ACCIDENTS & Emergencies in NEPAL

For those reading this who have never visited Nepal or not been involved with an accident or emergency whilst there, I consider it helpful to 'set the scene', as to how things operate under "normal" situations. The purpose is to allow a degree of understanding of the challenges/difficulties faced by the rescue-teams (both foreign and local) along with those attempting to co-ordinate the rescue and aid efforts. The main BBC reporter in Kathmandu said (29th April 2015) that there was some unrest as to how long it was taking for aid-supplies to be distributed. With the best will in the world, it does take days/rather than hours for arrangements to "swing into action". And striking the balance between continuing "search and rescue" activities with "distribution" of aid supplies is never easy. It can be especially frustrating for those "on the ground". After a certain period, only a very small number of people are brought out alive from collapsed buildings but each one does give the effort a boost. We are all human and small-scale victories boost morale, being on a scale that can be related-to.

SO WHAT IS IT LIKE IN NEPAL AT THE "BEST OF TIMES"?

ACCIDENTS/CRASHES

A 'local' bus on a safe section of mountain road but the potential for an accident is clear enough... © Chris Chadwell

And of course there are no seat-belts; they are frequently over-crowded (though the custom of riding on the roof is thankfully not as common as in India, where some people with a death-wish ride on the roofs of trains; have observed this in Dhaka, Bangladesh as well) © Chris Chadwell

Crashes are alarmingly common-place on roads in the Indian sub-continent. Joseph, my youngest son, when visiting Nepal with me aged 9, inquired, "What side of the road they drive on in his country?". Quite! For young people, accustomed to roller-coaster rides, travel on the roads might be quite thrilling. One has, if there is no other option, to be rather fatalistic, as local people are and take 'calculated risks' but IF you have the funds and a safer option is available, take it. It would represent a sound financial investment.

A 'minor' accident © Chris Chadwell

I have already commented about travel by road in Nepal within the 'Trekking in Nepal' section of this web-site (see: but am reproducing the following paragraph again:

In 2013 we were flagged down by Indian motorcyclists who had seen a bus go down a slope to a river. I composed myself (having received some first aid instruction during a spell as a junior officer in the Royal Naval Reserve and basic first-aid training during my basic training to become a police officer) got the medical kit I take with me on all expeditions from the boot of the car to add to the first aid kit I carry with me at all time in a small rucksack), then headed down to the bus by a safe route. There were numerous Nepalis and some Indian tourists standing watching but not having a clue what to do, beyond carrying off some of the seriously injured in the direction of the nearest village probably 2km away (where by chance a clinic had recently been built). 4 Europeans had been on the bus with a well-spoken Indian guide, sporting a gash in his forehead, busy on a phone calling for a helicopter rescue (a forlorn hope as the weather was cloudy and darkness was approaching). I bandaged his head, noted 2 of the 4 (all the injured Nepalese had been removed by then) had only minor cuts but were in shock. I assessed the remaining 2. One man was clearly in pain, probably with a broken arm but urged that his friend, was more seriously hurt, possibly with internal injuries - which required the attention of a doctor. I asked the crowd if a doctor was on the way. I was categorically told no. They were keen to start carrying (without a stretcher) the injured men. I strongly opposed this, stating the two should not be moved until assessed by a doctor; the man with the arm injury said, "that is the first sensible thing anyone has said"! I then searched through the luggage of the Europeans for first aid supplies, which one of those which shock indicated they had. If I used up all of mine, I would be obliged to travel back to Pokhara. They had ample. Then, a local doctor arrived and took charge. The local policeman was also there. As the two friends had now largely recovered from their shock and they had an educated guide with them, I felt I could do no more- and left, as the driver of the vehicle I had hired was anxious not to be delayed further.

A crashed local bus in October 2012 © Chris Chadwell

Which had come to rest at the edge of the Kali Gandaki river © Chris Chadwell

Two people, one with stick to ensure they were not swept away by the current (despite being fairly shallow this was still fast-flowing) valiantly checking to see if anyone was trapped under the bus. © Chris Chadwell

MEDICAL EMERGENCIES/LOCAL HOSPITALS

Several years ago, I started to feel really bad at the end of my stay in Nepal. The final afternoon, I had agreed to visit my guide's family at their 'home' in Kathmandu (he was renting a single room, with communal toilet facilities shared with several homes). Reluctantly, as I was feeling incredibly tired, I agreed to this but found I could not face eating anything, despite realising how 'shameful' it is to reject hospitality and did not have the strength to take the pictures of his family I had promised. Severe pain developed, which I recognised as most likely being 'renal colic', associated with a kidney stone (which I had experienced previously). After a while, as my strongest painkiller was not working, I asked to be take to hospital. There is no emergency phone number to call in Kathmandu for an ambulance. A taxi was called. Just to make the situation worse, the road outside the building consisted of rubble, awaiting re-surfacing, so the ride was initially bumpy. Our first stop was at a chemist/pharmacy. As best I could, I firmly said no, "HOSPITAL", I groaned. Next stop was a dentist (yes, this did really happen). Finally, I arrived at what was a teaching hospital. Neither the driver nor my guide knew the whereabouts of the Private Clinics which cater for Foreigners with insurance (which I had). Since facilities are so limited in Kathmandu to serve local people, this would have been the best place to have been taken - and, selfishly, in such a situation one seeks the best care available, if beyond the means of most Nepalese. The world is not a fair place.

