Every disaster has its own unique challenges, and the way in which the humanitarian system responds must be specifically tailored to the context. The recent earthquakes that rattled Nepal are a reminder that being prepared, and understanding the geography and topography, as well as the culture context are key to ensuring our efforts are effective.
There are often no defined standards when you arrive in a country devastated by earthquake, flood or typhoon. The Canadian Red Cross, with the support of the Government of Canada, has two health Emergency Response Units (ERU) on standby: a field clinic (also called Basic Health Care Unit), and a field hospital (also called Rapid Deployment Emergency Hospital). Following a major emergency, the preparedness, reliability and flexibility of these units allow for rapid deployment anywhere in the world within 48 hours.
They are fully self-sufficient for one month, and can operate for up to four months with supplies and a multidisciplinary team of 10 to 20 aid workers. Within 12 hours of arrival, a Health ERU can be providing health care services, including mother and child care, surgery, community health and psychosocial support, for up to 300 patients a day.
Among the 20 Canadian Red Cross delegates who left for Nepal 48 hours after the first earthquake were Ola Dunin-Bell, Diane Hyra-Kuzenko and Sarah Mutch, respectively surgeon, operation theatre nurse, and nurse. They had one thing in common: this mission was their first experience with a Canadian Red Cross ERU deployment. When they landed in Kathmandu on 28 April, it was to a scene of utter destruction.
Despite the needs in the capital, the Canadian team’s help was more urgently needed elsewhere. 150 km north, Dhunche is the administrative seat of Rasuwa, one of the districts most affected by the 25 April earthquake. The earthquake had destroyed the old district hospital, and the Nepalese Minister of Health asked the team to set up next to its ruins.
As the narrow roads leading to Dhunche had been blocked by rockslides, everything had to be flown in by helicopter. Ola, Diane and Sarah were sent along with the first series of flights.
In the rugged mountain environment 2,030 metres above sea level, the Canadian team set up a hospital with 15 different buildings on six terraces overlooking the village. A full medical team, including a surgeon, obstetrician, emergency medicine physicians, general practitioners, is immediately available, working together with experienced technicians and a communication delegates.
While dealing with their own workload, the team also supports doctors, nurses and health aid workers from Nepal’s health services, who are still active in the community.
Profile: Dr Ola Dunin-Bell
Dr Ola Dunin-Bell is a Canadian surgeon who shares her time between Oakville, Ontario, and Whistler, British Columbia. She is a member of the medical faculty at McMaster University in Hamilton and the University of Toronto in Mississauga. Nepal is her first emergency disaster deployment, though she has collaborated with the Canadian Red Cross for three years, and has been specifically trained to respond to situations like the Nepal earthquakes. “I would say the main difference between a first rotation and a regular field situation is that here we really have to look after each other,” she said. “From day one, we need to build living space, to make sure there is food and drinking water for everyone, while in parallel setting-up the field hospital to provide what we came here for: medical assistance to the victims.”
Profile: Diane Hyra-Kuzenko
With 41 years of experience as a nurse, Diane Hyra-Kuzenko has often worked in difficult situations. She was in Afghanistan with the Canadian Forces and in South Sudan with the ICRC, where she working within existing and highly organized structures.
This last experience with the ICRC made her wish to work more with the Red Cross Movement. After taking the Canadian Red Cross ERU training, she was deployed to Nepal 48 hours after the first quake struck. Her previous military and ICRC experience made her realize the difficulties that come with very early deployment where everything needs to be set-up. “It is impressive what a team of 14 people can accomplish in two weeks in a very chaotic environment,” she said.
Indeed, when the delegates first arrived on site, they were starting with a blank slate. Not only had the local hospital been destroyed, but also tons of rubble needed to be cleared before setting up the seven field-hospital tents and an operation theatre. “Throughout the mission, even though we were not already completely organised, we managed to perform surgeries and provide health care to the communities,” Diane said. “Common sense and creativity prevailed to meet all the challenges.”
Profile: Sarah Mutch
An experienced nurse from the UK, Sarah Mutch arrived in Canada in 1989. Joining international missions was something she had thought of doing for some time but she waited until her children were grown-up. Preferring short missions, and hearing that ERU missions were one-month rotations, she felt this was exactly what she wanted. After taking the training course, she waited over two years before being offered a deployment with the appropriate timing with her job in Canada. “When Nepal came, I was happy to be part of the first rotation team, but it was not quite what I had expected,” she said. “Though not in a bad way!”
She appreciated the fact that although it was more of a tent and site building mission, she learned how to quickly deploy a field hospital in a very challenging environment. “You see disasters on TV, but news have nothing to do with reality. I would do it all over again.”