Death, Disease and Hope
By Dr Mohammad. Afzal Arain

(Report filed from quake site in Pakistan)
As soon I heard about the earthquake I started preparations to go to Pakistan. I started to collect antibiotics, painkillers surgical supplies and other needed supplies. Local hospitals provided truckload of emergency medical supplies. One of my patients provided 8 large cases of surgical gloves. I cancelled all my scheduled surgeries, office appointments and was on my way to Islamabad.
My prayers were for the affected people and my intentions were to find the best possible way to help them.
Dr Seed Akhtar, urologist and transplant surgeon, was in the USA and was to receive an award on being designated Governor of Pakistan for American College of Surgeons. SWDR committee members started to have daily teleconferences and we convinced Dr Akhtar, who is a Islamabad-based physician, to forego the honor of recognition at American College of Surgeons and to return to Pakistan to help the suffering people.
Dr Murtaza Arain from Chicago went a day earlier (15 October) to ensure that APPNA doctors were appropriately received and collection of excess baggage and transportation of some 100 + boxes to a safe storage area could be arranged so that the items could be collected and used when needed.
We had a meeting at Shifa Hospital with various volunteer organizations and all of the newly arriving physicians were briefed about the ground reality.
Dr Saeed Akhtar from APPNA and IMANA & PIMA worked as individual coordinator. He opened up his home to all of us. Dr Piracha and myself had family in Islamabad but we stayed at Saeed Akhtar's home to better coordinate our efforts.

On October 18 we, Dr Piracha, Murtaza Arain and myself from APPNA, Dr Rehana Kauser, Parvez Malik from IMANA and Dr Saeed Akhtar (representing any one who wanted to work) went to various hospitals and met the local authorities. General Usmani who was designated incharge of relief efforts for the entire area told us that the army hospitals have mobilized their medical staff and do not need assistance from any one. He requested Tetanus and ATG vaccinations. Shifa international had designated 100 beds for the disaster relief and were providing free service. Their setup was better than most hospitals. PIMS (Pakistani Institute of Medical Sciences) hospital looked like Cook County but was ten times busier. There was continuous flow of injured patients on "charpai". One wondered where all of these were going. Patients were fast tracked and got timely care. I did not see any one standing idle. Everybody was motivated and was working with full vigor. The sight was very inspiring.
We met the director of PIMS Hospital Dr Fazle Hadi. He stated that they were performing an average of 170 surgeries a day. The operation rooms were being used on 8-hour shifts. He mentioned that they had ten operation rooms but only seven were furnished. He said if we could furnish three more surgery rooms their efficiency would increase by 33%. Islamabad Polyclinic, air force hospital army medical college had patients everywhere and hardly had any walking spaces.
We had a meeting and concurred that we could refurbish the needed surgery rooms at PIMS. The cost was estimated at $50,000. APPNA and IMANA each collected $25,000 and the next day the equipment was ordered. We all felt that it was better to invest in equipment rather than a cash transaction.
APPNA is not an NGO and members have been doing relief operations for many years. The earthquake had done extensive damage to property, infra structure and life. The injured, paralyzed and limb-loss patients were pouring in from everywhere. The scene was depressing. What nature did in thirty seconds would take 50 years to undo.
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October 19:
Some of the doctors tried to go to different hospitals and volunteer their services. Most were told that they had enough doctors but needed more equipment. Orthopedic supplies, pneumatic drills, anesthesia machines and C-Arms were in acute shortage. After some manipulation with the administration most of the doctors were able to serve the injured with their expertise.
We wanted to go into the damaged areas to access the needs of the people so that we could pass it on to APPNA members and obtain the needed help.
All the roads were damaged and everyone was taking a truckload of whatever they could get hold of. Water, food, blankets, clothes, carpets, medicines and blankets were loaded in trucks. Some of the homeless, shelterless hungry people stopped the trucks and took what ever they needed. Truck drivers felt relieved that the needy came to get what their needs were. Most of the people did not feel offended.
Dr Murtaza Arain was able to arrange a helicopter for a short time. We went to Abbotabad and visited numerous patients with spinal cord trauma and paraplegia. There were many with fractures awaiting surgery. The area looked like a flea market. People looked visibly disturbed.
From Abbotabad we went to Bagh. A young man, perhaps thirty-year old, had head trauma and had just walked in with his willpower using the last bit of his adrenalin. He fell down and stopped breathing. He was intubated but there was no oxygen or suctions. We decided to cancel our trip and put him in our helicopter along with nearly twenty other injured patients and turned around to PIMS. Dr Seed Bajwa (neurosurgeon) was with us. We rushed him and had CT done. The patient was placed on a respirator and stabilized. He had a fractured orbit and subdural hematoma.
Due to lack of respirators many patients were kept alive with Ambo bags pumped by family members who took turns.
The next day the patient did not show any improvement and needed craniotomy. When we last saw him, he was stable and was coming out of danger. I heard the family members say that when God wants to save someone He creates circumstances for help. We spent most of the day at PIMS.
We had a wrap-up meeting for the day and shared our observations and made plans for the next day

