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Neurology Today:
doi: 10.1097/01.NT.0000271247.94806.06
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Neurologists at Home Help Spinal Cord Victims of Kashmir Earthquake

Avitzur, Orly MD

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Neurology Today reported on the neurological injuries suffered by victims of the Kashmir earthquake last year. See “Neurologists Offer Aid in Earthquake Devastated Pakistan,” Mar. 7, 2006, pgs. 16–17.

The October 2005 Kashmir earthquake in Pakistan affected over three million people living in hamlets perched on the steep Himalayan slopes and valleys. It killed more than 87,000, and wiped out entire towns and villages, leaving 3.3 million homeless.

Fourteen-year old Awais Rehman, the son of a pushcart salesman, was one of many students attending school that day. He recalls feeling the ground heave beneath his classroom floor, and hearing the roar of rocks crashing through the roof. He tried to run for the door, but there wasn't enough time. The building collapsed on top of him, crushing his spine, and leaving him buried in debris. By the time relatives pulled him out of the rubble several hours later, he had suffered a T12 spinal cord injury (SCI).

Children were among those most vulnerable to injury in the disaster. Entire schoolhouses collapsed in the 7.6-magnitude quake, leaving 20,000 children dead, while others, like Awais, suffered fractured vertebrae and spinal cord injuries. Most men had been working outdoors, but women, still in their dwellings, were also defenseless against collapsing roofs.

Zeba Vanek, MD, a movement disorder specialist at the University of California-Los Angeles, and Sophia Janjua, MD, an interventional neurologist now at Long Island College Hospital, traveled to the region after the quake and visited several medical facilities. “It was the quadriplegic and paraplegic women and children who moved us the most,” Dr. Vanek recalled. The future seemed bleak once the injured left the hospitals. Their distant mountainous villages would make medical care nearly impossible. Even in towns, there was no infrastructure to assist the handicapped.

“To make matters worse, people with severe physical handicaps are socially marginalized in these poor and remote areas, and have almost no prospect of jobs or marriages,” explained Dr. Vanek. “When they go back to their villages they face a life of confinement and are dependent upon the goodwill of family members.”

When Drs. Janjua and Vanek returned from Pakistan in 2005, they made a commitment to help these victims, estimated to be 750 in number. “Life in the rugged Himalayans is nearly impossible for the spinal cord injured,” Dr. Vanek said, pointing out that wheelchairs are all but useless on this difficult terrain.

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CONDITIONS, EIGHTEEN MONTHS LATER

Eighteen months after the 2005 disaster, the two neurologists are still involved, raising funds in the US for a program that matches the most severe SCI patients from several institutions with donors to pay for their care with a therapist and contribute to their living expenses. To date, they have identified ten individuals for the pilot program.

Conditions, they told Neurology Today, are still bleak. Many disabled people are scattered in tents and camps next to their demolished homes. Access to electricity, heat, and running water is still marginal, at best. Most have been unable to seek medical help because of the difficulty transporting them to remote medical facilities. “They're likely to die from complications such urinary tract infections, skin ulcerations, and pneumonias,” Dr. Vanek said. What they require, she explained, are disabled-friendly homes uniquely designed for the steep mountains, and rehabilitation to improve their chances for gaining independence.

Drs. Vanek and Janjua gathered patient case histories with assistance from the relief organization, HOAP International (www.hoap.org.pk). “Medical students and local health-care workers helped gather the data now compiled on 319 patients,” Dr. Janjua reported.

In the summer of 2006, Sara Jeevanjee, a second-year medical student at Temple University, also joined the project. She visited SCI patients in the quake-affected areas, traveling to remote Himalayan regions in the company of a non-governmental organization (NGO) physician, and recording case histories. She described meeting eight-year-old Kaleem, a T12 paraplegic child who had lost his father, who had worked as a schoolteacher, and one of his brothers. The visit required a two-hour hike up the treacherous mountains of Balkot.

“It was a difficult walk, even for me,” said Jeevanjee. She found Kaleem's single room dwelling on the precipice of the steep slopes. He was seated in a wheelchair in which he could negotiate only the few flat feet in the sleeping room he shared with nine other family members. Relatives had tried to carry him to school — a one-hour trip each way that required two people — but the task proved too arduous to continue. The experience was transforming for Sara, who said that only then did she realize the magnitude of the challenges involved in the relief effort.

In February 2007, another student from the US, Komal Iqbal, volunteered for the project and made a field trip to the Himalayas. While there, she monitored the progress of many of the sponsored SCI patients, and took case histories of more patients. A full-time doctor was hired to make regular field trips to the remote regions where the patients were located, monitor their condition, deliver monetary help, and facilitate their ongoing medical, psychosocial and vocational rehabilitation. A charitable organization, Chaal, has begun to build disabled-friendly homes.

Figure. Sara Jeewanj...
Figure. Sara Jeewanj...
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Thus far the team has found sponsors for thirty-six patients, including Awais. Drs. Vanek and Janjua had earlier found the teen in the mountains of Kotbala in December 2005. He was bed-ridden, suffering from pressure ulcers and atrophied limbs. He was transferred to the Paraplegic Center in Peshawar where he began a rehabilitation program. He gradually improved, at first taking only a few steps with assistance, then using crutches, and eventually managing to walk short distances independently. By the end of March 2006, he returned to his village. Financial assistance will go towards his ongoing medical and educational needs.

For more information about the donorship program, contact HOAP at www.hoap.org.pk or Dr. Vanek through the AAN directory.

©2007 American Academy of Neurology

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