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Team Rubicon (TR) Operation Tenzing Reports from the field




Information has been a little spotty coming in from the field, so I apologize for not having an update sooner. On the last TR operations call, the Director of International Operations and the in- country Team Leader reported that “your docs are Rock Stars”. It was sort of like telling me water is wet, but nice to hear.


As you can imagine, things on the ground were pretty chaotic when the teams arrived. In addition to the destruction, imagine thousands of additional people and vehicles flooding into an area with devastated canadian pharmacy compendium infrastructure in order to “help”. The experience of TR and our crew allowed them to rapidly liaison with the international organizations such as OCHA while drawing on strong local connections through our relationship with the American Nepal Medical Foundation ( In the following days, Lee, Nilesh and Terez provided medical support for missions in the Sindhupalchowk region northeast of Kathmandu. They were seeing over 100 patients per day in this remote, rural area. Some pre-earthquake wiki data on the area (accuracy not confirmed) to give you an idea of the resources:


Following is the us militär viagra data obtained from the PHASE Nepal website:

  • Central/regional/zonal hospitals: 0
  • District hospitals: 1
  • Primary healthcare centres: 2 Bahrabise Primary Health Care Centre
  • Health posts: 11
  • Sub-health posts: 65
  • Number of doctors: 6
  • Number of nurses: 95

Although there is a district hospital as well as primary healthcare centers, these are not enough for providing health services. The small canadian universities offering pharmacy health centers in many VDCs are without Auxiliary Health Workers (AHWs), (Auxiliary Nurse Midwives (ANMs) and Community Health Workers (CHWs). So, people seeking emergency health assistance have to travel long distance to headquarter or Kathmandu or end up dying because of lack of treatment. Many people still believe in Dhami and Jhakris and are against taking medicine or going to hospital for the treatment. An NGO, PHASE Nepal[6] provides many healthcare facilities and training programs to two VDCs: Phulpingkot and Hagam. Many people residing in these VDCs have benefited from the program.





The TR team has partnered with a couple of UAV companies (HaloDrop and SkyCatch) to provide additional areal reconnaissance of the rural areas to help conduct needs assessments and allocate resources. Based on all of the information available and local contacts, on April 5th, the team headed out to Phujel west of Kathmandu. Garvey and Patel will be providing medical care cialis 10mg online for this 1- day trip while Malka will be heading out on a separate 5- day mission. Special thanks to all of you who helped cover shifts, swapped around your schedule or donated financially to the mission.


OCHA report on Medical Teams in Nepal (Note The ODM Division directly provided or arranged for 5 of the 15 medical personnel on TR’s team including 2 native Nepalese speaking physicians and our very own Lee Garvey, Nilesh Patel and Terez Malka.

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Challenges for Nepal Earthquake Response Continue

Thanks to extensive eye- witness video and the presence of US Search and Rescue teams already on the ground, the second major earthquake in less than three weeks in Nepal briefly brought the nation back into the 24 hour news cycle.  Our thoughts and prayers go out to the Nepalese people and to the US Marines who perished in the recent helicopter crash during relief operations.


Series of Nepal Earthquakes
Series of Nepal Earthquakes

From the Overseas Security Advisory Council (OSAC)

A 7.8-magnitude earthquake hit Nepal on April 25, leaving nearly 8,000 people dead and well over 14,000 injured, and these numbers are expected to rise. See the ReliefWeb Map.  In the aftermath, the U.S. Embassy issued a Travel Warning on May 1, advising against non-essential travel and authorizing departure for Embassy family members. Further, the U.S. Centers for Disease Control & Prevention (CDC) has issued a Level 3 Traveler’s Health Notice against non-essential travel.

Major issues:

1. Lack of clean water resulting in diarrheal disease.  This will worsen in the next several weeks with the upcoming monsoon season.

“The government is conducting public health messaging to reduce the risk of disease outbreak. Humanitarian aid workers are working to prevent the outbreak of communicable diseases – primarily cholera, dysentery, enteric ailments, typhoid fever, and respiratory infections. They are handing out bottled water and purification tablets and educating on basic hygiene techniques. However, according to the South Asia technical advisor for WaterAid, “We are going to get a cholera outbreak.” Cholera outbreaks globally often begin in rural areas where fresh water access and safe hygienic practices are less common.

The government is conducting public health messaging to reduce the risk of disease outbreak. Humanitarian aid workers are working to prevent the outbreak of communicable diseases – primarily cholera, dysentery, enteric ailments, typhoid fever, and respiratory infections. They are handing out bottled water and purification tablets and educating on basic hygiene techniques. However, according to the South Asia technical advisor for WaterAid, “We are going to get a cholera outbreak.” Cholera outbreaks globally often begin in rural areas where fresh water access and safe hygienic practices are less common. However, there are increasing reports of enteric diseases (diarrhea) in Khokana in the Kathmandu Valley.”

2.  Destruction of infrastructure: Roads are out and the KTM airport is taking a beating with the massive influx of heavy lift planes bringing aid.  The remoteness of Nepal, a key attraction to adventure tourists and expeditions, is also a major challenge in this crisis response.

