-need-to-know-20150427-htmlstory.html

Pesta, J. and Bhattacharya, S (2015). Rescuers struggle to reach outlying villages hit by Nepal earthquake. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/nepal-rescuers-struggle-to-reach-quake-victims-1430113791

 

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Nepal: The Disaster Response

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Image: http://i1.wp.com/www.kollytalk.com/wp-content/uploads/2015/04/Nepal-Earthquake.jpg

This past Saturday, April 25th, a 7.8 earthquake struck Nepal that has led to over 4,600 deaths and 9,000 injured people (CNN, 2015). A disaster this large in size with so many people injured requires a significant international response to provide needed supplies and care. Countless buildings and homes have been destroyed, people have have lost their families and are in dire need of food, shelter, and medical care.  The United States Agency for International Development (USAID) has assisted by deploying a search and rescue team to Nepal, along with a Disaster Assistance Response Team (DART) to identify and prioritize needs (The White House, 2015). Humanitarian organizations such as Doctors Without Borders and the Red Cross have also responded to the incident to provide care to those affected by the earthquake and subsequent aftershocks (The White House, 2015).

Recent priorities since the earthquake hit have included search and rescue operations to find survivors and relief efforts (CNN, 2015). Even with the help that has arrived through international aid, however, there have been significant barriers preventing the provision of adequate medical care. Hospitals in Nepal have been overwhelmed and lack needed medical supplies, survivors remain buried in building wreckage, and rural areas are not easily accessed by rescuers (CNN, 2015). One hospital is operating at over 3 times its normal capacity with over 1,000 patients (CNN, 2015). Difficult terrain creates difficulty for surface transport to more rural villages in Nepal, while storm weather conditions preclude access via helicopters (CNN, 2015). However these villages are seeing serious damage. One village in particular saw about 70% of homes destroyed with trapped people inside, especially children and the elderly (CNN, 2015). Another cited barrier has involved the small Kathmandu airport becoming jammed with incoming aid workers, which prevents the ability of all needed aid and supplies to enter the country (CNN, 2015). The supplies highly prioritized currently are food, which approximately 1.4 million people need, and tents to withstand monsoon weather (CNN, 2015).

I believe that there are some aspects of a disaster response such as this that are difficult to control for. Earthquakes are unpredictable and as such are difficult to plan relief for as the size and magnitude cannot be know beforehand. However, in 2009 the Nepal government launched a Nepal Risk Reduction Consortium, which raised awareness of the imminence of a large disaster in addition to retrofitting hospitals to withstand an earthquake (United Nations, 2015). This act has potentially saved many lives in this earthquake as the hospitals are still standing and able to treat patients. The United Nations also plans to assist Nepal in reconstructing the country to be more resilient to disasters (United Nations, 2015). Hopefully other countries will learn from this event to strengthen their own disaster preparation.

References:

Asia News. (2012). For World Bank, Nepal is Asia’s third poorest country. Retrieved from: http://www.asianews.it/news-en/For-World-Bank,-Nepal%27s-is-Asia%27s-third-poorest-country-24668.html.

CNN. (2015). Nepal earthquake: Death toll passes 4,600 as rescuers face challenges. Retrieved from: http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html.

The White House. (2015). America’s response to the earthquake in Nepal: What we can do to help. Retrieved from: https://www.whitehouse.gov/blog/2015/04/27/america-s-response-earthquake-nepal-what-we-can-do-help.

United Nations. (2015). UN allocated $15 million in emergency funds for Nepal earthquake response. Retrieved from: http://www.un.org/apps/news/story.asp?NewsID=50708#.VUAfI5Ozl2A.

Final Reflection

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It is almost unbelievable that I am sitting here writing my “final reflection.” In fact I am sitting in the exact spot in which I have done most if not all of my assignments in the last three years with my pug by my side. I am still very unsure about how I feel about this “graduating” thing. I have many emotions flood over my as I have been reflecting for the last month or so. I am filled with happiness, sadness, anxiety, fear, and hope. Happiness because I am finally finished with school after 8 very long years. Sadness because I have met amazing faculty and students that I will not be seeing on a weekly basis anymore. Anxiety because I am unsure of where I will end up in the next few weeks, months, and years. Fear because I will not have my instructors and peers holding my hand through it all anymore. And finally, hope, I have hope that I will succeed in everything that I will do here on out.

