During a medical mission to Nepal several weeks ago, my 19-year-old nephew remarked that despite its unstable government and lack of infrastructure, the people there seem to get by fairly well.
Having just returned to Kathmandu from China on a cold but bright day, he detected a sense of freedom in the air despite the poverty and chaos. Still, I suggested he consider what would happen if a disaster struck such as an earthquake or a health epidemic. The earthquake just happened, and the epidemic can be expected to follow.
The mounting number of traumatic deaths will likely soon be dwarfed by shortages of potable water, food, shelter and health care. Nepal is also now at great risk for epidemics such as hepatitis and cholera. Even during the best of times, the electricity is only on at night, and sewerage is primitive.
There is certainly no equivalent to the U.S. Federal Emergency Management Association. With an average gross domestic product of $750 per capita per year, Nepal, one of the world’s poorest countries, in the best of times has narrow, bumpy roads, no trash removal and questionable drinking water. The Kathmandu airport, which serves a country of approximately 30 million people, is no bigger than the Hilo airport.
In fact, Nepal does not even have a functioning government. Its 10-year civil war ended in 1996 when the Maoists prevailed. But the Hindu Nationalists, who are more closely aligned with India, hold the majority in parliament. The Maoists, however, comprising ethnic minorities and lower castes, take to the streets whenever they are displeased with the political weather. Consequently, after all these years, Nepal still does not even have a constitution. Neither does it have any substantial health care system, public or private. It does not have a public safety net or any substantial disaster response preparedness.
Natural disasters tend to unfold in a fairly predictable manner. The initial response is one of widespread sympathy and a rush of food, medicine and materiel from governments and charities. But part of a disaster is chaos. Establishing communication, coordinating assistance and building consensus is a challenge, even in developed countries. Fatigue and frustration inevitably set in, as do secondary problems related to recovery, rehabilitation and rebuilding. Regardless of good intentions and generous resources, there is never enough to go around.
It will still be some time before the true death toll from the earthquake is known. By then more people will be at risk for starvation and disease, especially as the monsoons arrive and spill waste into the water supply, followed by the cold of winter.
All of the people I know who I could reach in Nepal were fine. The ones I could not reach leave me worried. My instinct was to fly out immediately, but I know that the relief effort will be long and slow.
Through my tears last week, I communicated with a close friend who grew up in the Tibetan refugee camp in Pokhara, Nepal.
He consoled me.
"We are a strong people," he said.
I will return to Nepal soon for yet another medical mission. This time it will be different. When a natural disaster occurs in a failed state, the human cost is unfathomable.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