October 20:
We had an early morning meeting at Dr Saeed Akhtar's residence about the next step of planning. We went by road to Muzzafarabad and visited other neighboring villages. We also visited several makeshift hospitals and medical camps of different NGOs. Everyone was dedicated to whatever they had taken on and was very busy. There were numerous sick people who had no place to go. In medical camps they got food and shelter along with medical care. Almost all the camps were crowded. We visited the prime minister of Kashmir in a tent where he was staying. He said people called him prime minister of the graveyard. He said he saw a little boy buried under the rubble who was crying, " Ami, save me; Abboo save me. " The prime minister said that no help was available to lift heavy concrete slabs. Finally, when he returned with help the voice had silenced forever. On this he started crying. We spoke with him about thousands of people and children who had lost their limbs and those who were paralyzed due to spinal injuries. We told him that if APPNA EC and membership give us their blessings we will try to open a 25-bed rehabilitation hospital and endeavor to get physical therapists and artificial limbs from the USA. We will request various specialists and organizations for help. After one year we could gift the hospital by APPNA to the people of Kashmir. He became emotional and promised that he will be part of the project and promised to sustain it.
At Muzzafabad we saw nothing but destruction. Buildings had collapsed all around. Cloths were covering streets, people were wandering aimlessly. There were more volunteers than local people. The streets had an unpleasant odor of the dead bodies. There was hardly any building which was intact. It was a very tiring day and due to winding roads I got very nauseated.
We had our usual planning meeting at the end of the day.
We were all the time in touch with the APPNA officers and members of the SWDR committee and updated them with our findings and passed on the list of needed items.

October 21:
We planed to visit Abbotabad and Balakot (hardest hit area with near 100% destruction). We passed the Hassan Abdal and Haripur Hazara area. Abbotabad had no visible damage. Mansehra had few damaged buildings. After we crossed Mansehra the scene appeared different. Balakot was completely destroyed. Everything had flattened out. Numerous children of all age groups were found wandering like chicks. I saw a small baby sitting next to a pile of food. He had only a shirt on. She did not know that she could pick up a small cloth and cover herself.
Many children had dust in their hair. They looked like lost kids. No adults were with them. The DSP police said that eight police officers died in their home. He himself had a broken hand but was on duty. He said one police officer tried to dig out another person, got a minor injury which turned into gas gangrene leading to the amputation of his hand. He said he was able to come out of his home with a broken hand and saw a three-story building across his place which went up in the air and went it fell two floors were completely destroyed. He heard screams of people asking for water. He said that after the earthquake the well water level went down and he had to go to the river to get water for the people.
One of the local people told me that even the birds got disoriented and looked like they had gone blind. They were falling on the ground and dying. After his statement I looked around and I did not see any bird in the area, not even on the garbage area. (They may have left due to too many people).
We visited several clinics in the area. The best furnished was a makeshift hospital by UAE.
We went further on the road on top of the mountain. Even with all the destruction the valley looked very beautiful with tall mountains and a river flowing at the bottom. There was smoke everywhere from burning debris.

October 22:
We visited some of the patients at different hospitals and gave away the charity money to the needy. I was told that it takes four thousand rupees to go to Muzzafarabad from Islamabad. Some of the family members who were stranded with the injured at Islamabad hospital wanted to go back and look for other family members to find out if they had survived. I distributed money to help them.
We had a meeting at Shifa international. They had designated a section of the hospital as brain center of the relief efforts. Several young boys and girls were volunteering their time and to my pleasant surprise they appeared well versed with computer techniques.
Dr Saleem Nagra, general surgeon with orthopedic experience, arrived and declared that he has brought $ 100,000 from Canada which was raised by his community.
Due to spread of tetanus, many people had died and several others were on respirators. A lot of them were being managed by family members. Dr Ingra donated seven respirators and was willing to purchase other equipment.
There were acute shortages of pneumatic orthopedic drills. One was purchased from Karachi for $20,000. Dr Murtaza Arain called his hospital in Chicago and to his surprise he was told that they only used battery powered drills and the pneumatic drills were becoming antique. His hospital immediately donated two of them which will be reaching Islamabad soon.
October 23:
We have been able to furnish two surgery rooms at PIMS, thus increasing their efficiency by 33%.
Seven respirators.
Three pneumatic drills.
Six anesthesia machines.
About two million dollars worth of medical and surgical supplies.
A plane load of ten thousand blankets, ten thousand tents, and medical supplies (IMANA & Islamic Relief).
Arrangements are being made to send possibly two planeloads of medicines through a major drug company.
We have also been able to arrange:
All the doctors will be received at airport.
Assist them with immigration and baggage collection and transportation.
Provide accommodations and meals.
Provide a place where they be best utilized with respective expertise.
Arrange tour of the affected areas.
All the volunteers can feel secure and have no worry about anything except to do service to humanity.
Future plans:
Immediate needs are being taken care of.
Intermediate needs are addressed and will be accessed daily and necessary actions will be taken as needed.
Long-term:
Putting together a 25-bed rehabilitation hospital for amputees and paralyzed patients. Provide psychological assistance to children and adults. We will also plan to access any future needs and make available any services we are able to provide.
I will request all those who have know-how, resources and ability to help us in putting together this hospital.
In the end I want to thank our social welfare and disaster relief team members who have been working tirelessly since the day this earthquake disaster happened.
People of Pakistan make me feel proud of them. They have forgotten all difference and everyone feels that the earthquake has hit their own home.

 


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Editor: Akhtar M. Faruqui
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