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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

A variety

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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





Jordan- The Flight Home

29 SEP 2014

I swear my headache is from the near maniacal paces at which thoughts are screaming through my brain and smashing up against my skull; war, humanitarian crisis, renewable energy, friendships, family, humanity, Elizabeth, extremism, kindness… Or it could be that I am completely and unreservedly addicted to caffeine and 6 hours into my 13 hour flight to Chicago is the time to top off. It has been since breakfast!

I find blogging a bit of a challenge. I struggle to balance a desire to be articulate and provide relevant insights while still occasionally succumbing to the draw of treating it like a journal a la Super Fudge (Google it kids. It’s funny… Dcal and Super Fudge). My struggles were comically on display yesterday as I waited to meet with newly appointed US Ambassador to Jordan, Alice Wells. Ambassador Wells has been in Jordan for 6 weeks and from what I can tell, has been moving every minute of it. During my first trip, I had the fortune to meet with her predecessor and have a great conversation about health, security, and regional politics. Maybe I had gotten too comfortable- almost 4 weeks in Jordan, third time to the Embassy, end of the Fellowship. But, I should have seen it coming.

As I sat alone in the receiving room, a tall, well dressed, bald white guy with a goatee walked in, gave a big smile and met me with a firm hand shake. I looked at his left hand and saw the unmistakable logos of the Eisenhower Fellowship and OMI. Catching my glance, Tobias said, “I’ve been reading your blog.”

“Shit”, I thought. I had just thrown out that sappy entry about missing my daughter, struggling with guilt and empathy, and some cheesy comparison of the weather and people’s attitude. Hopefully, he started further back.

“A depression, huh?”   Crap.

“Yeah, but you should see what I wrote about ISIL,” I shot back. No sooner had the words left my mouth than I realized that I had referred to ISIL as the “Islamic State in Lunacy”. Hmm, there goes my Diplomatic career. Oh well, what the hell do I know? At least I still have a day job in the Emergency Department. Might as well roll with it.

“I like your stuff. You are asking some tough questions.” My man! Tobias. I knew we’d get along well. Let’s just keep that “depression” analogy between you, me and the 12 friends and family who read my blog.

The next 45 minutes was filled with great insights, comments and questions from Sarah Blanding (USAID Health Lead), Tobias and Ambassador Wells. I felt challenged, validated, energized and, still hopelessly unprepared for the complexity of the issues facing the Middle East. What a great way to end the travel portion of the Eisenhower Fellowship. The Fellowship was truly an amazing experience supported by an incredible team, a gracious group of hosts, and generous leaders willing to share their precious time.

Eisenhower Fellowship

20100202 EF Logo

May 18th

All things considered, a 0410 wake up is not too bad for my first day in Amman- just in time for the first call to Prayer. The morning is cool (55 FO on my iPhone). The sounds of spring- time birds fill the air over the gentle hum of the hotel air conditioners. I am 3 shawarma’s and 1 coffee deep into my first adventure in Jordan! So, I will try this blogging thing- recall I can’t tweet and I only venture on to Facebook to throw out occasional rants about the political lunacy in the US.

I arrived at Queen Alia International Airport last night after a pretty uneventful 12 hour flight from Chicago O’hare. My seatmate was named Joe, an Indian National who works in telecom out of Kuwait City and coincidently enough, does some tele-health infrastructure work.
“It’s all about bandwidth”, Joe told me. Yep, and getting it mobile, and powered, and having the right tech team and medical team on both ends, and having an easy, common sense interface that links with some universal platform that can do analysis and mapping… But, I digress.

My driver and fixer is named Muhammad (Moh’D) Shabakeh (Shabakeh meaning “Network” is now also the common parlance for Internet). So, jokingly, I asked if he referred to his son as “ibn Shabakeh”- of the Internet (I can actually hear my wife groaning in Charlotte). Fortunately, Moh’D sense of humor is apparently as demented as mine and he got a good laugh out of it. Moh’D is Palestinian and Jordanian. So far, he is hooking me up.

Moh’D gave me a brief run- down of the city. Amman is the capital of the Hashemite Kingdom of Jordan. It is a richly historic and complex city. Even a simple question like, “How many people live here” gets a variety of answers.
• Wiki (2010) 2.8 million
• CIA world factbook (2009) 1.088 million
• UN Office for Disaster Risk Reduction (USISDR): 4.04 million

Moh’d says between 5 and 6 million people (though he may mean all of Jordan). 2.5 million Jordanians, 1.5 million Syrians, 500,000 Iraqi’s, 500,000 Egyptians.

Amman is divided into the Old City (Seven Mountains) and the New City (Seven Towers). The city now spans 19 mountains and has an elevation of 700-11oo meters which keeps it relatively cool (comparatively in the Middle East). There are apparently 7 circles (roundabouts) in the city that are landmarks for neighborhoods and food- I will revisit this for accuracy later.

3rd Circle Amman
3rd Circle Amman

Last night’s dinner was at the Circle 2, Reem Shawarma. Reem is a hole in the wall Shawarma shop with a bunch of guys packed into a kitchen with a register. A huge cone shaped piece of lamb rotates on the spit and scores of people pack the side walk waiting for food or eating their meals. 1 shawarma runs (0.5-1 JD or ~$1.25-1.50 USD).

Circle 2 Shawarma
Circle 2 Shawarma

I tried not to dive too deeply into the work side of the trip last night, but it will come as no surprise to anyone who knows me that the conversation quickly turned to the challenges facing the families and communities in Jordan. The responses were uniform and completely in line with the various assessments, reports and opinion pieces I studied prior

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to the trip: Inflation is squeezing the working class, driving up food, gas and rent prices, and creating some tension on

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One father I spoke with about healthcare gave this response, “On one side you have free but poor quality care from the government. On the other side is expensive private care- that I can’t afford. So, what do you do?” Now, to be honest, I don’t know if this reflects the general perception (though it is consistent with many large scale population surveys) or, frankly, if the question would be answered differently in any other country around the globe.

The fact is that Jordan is largely landlocked, has no significant oil resources, and has a rapidly expanding population (one issue they are aggressively addressing). They have graciously taken in around 600,000-800,000 refugees from the Iraq War and post war violence and now are hosting between 600,000 and 800,000 refugees from the Syrian Civil War (Note: I am a stats guy or a population surveyor and this is the best I can tell from my research). So, this country of 6.7 million people has taken in- call it 1.5 million new visitors/guests/neighbors in the past decade (23% of its population). Put in context, that would be like the US taking in 72 million Canadians and Mexicans. The magnitude of the challenges is staggering.

Today, I have my first meetings. Time for some last minute preparation.
Signing off 0545