Critical care was the first rotation where I actually felt that I could do this nursing thing and be successful at it. I don’t know if it is the staff at West Hills or if you receive more respect and trust from the nurses in your last semester. When asked by the nurses, “What semester are you in?” and the reply of “My last” and the excitement of them letting you have so much more autonomy. I actually felt like they trusted me to care for a patient competently. Of course if something went wrong you had them there as your number one resource. I feel blessed to have had critical care in our last rotation. I feel like a learned more in one day in the ICU than I did in an entire semester in Med-Surg. This has by far been my most favorite rotation out of the entire program.

As we close on our last days I can’t help but think about all the memories I have with many of my peers and wondering where the nursing professional will take them. I can’t say right now that I will miss nursing school and don’t think I ever will say that, however, I will miss many of the experiences I had with my peers and faculty.

Natural Disaster

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Hurricane Katrina was the costliest natural disaster at roughly $108 billion (2005 USD) and one of the five deadliest hurricanes in the history of the United States (The Data Center, 2014). It first formed as a tropical depression on August 23rd, 2005 but upgraded all the way to a category 5 hurricane by August 28th, 2005. It struck the city of New Orleans with the intensity of a category 4 hurricane on August 29th, however, despite the weakening of the storm, levee failures caused flooding of 80% of the city with some parts being under 15 feet of water (History, 2009). Because of this, there was a widespread loss of power, communication, and clean water in the city (History, 2009). In addition, there was significant damage to infrastructure such that there was only route out of the city (History, 2009).

This disaster presented huge barriers for providing and accessing healthcare. Many healthcare providers were displaced by the storm and vital public health infrastructure such as laboratories and other facilities were damaged (CDC, 2014). It was also difficult to calculate exact resource needs because many of the city’s population of 500,000 had been evacuated (CDC, 2014). Since water quality and sanitation was poor, there was a huge risk for illnesses such as cholera and norovirus (CDC, 2014). Furthermore, a majority of the people who remained in the city were those that were very poor and had no means to evacuate the city so many took refuge in the Superdome stadium, thus increasing the risk for transmission of diseases (CDC, 2014). The stadium suffered damage from human waste and trash in addition to the elements and refugees were subsequently moved to the Astrodome in Texas (CDC, 2014). There was a response from local, state and federal agencies such as FEMA, the CDC, the Coast Guard, and the Louisiana National Guard but the federal response had been criticized due to mismanagement and poor leadership.

 

Even though the city held its first major convention in mid-June 2006 and major events like Mardi Gras were never disrupted, the New Orleans’ recovery is still ongoing (The Data Center, (2014). As of 2013, child poverty is higher than it was before Katrina, the overall poverty rate is still the same as pre-Katrina, and 36% of the city’s renters spend over 50% of their income on housing (The Data Center, 2014).

 

I imagine that working as a healthcare provider during this time must have been quite difficult. Power outages, unsanitary conditions throughout the city, limited resources, and possibly even damage to hospitals could have contributed to an environment unsuitable to deliver even basic patient care. In addition, it would be hard to not only take care of people with extremely limited resources but also to effectively care for patients while worrying for the safety of your loved ones and also if there is damage to your own personal property.

 

I think that since this disaster, there was a lot of focus on disaster preparedness and there were many lessons learned from various responding agencies. If something were to occur in Ventura County, I know the public health department has infrastructure in place to handle disasters such as stored medical supplies, food and water. Despite this, I don’t think the average citizen has even the minimum requirements of at least a 3-day supply of water for each person in the household, 1 gallon per person per day and two weeks worth of non-perishable food, not to mention extra cash, a first aid kit, and a disaster plan (CDC, 2014).

