The medical crisis

TWELVE days after the earthquake, when the first phase of emergency relief was over, Liladharbhai Gadha, a trustee of the Bidada Sarvodaya Trust hospital, summed it up: "The tragedy was lack of coordination. There was no shortfall in medicines, doctors o r money, but it was there in the distribution of these. We finally decided that the best thing would be to send the doctors back to where they came from, along with some patients."

Stories abound of foreign medical teams being underutilised, of planeloads of supplies being misappropriated, of aid workers and doctors with confirmed tickets being offloaded from aircraft only to be replaced by politicians or media crew. A fortnight af ter the earthquake, the exact number of medical teams working in Kutch was not known. Independent aid agencies fixed their own areas of operation by tying up with local non-governmental organisations (NGOs), while foreign government-sponsored agencies we re directed via the local administration. The initial lack of coordination between the administration and the NGOs resulted in some areas receiving more medical aid than was required. Worse still, some medical teams were unable to utilise their services fully . A team of Israeli doctors, who arrived with six planeloads of supplies and equipment, found that after the first few days they were at a loose end. This was not for reasons of shortage of patients. One doctor explained: "Patients are too scared to rema in in Bhuj. They take their basic treatment, and then if they are able to, they go to safer places."

Most in demand were orthopaedic surgeons. Doctors said that more than 50 per cent of the fractures were of the lower limbs, and there were a few skull fractures. Although there were reports of mild gastroenteritis (300 cases in Bhachau taluk, according t o a report of the Voluntary Health Association of India) and chicken pox (40 cases in Rapar taluk), the district administration and the NGOs said there was no fear of an outbreak of epidemics.

During the initial days of the disaster, the victims in Kutch had access only to Military and Field Hospitals, the Leva Patel Hospital in Bhuj, the Bidada Sarvodaya Trust Hospital and the Bhojai hospital. The latter two could mobilise services rapidly be cause, located as they are in southern Kutch, they were unaffected by the earthquake.

AT the 15-bed, two-year-old, Bhojai hospital a team of doctors sent from the Sultanate of Oman's Ministry of Health work ceaselessly. The majority of the cases are orthopaedic. Like so many others, this team works with whatever is available and find that more than just its medical help is being called on.

At the Bidada Sarvodaya Trust Hospital the first phase of emergency medical treatment is over. New patients still come to this 27-year-old institution from remote regions of Kutch. However, since the 11th day, new registrations fell to 10 per day. The ho spital has treated more than 800 seriously injured persons. At the peak of the calamity surgeons carried out 30 to 40 surgical operations daily.

With the experience of 30 years, the Bidada team was quick to respond. By the evening of January 26, Mumbai's Kutchi community had pledged Rs.1 crore to the hospital. The next day volunteer doctors reached Bidada, and the operation theatre began working. A vast tent was erected to house more than 250 beds. Another tent served as a transit camp while yet another housed the homeless. The hospital kitchen served 2,000 people every day. The civil administration gave the hospital full access to their medical stocks.

Ninety per cent of the serious injuries are orthopaedic, according to the hospital records. In 30 per cent of the cases, amputation was done. The hospital has already organised a 15-day workshop to fit patients with artificial limbs.

THE number of psychologically disturbed people is yet to be ascertained. Dr. Dhiraj Chheda, who has had long association with the Bidada hospital, says psychological fears are being manifested in small ways like stress-induced gastric bleeding and a heig htened sense of fear of noise and vibration. Children, especially those below the age of five, seemed to want to blank out what happened, he said.

Jagrutiben Vyas was brought to the hospital from Bhuj by cadets of the National Cadet Corps. She has no surviving family. The case papers of the 75-year-old read: "Highly anxious. Unable to respond to verbal supportive psychology. Unable to monitor her o wn medical needs. Traumatic paraplegia. Psychiatrist required."

However, doctors do not expect psychological problems to escalate to any severe extent because of the strong emotional support from the community. The case of Chetana, 26, is an example. Her broad smile and cheerful conversation are at odds with the fact that both her legs have been amputated from the knee. She has lost her husband and daughter. She says she lives for her son. For the first three days she cried almost non-stop and clung to her sister-in-law who, she says, gave her tremendous emotional s upport. She believes that helped her recover.

She echoes the anthem of Kutch when she says: "It's in the past now and we have to get on with our lives."