Practice practice practice

If you are a follower on my Facebook, you will have seen my ‘share’ of some photos of the January 27th, 2016 Disaster Response Drill at SIRC.  The drill came out of the blue for me and I discovered later, it came out of the blue for almost all SIRC staff members including SIRC’s Executive Director Esha Thapa Dhungana!

I wanted to dig a little deeper into how the drill came together, so interviewed SIRC’s Assistant Project Manager Nikita Kayastha, to get all the details.  Here’s the story.

Context

You’ll remember before last year’s earthquakes (April 25th and May 12th), SIRC was but a 51-bed facility with small teams of nurses, physios and occupational therapists, no doctor on staff (there is now) and a small support team in administration, kitchen & cleaning staff, drivers, gardeners to tend to the vegetable garden.  Within two weeks of the earthquakes, these small teams of professionals had to pull strength from their toes and scale up fast and furious to provide medical care and rehabilitation services to 170 patients.  Serious dedication to the injured of Nepal at a time of national disaster, when they would have been entitled to be there for their families who were equally as affected by the earthquakes.  I consider them heros one and all.

The numbers of staff  has now more than doubled, and what I really want you to note is this, over half the staff had never experienced a disaster response scenario given they did not work at SIRC in the immediate few weeks after the earthquakes.  Because there are constant aftershocks of 4+ magnitude and another ‘big one’ expected, SIRC was keen to ensure the staff and facility were prepared to handle such an eventuality.  As part of the generous funding from UK Aid – Department for International Development (DfID), disaster preparedness  has been part of staff training over the past few months.  It was time to put all that training to the test.

Scenario

A house collapsed in Banepa and more than 30 injured people are being sent to SIRC for urgent medical treatment.  At this point, no one knows if any of the injured have suffered spinal injuries.  But because SIRC is one of closest medical facilities to Banepa, all patients were being sent there.

How the plan was implemented during this drill

  • As Incident Commander, a call came into Esha Thapa Dhungana letting her know in less than half an hour, over 30 injured patients would arrive at SIRC for urgent medical treatment.  The Disaster Response Plan was immediately kicked into action and an alert put out to SIRC’s staff.
Keshab setting up the privacy screens for the treatment locations, prior to the arrival of the injured

Keshab setting up the privacy screens for the treatment locations, prior to the arrival of the injured.

  • After a quick debrief at the Hospital Incident Command Centre (HICC) in the Admin Director’s office, the staff rolled into action.
The packed Incident Room with Incident Commander Esha on the left.

The packed Incident Room with Incident Commander Esha on the left.

The reeiving team waiting for the injured to arrived. The Nepal Army were on hand to assist if needed.

The reeiving team waiting for the injured to arrived. The Nepal Army were on hand to assist if needed.

  • The receiving team was set up at the main door lead by Physiotherapist In-Charge Shashi Shrestha and her team of physios.  The receiving team arranges for the proper transfer of patients from ambulances to the triage area.
The receiving team jump into action as the first of the injured arrive

The receiving team jump into action as the first of the injured arrive

  • The triage area was located in the large reception area.  The team led by Occupational Therapist In-Charge Keshab Prasad Sitaula and Dr Bishow Jung Thapa, had 15 seconds to quickly assess the injuries and determine whether to refer them to the Red, Yellow or Green areas for treatment.
  • The Red Treatment area was located by the Nurses Station, in close proximity to the medical equipment that may be needed urgently.  This area handled the most complex patients with possible life-threatening injures.  As a result, Nursing In-Charge Mandira Baniya along with volunteer Dr Christine Groves were the leads, ensuring immediate treatment of the patients with the most acute of injuries.
Initial assessment by Dr Christine in the Red area

Initial assessment by Dr Christine in the Red area

  • The Yellow Treatment area handled the patients with serious but non-life threatening injuries.  This team included senior nursing and physiotherapists, many of whom have longer experience and had oversight from Keshab and Dr Bishow once the triage area was cleared.
Nurses and physios at work in the Yellow area

Nurses and physios at work in the Yellow area

  • The Green area handled patients with minor injuries and included those who were mobile.  This team were located down the ramp to outside the Vocational Training area.  As soon as these patients received minor medical care (stitches, strapping etc), they were discharged through the exit out to the mobility practice area rather than having them return through the busy Yellow and Red treatment areas.

