“She’s safe,” my friend and fellow resident told me over the phone just hours after reaching his Mom in Kathmandu. A text from my undergraduate Hindi Professor read, “My own family is safe. But it’s hard to comprehend the amount of loss. My own house in which I was born is gone.” Calls, texts, and emails over the last week have been reassuring in the midst of media depictions of intense devastation. Their loved ones are safe. But I wonder, for how long?
The stories of the many who are safe cannot be told alone of course. Over two weeks have passed since the earthquake hit, and the death toll has reached over 8,000 and is expected to rise to 10,000 in the coming days. Millions are without electricity and clean drinking water. Thousands huddle in tents with monsoons looming. Hundreds overflowing the make shift hospitals that are all that are available to care for the wounded and sick. Countless villages cut off from any relief efforts by roads made impassable.
As a member of the South Asian community, I feel connected to the many faces in peril. As a physician, I feel a sense of calling to alleviate suffering. While I view my Facebook feed overflow with news of ongoing despair, I ask myself the question I know I share with many others: What can I do to help?
Give money? Twitter and Facebook are flooded with suggestions of where to send the necessary funds so that vital essentials including water and food can prevent even more deaths. The government with international financial support can continue rescuing people trapped under the rubble and supply tents to the newly made homeless.
Give my expertise? I watch as those with essential skills travel to Nepal to provide the help they are trained to give. Surgeons, such as the Dr. Sanjay Gupta of CNN and countless others, can use their skills to perform life-saving procedures. Workers in construction can assist in removing the wreckage. I long to catch the next flight over to do my part but know that as a doctor still in training, with no knowledge of the landscape, I risk being more of a burden than a help.
However, taking a deeper look at the earthquake gives another story. What is telling about Nepal now, Haiti in 2010, or the Indian Ocean earthquake and tsunami of 2004 is the morbidity and mortality that comes after the immediate emergency is over. After the aid worker packs up and heads home. The risk factors of vulnerable construction, a weak public health system, and political instability remain, situated within an impoverished nation. With limited resources to either recreate even what was lost, much less move forward.
My training has ingrained within me the desire to alleviate pain and suffering in the here and now. But giving 50 dollars to the American Red Cross seems too impersonal and potentially ephemeral in the context of larger systemic issues. So I sat with my credit card in my lap, debating how entering these numbers would impact Nepalis 7,000 miles away. Reaching out to a friend, Mark Arnoldy, currently in Kathmandu, made things a bit clearer. He spoke of the words “unearthing hope.” That out of glaring despair, can we uncover the opportunity to strengthen Nepal for its future ahead?
I too see this as not only as an opportunity to give for the acute nature of relief, but to give so we can rebuild Nepal’s infrastructure. As a physician, I am biased to look first at health care.
Just as global health experts have considered developing more robust health systems in response to the Ebola outbreak in West Africa, I feel that it is imperative to consider the same approach in rebuilding Kathmandu. A call is needed not for more doctors or relief workers, but for leaders who will strengthen care delivery systems. Otherwise, we may fail to keep Nepal truly safe moving forward.
I know all of this is easier said than done, especially coming from my physician quick fix mentality. But this work is possible and is already happening. The work of Possible Health that Mark alongside hundreds of Nepalis is doing is a distinct example of this. It is a durable health care model for the poor in Nepal, to strengthen health care delivery within the government’s current infrastructure. Of course, this work alone will not solve all of Nepal’s risk factors for a devastating aftermath from an earthquake to happen again. But it may allow an opportunity for me to give for the future safety of Nepal moving forward.
Yet as we speak, thousands still camp out in tents fearful of another aftershock that will trap them in their homes. Should my friend’s Mom, my former professor, and the millions in Nepal feel safe as they re-enter their homes or what’s left of them? I believe the answer will lie in the years, not just days, ahead.
Amish Desai is an internal medicine resident.