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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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this post).

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 http://genericcialis-onlineed.com/ have arrived in Nepal in support of Team Rubicon’s Operation genericviagra4u-totreat.com 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
Blog: iRevolutions.org
Book: Digital-Humanitarians.com

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

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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.




Response to Active Shooter Incidents and Terrorist Attacks

18 OCT 2014

David Callaway, MD

The evolution of Tactical Emergency Casualty Care (C-TECC) continues and provides the most comprehensive framework and set of principles for high threat civilian prehospital response.

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Some good reads (well, some Smith, Callaway and Bobko reads)

High threat response in 2014

Pediatrics and active violent incidents


Intolerance Rant

02 OCT 2014

Ignorance is bliss. Sadly, it is also what fuels extremism and intolerance.  Originally, this had a different follow on, but after returning to the States and listening to the barrage of lunacy and self righteous bigotry regarding the Middle East, I went with a different rant.

Reza Aslan’s recent interview on CNN demonstrated the inane reductionist fear mongering that passes as legitimate reporting in the United States.  It would have been funny, if it weren’t so uncomfortable.  Rather than focus on the real issue, CNN anchors Don Lemon and Alisyn Camerota frankly reinforced the global stereotype of the ignorant and arrogant American.  I find it funny that Aslan’s previous interview on Fox News in 2013 was largely considered “The most embarrassing interview in Fox News history”.  You can add this one to the record books.

As Americans and global citizens, we should be insulted by CNN’s (and Fox’s) Entertainment news style.  Here is their view:  You are a frickin idiot.  We are going to spoon feed you a crap sandwhich and you’ll not only take it, you’ll feel like you now have an educated opinion on the topic.  And, frankly we let them do it.

Chris Coumo’s response to the interview, “It’s not a coincidence that ISIS begins with an I. I mean, that’s what’s going on in that part of the world. ”  Good point, Chris.  Thank God (with a capital ‘G’) that we can unite all of the World’s other peaceful religions against the barbarians:

The peaceful KKK is thankfully “a faith-based Christian organization that does not condone violence.”  And, thankfully there is no violence against women in the secular/ Christian dominated United States.  Dang it, Ray Rice,Columbia University, Alabama Judge, US “faith-based” Antiabortion movement, the list goes on.  Aslan’s comments that “Extremism” is the problem and that “violent people” will bring violence to their religion is a pretty articulate statement.  Perhaps, a little too nuanced though for Lemon, Camerota and Coumo.  Besides, rational discussions don’t generate ratings.

If we take a step back and look at UBL’s original declaration of War on the United States (here is the original Fatwa), his stated goals were to draw “America” into a generational war that would bleed us dry and drive us to both financial and moral bankruptcy.  So for a moment, let’s consider Daesh’s decapitation movement (put aside the very legitimate observation that Saudi Arabia, our close “ally”, routinely beheads “criminals”).  Why decapitate people:

  1.   Tactical:  This certainly creates fear on the tactical level- meaning it sure as hell scares local civilian Iraqis and Syrians.  It probably also weakens the morale of already disenfranchised soldiers.
  2. Strategic:  What is the broader purpose of this barbaric practice?  Daesh has an extremely savvy media strategy with extensive YouTube, twitter and social media presence.  They sat dormant for years, planning this offensive.  Perhaps, they think that this extreme violence will generate more revenue and recruits.  Maybe, they think it will go viral and spread their fucked up, non-Islamic brand of Islam globally.  Maybe.  But, maybe it is something else, something related to the original AQ goals of destroying the United States through economic and moral subterfuge.  I find it hard to believe that the Daesh leadership believes that beheading Americans, British and French citizens while demanding the “Crusading West” withdraw from Islamic lands will do anything other than draw us further into direct conflict.  Daesh is baiting the West.  If I were a conspiracy theorist, or even a touch more cynical, I might suggest that their are certain industries/forces that benefit from perpetual conflict.  And, that the use of political, economic and military mercenaries would not be out of the question.

So, the question is how will we deal with the root causes of extremism and violence.  When will we stand strong and confident in the face of hatred, whether it is overt- like we are seeing in conflict zones across the globe- or more subtle- as we are seeing in the US as we wage war against the poor and disenfranchised.  Hard problems without easy answers.  I have faith.

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.

Heroes of humanity

30 SEP 2014

As I settle back into my life in Charlotte, I am amazed at both how easy it is to reintegrate and how quickly the palpable tension from the Middle East fades. And, yet it still surrounds us, this fear and uncertainty.  I will write a little more on risk later (I had an interesting conversation with British Ambassador Peter Millet about risk just prior to jumping off a 30 foot waterfall).

The news coming out of the Middle East would seem to suggest that humanity is dead.  Daesh is truly a nihilistic group of murders who are less “Islamic” than my dog Sam.   And, still we must not forget that this is not some obscure, distant, and faceless war.  The victims are women and children- mothers, sisters, grandparents, babies.  The violence and disruption is unimaginable.  But, there are heroes as well.  This video was sent to me by a friend who works at the USAID Office of Transition Initiatives.  It is worth the 3 minutes.

On a tangentially related note, I wanted to return to the vitriolic, partisan lashing that the press gave President Obama for his earlier statement regarding the lack of a US policy to address ISIL.  Now, I will admit “We don’t have a strategy”, though refreshingly honest for some, is not what you want to hear from your President.  It does not instill confidence domestically and echoes of weakness internationally.

That said, Politico outlined some of the complex domestic “political” challenges in crafting a coherent strategy.  Clearly, domestic concerns are critical.  However, this is not even half of the story.  Any efforts require a political solution and must address AT LEAST:

1.  Creation of a  strong and unified Iraq with control of the sectarian violence and establishment of stronger governance practices.  Note this is strongly opposed by Iran, moderately opposed by the Kurds who are essentially independent, and not supported by the Sunnis who have been subjected to nearly a decade of retribution for Saddam’s rule.

2.  Addressing the subterfuge of the Saudis and the Iranians.  Challenging since we are economically tied (read dependent on) to Saudi oil and hyperfocused on preventing an Iranian nuclear program.
3.  Working with the increasingly totalitarian Turkish state and acknowledging their concerns vis-a vis an independent Kurdish republic.  They just took 200,000 refugees in a week, hard to complain about them, though there is ample evidence of their complicity with ISIL.4. Controlling or containing the impact of the smaller Gulf states on the escalation of violence through funding of Salafist extremists (see a recent Foreign Policy article details some of the support for my comments about Qatar in my ISIL/ISIS diatribe).5.  Some semblance of understanding of the divided opposition forces (None or which are “moderate” any longer- 3 years of conflict has a way of driving the moderation from ones belief system).6.  An understanding of the global economic implications of intervention or lack of action.7. A massive commitment of diplomatic and development forces to augment the military forces currently attempting to halt the ISIL advance.  Think of it like chemotherapy treatment- extreme violence is required to halt the advance of this malignant cancer.  But, in doing so we will destroy a great deal of surrounding healthy tissue (e.g. infrastructure, education, moral, ethics, crops, etc.).  Unless we combine the destruction with an aggressive rehab program (i.e. political and economic support), the ideology will survive.

If this were a senior comprehensive exercise for a political science master’s degree, it would be viewed as a seemingly unsolvable problem that the faculty put together to “test the student’s thinking”.  That said, with people like Ambassador Wells (Jordan) and Stuart Jones (Iraq) working with local leaders, I have hope.  I have to; the alternative is surrender to evil.

A good overview on Syria from 10 months ago.

Those who society abandons, we defend.