The Disaster Response was supported by a variety of roles:

  1. Logistics who ensured the right equipment was in the right place at the right time
  2. Data coordinator who along with a small team, gathered the latest news from each of the teams and ran it to the HICC and Communications.
  3. Communications who prepared all external communications and updates to media, politicians and other governing bodies as needed.
  4. Security who ensured any onlookers, media etc did not impede the emergency treatment underway.  Yes, there are paparazzi of sorts in Nepal too!

So how did it go?

The whole exercise lasted three hours but I guess the staff found out pretty quick that this was just a drill.  A Lessons Learned session was run immediately after the drill, ably facilitated by Nikita. Generally, everyone was pretty pleased with how well it went and a note of Did Wells and Do Betters is being finalized, ready to be implemented before the next drill or real disaster response.

The very large group of staff and interested parties who attended the Drill's Lessons Learned session after the Drill was completed

The very large group of staff and interested parties who attended the Drill’s Lessons Learned session after the Drill was completed

Guests and evaluators with Esha at the Lessons Learned session

Guests and evaluators with Esha at the Lessons Learned session

Who was involved?

The “injured” were students of the Medicine Bachelors degree program from Patan Hospital, Kathmandu.  Their injuries were made more authentic by make-up specialist Kanchan Karki.

The drill was jointly coordinated between three SIRC staff members – Dipesh Pradhan (Admin Director), Lekhnath Paudel (HR Manager) and Nikita Kayastha (Assistant Project Manager) and Patan Hospital Drill Coordinators Dr. Ashish Shrestha and Dr. Sumana Bajracharya.

The drill was video’d by Somesh Malla and his team – an important tool to allow detailed assessment of how each team performed, and any areas of improvement that are needed.

There were many stakeholders interested in evaluating how the drill went, including Prof. Dr. Bharat Kumar Yadav, Patan Hospital; Dr. Guna Raj Lohani, Head of HEOC, Ministry of Health and Population; Mr. Damodar Adhikari, Health Cluster Coordinator of WHO; Brigadier General Dr. Naresh Giri  and Dr. Kulesh Thapa, Army Hospital Kathmandu.

Other interested parties included:  Nepal Television and Prime FM from the media, Samacharpatra, Khadga Dal Gan (Dhulikhel) from the medical community as well as Nepal Police (Kavre), Traffic Police (Kavre), Red Cross Society (Kavre), CDO (Kavre), LDO (Kavre), Colonel Subash Jung Thapa and Colonel Prakash Chand of Nepal Army.

My thoughts

You know, I was hugely impressed with the degree of preparation and seriousness that went into the planning of this drill.  Just take a look at all who participated (list above), that’s a lot of coordination!

And all under the watchful eye of so many evaluators from key bodies including Nepal Government’s Ministry of Health and Population as well as the World Health Organization (WHO).

A huge learning experience too for Patan Hospital, Nepal Police, Nepal Army and the local Red Cross.    I’m amazed it was all kept under wraps to make it a true Drill.

It was a true test of the skills of SIRC staff and management to respond so quickly and effectively to a disaster with minimal notice.  Remarkable really that yet again SIRC lived up to the standards the founding Board set all those years ago.  I’m not sure a similar Drill in Vancouver would perform much better, despite the many more resources available here.

For me, it’s just reinforced my commitment to SIRC all the more.  Makes me proud to be a part of the SIRC family.  It really does.

 

 

About Kate Coffey

After 25+ years in the investment management industry, I packed in my job and spent 2014 living and working in Nepal and Bangladesh, and visited some other places in between. It took me on a journey I did not expect, had me fall in love with Nepal and it's people, and become inspired at the work of Spinal Injury Rehabilitation Centre (SIRC) located 2 hours east of Kathmandu in the Sanga foothills. Since 2014, I have continued my warm relationship with SIRC and worked closely with my friends there in the aftermath of the 2015 earthquakes to date. This blog initially started out as a travelogue of sorts to keep friends and family worldwide updated while I was off on my travels in 2014. Since then it has morphed into a life story of the many places I have lived and worked and of the wonderful people I have met along the way. I hope you enjoy.
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2 Responses to Practice practice practice

  1. Hi Kate, I would like to make fewer comments on your blog- my post is Assistant Project Manager and SIRC was initially 51 bedded facility not 52. I have done proof reading and not gone in detail. Looks great though!!!

    Thanks!

    Best Regards,Nikita KayasthaAsst. Project ManagerSpinal Injury Rehabilitation CentreBhainsepati, Saanga, KavrePhone no: +977-011-660847/48Website: http://www.sirc.org.npFacebook: Spinal Nepal

    Date: Tue, 23 Feb 2016 02:10:58 +0000 To: nikitakayastha@hotmail.com

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