 

References

CDC. (2014, December 4). Gather Emergency Supplies. Retrieved April 22, 2015, from CDC: http://www.bt.cdc.gov/preparedness/kit/disasters/

History. (2009). Hurricane Katrina. Retrieved April 27, 2015, from History: http://www.history.com/topics/hurricane-katrina

The Data Center. (2014, August 28). Facts for Features: Katrina Impact. Retrieved April 27, 2015, from The Data Center: http://www.datacenterresearch.org/data-resources/katrina/facts-for-impact/

The Times-Picayune Editorial Board. (2014, August 29). Nine years post Katrina, a recovery still in progress: Editorial. The Times-Picayune .

 

Disasters in 2015

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Coincidentally, waiting until today to do this on health care disaster blog has given me an opportunity to look into a disaster that didn’t happen 10 years ago, 5 years ago, or last year—but three days ago. On Saturday April 25th, Nepal experienced a 7.8 earthquake affecting 8 million people that according to CNN news has more than 4,600 people dead, more than 9,000 injured, more than 1 million children urgently in need, and the count continues. As quake relief efforts continue today, officials warn that there are problems of getting aid into the country and then delivering it to some of the remote communities in desperate need.

 

Currently, there are worries about food and water supplies only lasting until the end of the week and so far the weather has showed no mercy to the country as thunderstorms and more bad weather threaten the region.

 

Also, according to a 2011 World Health Organization report, this country of 28 million has only 2.1 physicians and 50 hospital beds for every 10,000 people, making this disaster even worse from the healthcare prospective. In the hospitals, there are reports of doctors are washing up using sterile water and iodine poured from a bottle rather than hot water from a scrub sink, and instead of electric drills, relying on saws of the variety usually only used in war zones and natural disasters due to the lack of electricity. One doctor reported “I’ve seen a lot of situations around the world, and this is as bad as I’ve ever seen it.” The hospitals need more resources and personnel, and even though the help is more than willing to be given, it is not being received.

 

Countries around the world have launched massive aid operations to help victims of the Nepal earthquake, but the distribution of the resources and help is a challenge that Nepal is facing because of the size of this disaster. The question is, are we better prepared than before for this disaster? Well, the main problem seems to be how to effectively coordinate and organize the massive influx of humanitarian aid.

 

You may ask, how are there worries about food and water supplies and help with the hospitals with the enormous amounts of international aid that has been donated? Well, there have been three major obstacles identified that are slowing the efforts of distribution.

 

  1. Airport bottleneck
    1. Relief organizations say the tarmac at Tribhuvan International Airport remains jam-packed with a large number of cargo planes.
    2. Several aircraft carrying essential supplies have been turned away, or diverted to India and elsewhere.
  2. Damaged roads and infrastructure
    1. Remote areas are largely inaccessible
    2. The Nepalese government has not been able to provide relief to all affected areas because of difficulties transporting goods
    3. The helicopters to distribute goods are small and don’t fly in windy and cloudy conditions.
    4. The situation has deteriorated to the point where relief workers are as good as stranded.
  3. Ongoing damage assessment
    1. Authorities leading the response are still trying to fully understand which areas have been affected, how they are affected and what the priorities are.

 

In the past, what has been seen is that it takes a few days for supply and distribution lines to stabilize. They expect that it will be a few more days before the distribution becomes organized because the government is still constrained by the scale of the disaster. Now that the world has become more equip to help at a moments notice, hopefully in the future we can find ways to get around the obstacles that we are seeing now in this situation.

 

 

All information about this disaster has been taken from the following articles:

 

Ng, N. (2015). Nepal struggles to cope with international aid. http://www.cnn.com/2015/04/28/asia/nepal-earthquake-aid-struggle/index.html

 

Hume, T. (2015). Nepal earthquake’s victims overwhelm hospitals. http://www.cnn.com/2015/04/27/world/nepal-earthquake-bir-hospital/index.html

 

Watson, I., Mullen, J., & Smith-Spark, L. (2015). Nepal earthquake: death toll passes 4,700 as rescuers face challenges. http://www.cnn.com/2015/04/28/asia/nepal-earthquake/index.html

Fukushima

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On March 11th 2011 an earthquake of a magnitude of 9.0 hit the East of Japan. The earthquake did considerable damage but what followed did much more damage. A tsunami inundated about 560 sq km and resulted in a human death toll of over 19,000. Over 1 million building were destroyed or partly collapsed.