There was not an 'Accident & Emergency' department as such but a room with a few plastic seats on the perimeter. Two elderly ladies occupied a single trolley (one was attached to a rudimentary drip). No medical staff were to be seen. After thankfully a relatively short period (I have absolutely no idea how long) a couple of young doctors appeared. No nurses were visible. One of them was concerned that by then I was lying (in considerable pain) on the floor, which she told me me was, "unhygienic". She advised me move to the trolley. Was I expected to "push off" the old ladies occupying it? As far as I could tell, this was the hospital's only trolley - and of a basic type, nothing like the substantial ones in most UK hospitals (having spent the night on a trolley in my local A&E, I cannot see what all the fuss is about being on a trolley - the as the one I experienced was more comfortable than most beds in wards; and in the UK, A&E is actually the safest place to be if you are in a bad way, as doctors are present 24 hours a day, with consultants either present or "on call" - the same does not apply in wards, especially at night or weekends - yes, I was perfectly well aware of the inferior attention one got at weekends, waiting for the consultants to re-appear on weekdays, YEARS ago).

I tried as best I could (I had a small sheet of paper with a typed explanation in English that I had suffered from kidney stones before) that I had already taken the most powerful pain-killer available to me in the small emergency medical kit I carry at all times (it would not have been much use back at my hotel). I demanded an injection of 'morphine' to stabilise my condition. Whether they thought I was a drug-addict after their next fix or not, I was treated with consideration and professionally by the rather young doctors (presumably student doctors). They were reluctant to go for the morphine (probably supplies were strictly limited), so something less powerful was given by mouth and I had to wait to "see if it would work". Eventually, they decided something stronger was required. Naturally, doctors are not accustomed to be instructed as to what to do by patients! And supplies of powerful drugs are strictly limited.

Once I had stabilised and could sit up on a seat, I was sent for an X-ray. Providing a urine sample was not straightforward. I was simply presented with a very small bottle and pointed in the direction of the toilet. It was quite hard even to enter (the door was jammed) and then pitch-dark inside.

The conclusion was that the kidney-stone had probably had passed-through, which came as a relief, as I did not fancy a protracted stay in any hospital in Nepal - not least as I had a flight booked the following day from Kathmandu to Dhaka in Bangladesh. I was NOT impressed to be provided with only 24 hours supply of pain-killers, with the advice that I should consult a doctor if serious pain returned - not a straightforward thing when travelling in developing countries. That night, the pain did come back, thankfully only at a moderate level. I did not much fancy searching for the hospital in the dark. My own remaining painkillers seemed to work and I was in reasonable order for the journey to the airport. I ALWAYS set off ahead of time, which on this occasion proved invaluable, as the worse traffic jam I have ever experience in Kathmandu ensued. We moved about 100m in 45 minutes. Were the Gods against me?

I did make it to the airport, just on time, only to told at the Biman Bangladeshi airline check-in desk that I did not have a seat confirmed on the flight. I FIRMLY stated I most definitely had RE-CONFIRMED my flight (this was a tiresome requirement in the past for flights to and from and within the Indian sub-continent). I was told at the desk various stories, from the flight being full, to it not operating that day. The facial expressions of one of the airport staff standing behind the check-in counter staff (and thus able to see the screen) 'revealed' that I was being lied to! I was told I should come back the next day. MOST of the others in the queue followed this instruction. Not fancying this option, I persisted and asked to speak with the duty manager. This lady proved elusive; she was NOT in her office when I ventured up there. Just minutes before check in closed, she magically appeared (having avoided having to deal with numerous disgruntled passengers) and confirmed that the flight to Dacca was operating after all - it turned out to be almost empty.

I always consider it best to complete whatever leg of a journey I can, even if cannot complete the whole journey at one go. Better to be in Dhaka than waiting back in Kathmandu. And the explanation for the pretence? It seems a decision had been made to cancel a London to Dhaka flight the following day (probably there were too few passengers), thus there would be no aircraft in Dhaka to fly passengers to London. Under such circumstances, Biman would be liable to meet the costs of hotel accommodation for any of their 'London' passengers stranded in Dacca. By getting MOST to stay another night in Kathmandu, the passengers would pay. I had suspected this would be the explanation.

At Dacca airport, the airline agreed to organise a hotel for the handful of passengers awaiting the London flight (now due the following day) but we had to agree to make a payment to the hotel. Thankfully, I had an emergency supply of dollars. The hotel proved OK, with meals thrown in - the rice was the best I have ever tasted. With considerable relief, my internal adrenalin came into play and I experienced no significant pain whilst waiting in Dacca for 24 hours.

My faith in the airline was further tested by whilst waiting to get back into the airport, there was a power-cut (presumably including the runway lights).... But made it back to the UK in the end.

So those attempting to co-ordinate aid efforts in 'Crazy' Kathmandu certainly have their work cut out!

It is being said that this is the 'worst' earthquake to hit Nepal in 8o years. Regardless of the accuracy of this statement, I hope that the above information will convince you of the wisdom of having first aid training and be properly equipped prior to a visit to this country. PLEASE do not rule out visiting this amazing country due to safety concerns (though extra care will need to be taken during 2016). Nepal needs foreign visitors to help its economy recover. Just be better prepared, to ensure you can deal with unexpected events, ensuring you are kept safe, along with your travelling companions and any Nepalese who work for you - whether as guide, cook or porter. Risks must be taken in life. Provided they are calculated and considered, they are manageable.

SOMETIMES one must turn back - the mountains will still be there the following year. If I can stay in one piece during many expeditions to the Himalaya, others can complete their holidays safely - unless being very unlucky to be in the wrong place at the wrong time. But greater preparations may be required than you might have considered necessary in the past.