After Quake, Medics Forced to Extremes

The Ayub Medical Complex in Abbottabad, Pakistan, shifted victims to a makeshift hospital outside after an aftershock from the Oct. 8 temblor.
The Ayub Medical Complex in Abbottabad, Pakistan, shifted victims to a makeshift hospital outside after an aftershock from the Oct. 8 temblor. (By Andrea Bruce -- The Washington Post)

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By John Lancaster
Washington Post Foreign Service
Thursday, October 20, 2005

ABBOTTABAD, Pakistan, Oct. 19 -- A British-trained orthopedic surgeon, Sohail Sahibzada, said he could not find his patient. A moment earlier, the young woman had been lying nearby on a gurney with a gaping infected wound on her broken leg. Now, she was missing. "We're in a bit of chaos at the moment," Sahibzada said during a pause in his search at the Ayub Medical Complex here. "The system is collapsing."

Following a strong aftershock Wednesday morning, several hundred earthquake victims had been shifted out of the hospital and onto the front lawn, some displaying bandaged stumps from amputated limbs. The operating theaters were no longer functioning because of fears that the building might collapse. New patients were still arriving at the rate of 40 to 50 per day, many with badly infected wounds.

"I don't know how long it can last," said Sahibzada, 51, reeling with fatigue after 12 consecutive days of performing and overseeing surgery at the hospital. "It's all just the beginning, not the end."

The chaos at the hospital underscored the monumental challenge facing medical and relief workers as they struggle to provide treatment for tens of thousands of people injured by the massive earthquake that rocked northeastern Pakistan on Oct. 8.

As in the case of many major earthquakes, this one exacted a gruesome toll in crushed limbs, smashed pelvises, broken spines, fractured skulls and other trauma caused by falling debris. But the injuries have been made worse in many cases by the difficulty of reaching survivors trapped in remote mountain villages. As time passes, medical workers say they are seeing more and more patients with gravely infected wounds.

"In principle, most of them are broken bones, but if they're open they're going to get infected very quickly," said Sebastian Nowak, who runs helicopter operations for the International Committee of the Red Cross in Pakistan. "They get black. They get gangrene. They get flies. They get worms. They get everything."

Because of the huge toll in injuries, and the difficulty of providing shelter in remote areas that will soon be blanketed by winter snows, relief experts said the earthquake in many ways poses a bigger humanitarian challenge than last year's Asian tsunami, even though it affected 11 countries and killed many more people. Estimates of the number killed by the earthquake range from 40,000 to 80,000, compared with more than 220,000 for the tsunami.

"The tsunami was something that you escaped completely or it killed you," said Kevin Hartigan, who runs the South Asia office of Baltimore-based Catholic Relief Services. "It was like a plane crash. Whereas the earthquake, on the contrary, was something that severely wounded many, many people in a very large, inaccessible area."

In Sri Lanka, the tsunami killed more than 30,000 people, traumatized many times that number and caused staggering property losses. But the damage was confined to a narrow strip of coastline, all of which was readily accessible by road, and most injuries consisted of relatively minor cuts and bruises. Medical teams that flew in to treat the wounded often found themselves with surprisingly little to do.

Nowak, the Red Cross worker, said he accompanied one young woman on a flight out of an isolated village on Sunday whose wounds were so badly infected, after three days trapped in the rubble of her house and several more waiting for treatment, that both her legs had to be amputated above the knee and her right arm above the elbow.

"About 20 percent of the patients I evacuate go straight to amputation," he said. Then he corrected himself: "It's more than 20 percent that get amputated. It's probably 30 percent. And I'm just seeing a small portion of it. There must be hundreds of villages like this."

The 7.6-magnitude temblor inflicted the bulk of its damage in the mountainous realm of Pakistani-controlled Kashmir and adjacent parts of North-West Frontier Province. With many roads blocked by landslides, thousands of injured victims have been carried down from the mountains by relatives or evacuated by helicopter. They are being treated at hospitals in Islamabad, the capital, and other cities, as well as a growing number of field hospitals.


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