Eleven reactors at four different nuclear plants were operating at the time of the quake, all of them shut down when it hit. Subsequent inspection showed no significant damage to any of the reactors from the quake. The reactors were not affected by the quake it self but were vulnerable to the tsunami. There was power from the backup generators that were running the residual heat removal system cooling pumps at eight of the eleven units. The remaining 3 at Fukushima lost power when the site was flooded by the tsunami. The flood disabled 12 of 13 backup generators on site and also the heat exchangers for dumping reactor waste heat and decay heat into the sea. The 3 units were unable to maintain proper cooling methods and water circulation functions. The electrical switchgear was too disabled. Many weeks were spent trying to remove and restore the heat removal from the reactors. Radioactive material was released into the ocean and the air because of deliberate venting to reduce gas pressure, deliberate discharge of coolant water into the sea, and uncontrolled events. The emission into the sea is the most important individual emission of artificial radioactivity into the sea ever observed. Fukushima has some of the strongest currents causing dispersion to the Pacific Ocean.

Many inter-governmental agencies responded to the disaster; International Atomic Energy Agency, World Meteorological Organization, Comprehensive Nuclear Test Ban Treaty Organization. Most were concerned about the radiation exposure and populations around the world had lost faith in the use of nuclear power. Many countries have opted out of using nuclear power. International experts have said that workforce of thousands will take decades to clean the area.

The precise cost of the abandoned cities, towns, agricultural lands, businesses, homes and property located within 310 sq. miles have not been established. Estimates of the total economic loss range from $250-$500 billion dollars. 159, 128 people had been evacuated from the zones lost their homes and all their positions. Many of the people have not been compensated and some are still paying mortgage on homes that will never again be habitable.

There have not been any reports of people with radiation exposure because it is still early. However, when radioactive chemicals are released they are not only released in the air but in the water systems, and soil which will affect the population for years to come. Those who were closer to the incident are more likely to develop leukemia, thyroid cancer and breast cancer. There are barriers to accessing healthcare because the effects of radiation can take years to develop. It would be most beneficial to screen patients for early detection of cancers because of the exposure. This is an ongoing problem because there are the zones that are still affected by the radiation as stated above, the soil and water systems are contaminated. I could not imagine being a healthcare provider in such a huge disaster. Fukushima started as an earthquake where residents needed help with ruined homes and then for the tsunami to wreck more homes and kill more of the population and lastly constant radiation exposure in some areas. It was like 3 major disasters all within hours. I am unsure if in the future we are more prepared for a nuclear disaster. It has happened before Fukushima and I think unfortunately it is all about trial and error and having the proper policies and procedures in place.

References

Association, W. N. (2015). Fukushima Accident . Retrieved from World Nuclear Association : http://www.world-nuclear.org/info/safety-and-security/safety-of-plants/fukushima-accident/

Responsibility, P. f. (2015). Costs and Consequences of the Fukushima Disaster . Retrieved from Environmental Health Policy : http://www.psr.org/environment-and-health/environmental-health-policy-institute/responses/costs-and-consequences-of-fukushima.html

 

 

 

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The Boston Marathon Bombing: Alerted by a Tweet

