Nepal rescue heroes face incredible stress, challenges

Story highlights

  • Usha Periyanayagam: Responders to deadly Nepal quake face immense logistical challenges
  • In disasters, all normal systems break down, imposing psychological burden on rescuers

Usha Periyanayagam is an attending physician specializing in emergency medicine at Brigham & Women's Hospital in Boston, research director of the Global Emergency Care Collaborative, and affiliate faculty of the Harvard Humanitarian Initiative. The opinions expressed in this commentary are hers.

(CNN)Nepal's disaster responders in Saturday's magnitude-7.8 earthquake have quickly become unsung heroes. Aid agencies and the United Nations have begun to coordinate a response and will soon join in their effort.

Both local and foreign disaster responders face incredible challenges of resources, logistics, threats to personal safety and stress, but the response must continue. This large earthquake in a country with a diffuse population, shoddy infrastructure and minimal disaster training threatens to produce a massive death toll.
Usha Periyanayagam
In the first 72 hours after a disaster, the response is always local. Neighbors are housing others in makeshift shelters and are sharing their meager resources with strangers who have even less. Untrained teams have formed search and rescue committees, saving people in demolished buildings. The outside aid agencies will join them soon.
    In hospitals, the lack of resources is especially acute. Medical personnel are responsible for the difficult process of triage, limiting their precious time and resources to those who can be helped. Basic items -- such as clean water and gauze to prevent wound infections, plaster to splint broken bones, and pain medicine to ease the suffering of the dying -- are in short supply.
    Nepal's already understaffed hospitals lack the doctors and nurses to treat the massive influx of patients. Clinics in rural areas don't have the experience, personnel or equipment to treat the traumatic injuries common in earthquakes.
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    Even when resources are available, disaster responders are challenged by lack of infrastructure. The airports are running and many countries have sent supplies. However, the feeder roads to distribute these donated goods are covered with debris. Nepal lacks the equipment and personnel to clear them quickly. Furthermore, the forecast of a cool night and rainy day on Sunday has the potential to destroy perishables. The government has yet to allow expedited customs clearance for donated goods. This infrastructure limits the disaster responders.
    Challenges to the responders' personal health are particularly daunting. The sheer needs after an earthquake force untrained personnel to enter dilapidated buildings, risking their own safety. The potential for aftershocks, avalanches and landslides threatens the responders. Treatment of the wounded without gloves or clean water places them at risk of infection and endemic diseases. They are vulnerable to assault and battery as desperate populations attempt to save their loved ones.
    The stress of relief work is indescribable. Aid workers know that pausing to sleep or eat prevents them from helping others and results in more lives lost. Guilt and frustration accompany the unending critical decisions workers must make; there is constant exposure to misery and suffering. Foreign disaster responders' stress is compounded by the pressure of working in an unfamiliar country.
    Disasters cut all human support systems, breaking families, displacing neighbors and destroying comfort items. In an earthquake this size, there is no place to take a break from the unending grief.
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    While the challenges are large, a well-organized response has the capacity to significantly mitigate suffering. The need for aid is obvious; however, the distribution of aid first requires a needs assessment.
    Waiting for this assessment takes valuable time and requires working communication systems and a knowledge of disaster response. However, this assessment is critical for effective aid. Without it, a village becomes flooded with free food, undercutting the local farmers and creating a long-term dependency on outside food. Without it, a clinic receives supplies it doesn't need or have trained personnel to use. Without it, the response does not fit the community to be helped.
    Those in developed countries have to understand aid cannot reach local populations as quickly as cameras can; however, this is not a failure of aid work. They must support the Nepalese government's internal disaster response mechanisms and understand the importance of local relief organizations. Most importantly, they must realize that the disaster response occurs over months to years, and the first 72 hours doesn't predict the full measure of the response. This can be seen in Vanuatu, where getting clean water and fighting a measles outbreak are still active problems, over a month after Cyclone Pam.
    In the next two days, the American public will be blinded by images of suffering in Nepal and stories of the "slow response" of aid workers.
    Well after public attention leaves Nepal, the disaster responders will continue working, treating people, building wells and sustaining growth. They will assess their work and the response, look for areas of improvement and train others from their experience and knowledge.
    They'll create higher standards for relief work and disaster preparedness. The challenges they face are large, but their determination and compassion will help Nepal succeed and eventually thrive again.