Offering “Some Hope” and Medical Support, Health Providers Care for Nepal’s Flood Survivors

The woman was trying to make her breathing medicine last, a drop at a time.

She had chronic obstructive pulmonary disease and feared running out. By the time she reached Dr. Alok Pradhan's team in Nepal's Nuwakot district as part of a mobile medical deployment with the Nepal Red Cross Society, she was struggling to breathe, and her blood oxygen level was low. The clinicians gave her a full dose of medication and stabilized her, Pradhan said.

"Can you imagine that?" he said of how little medicine she had been using.

During a six-day deployment about two weeks after devastating floods swept through the region, Pradhan found that many of the most pressing needs involved illnesses that had preceded the disaster and the psychological toll of surviving it.

Where his team worked, a health care facility stood on the other side of a river. Both bridges connecting residents to it had been swept away. The facility had survived, but the route to treatment was gone.

The Aug. 26 floods devastated communities in northern Nepal, with Rasuwa and Nuwakot among the hardest-hit districts. Roads and bridges were destroyed, complicating the delivery of aid and separating patients from medical services.

Pradhan, an emergency physician based in Bharatpur, had participated in the Nepal Red Cross Society's emergency clinic program since 2018. After the floods, the organization asked him to help provide care in an area where access had been cut off. Pradhan was joined by volunteers from Dhulikhel Hospital, which deployed with medical aid from Direct Relief to support health services post-flood.

"It was a very bad thing, understanding what happened. We immediately started thinking about how to help those people," he said.

Pradhan's training had prepared him for the broad demands of practicing medicine in rural Nepal. After graduating in 2011, he chose postgraduate study in family medicine, drawn to a discipline that equipped one physician to handle many of the needs of a remote community.

Bringing a full roster of specialists to every community would be prohibitively expensive, he said. General practitioners instead learn to treat a wide range of illnesses and perform procedures including appendectomies and cesarean sections.

In Nuwakot, the scale of the destruction was difficult to absorb, with mud covering riverbanks and entire homes.

"Before that, I couldn't have imagined. It was like a Hollywood movie, but it was right in front of us," he said, describing the level of destruction.

Patients described watching relatives and friends being swept away. Some began crying during consultations. A man said he lost his home and only had the clothes he was wearing. The response team included a separate unit for psychological and social support.

"They were very much traumatized," Pradhan said.

Grief accompanied patients who had come for ordinary medical needs. One man had lost his family and his home in the flood. He also had diabetes and other chronic conditions, and needed his medications refilled. To determine exactly what he needed, Pradhan asked for his medical records. The man returned to the government shelter where he was staying to retrieve them.

For the medical team, maintaining that care required a steady supply of medicines. So many patients came to the tent clinic that it ran out of drugs, Pradhan said. The team sought additional supplies through government health services and a regional hospital, with medicines arriving by truck.

Pradhan said he did not see physical trauma, and said colleagues explained to him that patients who were affected either didn't have injuries or were dead or missing.

The wider relief effort has also focused on helping local providers continue treating patients. As of Oct. 2, Direct Relief had sent 21.5 tons of medical aid to partners responding in Nepal's flood-affected districts.

Direct Relief also provided emergency operating grants to Mountain Heart Nepal, Shanti Foundation and One Heart Worldwide. The funding supports mobile medical teams, psychological and social support, hygiene supplies, and maternal and newborn care.

Pradhan said restoring roads and bridges would be central to helping residents regain access to health care. For people managing chronic conditions, recovery depended in part on being able to reach a clinician and replenish medicine before it ran out, which are both challenges that preceded the floods. He also noted the immense challenge of identifying potentially thousands of corpses that are still buried.

The encounters also stayed with him personally, as a clinician, Nepali, and human being, he said.

"As a Nepali citizen, we are so vulnerable to natural disaster, climate change issues; no place in Nepal is 100% safe from these natural calamities, and the human being side is making it worse," he said.

"As a human being, we don't know what the next moment will be like. Maybe we must be more forgiving and cherish our moments more."

"As a clinician, we need to be exposed to patients from different experiences. So many people who had been together before the flood were suddenly living without members of their families… the mental trauma we had to deal with… we tried to console them," Pradhan said.

During consultations, he tried to reassure patients that people and government agencies were working to help them, and that they had much to look forward to. He knew those assurances could offer only limited comfort to someone who had lost everything.

"But I hope they got some hope, seeing that there are so many people who are willing to help them and support them," he said.