“A World Health Organization (WHO) rapid assessment on May 1 reported that hospitals in the four most-affected districts (Ramechhap, Nuwakot, Chautara, and Rasuwa) were “completely
destroyed or too badly damaged to function,” and that five major hospitals (Gorkha District Hospital, Patan Academy of Health Sciences, Dhading District Hospital, Hetauda District
Hospital, and Alka Hospital in Lalitpur) were “in [urgent] need of further medical supplies.”



Rural Nepal Hardest Hit: Carolinas Medical Center Disaster Medicine Docs on Scene

May 1 (D+6)

Carolinas Medical Center Division of Operational and Disaster Medicine physicians supporting Team Rubicon have moved to the Sindhupalchowk district outside of Kathmandu. Reports indicate that within the city, hospitals and communication infrastructure are functioning adequately and USAR activities are robust.

Recognizing that assessments of the rural areas were limited and the communities largely not yet accessed by relief workers, our team moved rapidly to assist with both assessments and provision of care. Team Rubicon’s Operation Tenzing is moving quickly and updates can be found on their website.


Raw update from people on the ground (reported through CAN-USA personnel)

Total number of fatalities 5825 and injured 10866. These districts have highest number of casualties: Sindhupalchwok
1820, KTM 1099, Nuwakot 717, Dhading 570, Gorkha 407, Rasuwa 304, and Kavre 277. Road transportation in Sindhupalchowk and Rasuwa towards China border is not operational. Phone is also dead there. Power is off.

Rest of the highways are on except for erratic disturbances.

Mobile including Internet is running in Kathmandu valley and other
parts of Nepal except some quake hit districts.

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People are in need of power, water, tent, food, and medicine. However relief operations are going on in most districts”


Picture of a man retrieving his possessions after an earthquake in Thame, Nepal

National Geographic has an incredibly powerful series of photos documenting the destruction (some included in

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Carolinas Disaster Medicine Docs arrive in Nepal

April 29, 2015 generico del viagra prezzo 1500 EST

Four Emergency canadiandrugs-medsnorx Medicine physicians from the Carolinas Medical Center Division of Operational

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Medicine have arrived in Nepal in support of Team Rubicon’s Operation Tenzing. We are awaiting the initial situation report and continuing to track the ongoing response will cialis make me last longer requirements. A good summary of the eathquake can be found at ReliefWeb

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If you are interested, please considering donating to support the mission (DONATE HERE).




Nepal Earthquake Response

Dr. David Callaway
Director, Division of Operational and Disaster Medicine (ODM)
Director, Disaster Medicine Fellowship
Carolinas Medical Center- Main, Charlotte, NC



On April 25th, 2015 an earthquake of magnitude 7.8 struck Nepal with the epicenter west of the capital of Kathmandu. Within 12 hours, the Carolinas ODM team was working in coordination with Team Rubicon , the American Nepalese Medical Foundation, The Computer Association of Nepal-USA, and the Nepalese diaspora to provide medical and technical expertise for a rapid response reconnaissance team. Within 24 hours of the event, the Division coordinated the deployment of Dr. Sapana Adhikari, a Nepalese-American Emergency Medicine physician from Charlotte to support Team Rubicon Operation Tenzing (Donate Here).

Efforts are ongoing with an additional team of 3 physicians

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from Carolinas Medical Center deployed today (Drs. Lee Garvey, Nilesh Patel and Terez Malka). The CMC ODM physicians will be working to provide clinical care in the hardest affected areas, serving as physician leaders to coordinate care, and assisting with rapid needs assessments.

Nepal Earthquake Needs

Leaders from the GNPN have put together a real time Hospital Status worksheet that is extremely helpful for donors and responders.

For some background reading,

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you can check out an interview Dr. Callaway conducted in 2011 on earthquake preparedness with the Global Nepalese Professional Network (GNPN) entitled When the Quake hits Nepal

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of revolutionary technologies and strategies are being deployed in response to the tragic Nepal earthquake.


See work by Patrick Meier, PhD

Unmanned Aerial Vehicles (UAV) Work in Humanitarian Crisis


Team GlobalMedic





U.S. Movement on Cuba

Havana Cigars  16 January 2015
David Callaway

In the past several weeks, President Obama has taken executive action to begin dismantling the U.S. embargo on Cuba and hopefully drive closer relationships and well as political change in Cuba.  There are only two groups that really oppose this move:

1.  Republicans looking for any political advantage.

2.  A small, radical group of Cuban Americans in Florida with first or second generation ties to the Castro opposition.

Though I disagree with group 2, I understand the difficulty in apparent compromise given Castro’s treatment of many dissidents.  That said, if you believe in the power of capitalism, free market economics, and democracy, then you know that flooding Cuba with U.S. goods, improving the telecommunication infrastructure and increasing trade/ travel ties will only serve to show the Cuban people the “truth”.



Being married to a Cuban American ( a really smart one) and having traveled to Cuba twice, I think I have some perspective on the issues at hand.  That said, I am not a politician.

The attached link is to a policy memo I wrote in 2009 for my Diplomacy course at the Harvard Kennedy School of Government.  In retrospect, it makes more political sense to execute this move near the end of the second term- far less risk if you need the key state of Florida.

Enjoy and I look forward to any comments.




Those who society abandons, we defend.