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    Just over two years ago, on April 15, 2013, two pressure cooker bombs exploded near the finish line of the Boston Marathon, killing 3 people and injuring an estimated 264 others. Although unexpected, the time and location of the event was favorable in regards to healthcare response. For one, hospitals were already on standby for marathon runners and numerous medical professionals (doctors, nurses and emergency medical staff) were onsite at the marathon to address the needs of the marathon runners. Secondly, the 1449 EST explosion happened to also be the time of the mid-shift staffing change at surrounding hospitals, nearly doubling the number of medical staff on site.  However, the chaos surrounding the disaster made challenges inevitable.
    One of the major barriers that the trauma hospitals faced was treating unidentified victims. Within minutes of the April 15th bombing, nearby hospitals were inundated with unconscious victims without purses, wallets or family members to identify them. At Brigham Hospital, staff assigned unidentified victims six-digit numbers. However, this system created confusion for the doctors and nurses who continuously had to double and triple check that the test results and medications were going to the right patient. The chaos surrounding the unidentified victims was only exacerbated when frantic and upset family members swarmed hospitals searching for their loved ones. As a result, Brigham Hospital
now identifies anonymous patients using states, colors or the military alphabet.
    One of the most interesting facts that emerged from this disaster in regards to healthcare was the influence of social media. According to a report by The Boston Globe (2013), the hospital staff was alerted to the bombings when a physician at the scene sent a tweet. A fellow colleague and anesthesiologist was alerted of the tweet immediately notified the chief of emergency medicine and the chief of surgery, who promptly responded by canceling elective surgeries, clearing ER rooms and calling in staff members. Thus, social media is now understood to possibly be the most effective early warning system, especially in trauma as every minute counts in preparing trauma teams and operating rooms.
    Social media has not only become a means to communicate and relate information, but it has evolved to be an essential multipurpose tool for various industries. However, in medicine, social media could make the difference between life and death.

Reference

Kowalczyk, L. (2013, July). The Boston Globe. Retrieved April 26, 2015, from http://bostonglobe.com/lifestyle/health-wellness/2013/07/27/boston

 

 

Final Blog

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Reflecting on just three months shy of three years brings tears to my eyes. Tears of joy, laughter, sadness, and hope. We entered this program as strangers and we are leaving as family. Through the program, it seemed to go by slow; now, the remaining ten days are flying by. Each day, I try to slow it down a bit and take in the moment because nursing school is the greatest experience thus far in my life. I will forever treasure each moment we all created together. I have made lifelong friends and through it all have made substantial personal growth.

I underestimated the nursing profession prior to the start of the program. However, I know now that nurses are truly superheroes, irrespective of the specialty we enter. We have the pleasure of delivering babies, sitting next to those who take their last breath, and everything in between. We change lives every single day. We keep patients alive medically and emotionally. We care for families and have learned to better care for our own loved ones and ourselves. We are advocates. We are the most dedicated group of individuals that I have ever met. Nursing is a profession that I am proud to be part of. If I could afford to do it for free, I would.

I remember how terrified I was to learn my head-to-toe assessment and perform it in front of the lab instructors. Next was the foley catheter insertion. Today, I can perform these skills with my eyes closed. I will forever cherish all the care I have been honored to perform with members of my cohort. I have learned to trust my intuition and my knowledge. I remember learning that there may be a chance we could insert catheters in this semester and I was terrified. However, I have learned that the unknown is what I fear the most. Knowing this, I am ready to move forward and experience what life will bring to my next chapter.

Critical care has been such a wonderful gift as our last semester. I truly believe it is the perfect way to end this program. I have learned more in this semester than ever before; I know now that I am ready for the transition to call myself a RN. I have learned what to do and what not to do. I have gained a myriad of insight into the type of nurse I want to be. I vow not to get “lazy” with my interventions or assessments. I want to change the world one day at a time; as nurses, I believe we can. For me, critical care has transformed me into a butterfly; throughout nursing school, I have been a caterpillar. I am ready to fly.

We have worked so hard to get to this moment. Pinning and commencement is around the corner, and we deserve to celebrate us. All our hard work and accomplishments will pay off with beautiful, fulfilling careers. Amazing job to everyone and a special thank you to each and every instructor we have had as they are such a huge inspiration. They have truly changed my life. I couldn’t have or wouldn’t want to endure this journey without our cohort. Congratulations and thank you for impacting my life. I am forever grateful and I love you all <3