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NEUROLOGISTS OFFER AID IN EARTHQUAKE DEVASTATED PAKISTAN

Avitzur, Orly, MD, MBA

ORIGINAL ARTICLE

In 2005, there were a record number of disaster-bred casualties. Observers felt helpless viewing the succession of televised images from the aftermath of the tsunami, the hurricane-ravaged Gulf, and the earthquake in South Asia. Many physicians, watching the suffering, were impelled to help. Some left their jobs and boarded planes to offer whatever medical assistance they could provide.

Child neurologist Amer Khan, MD, was one of them. He, like other neurologists with ties to Pakistan, understood the urgency of the situation. Even before the Kashmir earthquake killed over 73,000 people, left millions homeless, and caused an unprecedented number of spinal cord injuries, there was a dire need for neurologists. Although Pakistan is one of the most populous nations in the world with an estimated 150 million inhabitants, it has only 70 practicing neurologists – a ratio of one neurologist per 2 million.

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HIKING UP THE HIMALAYAN MOUNTAINS

Dr. Khan had signed up for earlier volunteer missions sponsored by his employer, Kaiser-Permanente, but had not been chosen. “The need to do something had been building up over this past year,” said Dr. Khan, “and when I saw the devastation from the earthquake, I could no longer sit back.” Having grown up in Islamabad, Dr. Khan felt he had the cultural background and language skills needed to be useful. So he contacted Relief International, a Los Angeles-based nonprofit agency, and in late October, he and three other physicians spent two weeks caring for remote villagers in the foothills of the Himalayan Mountains.

The team had to hike up washed-out mountain roads and fly on army helicopters to deliver much-needed tents, blankets, and basic medical supplies. Dr. Khan served as a translator, facilitating communication with local police, military personnel, and victims. He and the others delivered as much first aid as they could, but in most cases they were hamstrung by the lack of modern equipment and medications. They did not have tetanus antitoxin, for example, and could do little for those infected. “It was heart-wrenching seeing the effects of lock-jaw – its victims couldn't eat, drink or swallow; they eventually became encephalopathic and died,” said Dr. Khan, who had never seen the disease before.

Zeba Vanek, MD, Director of the University of California-Los Angeles Spasticity Clinic arrived in Islamabad several weeks later along with Sofia Janjua, MD, an Interventional Neurology Fellow at the University of Medicine and Dentistry-New Jersey, and Susan Escueta, an epidemiologist from the Epilepsy Foundation in Los Angeles. The HOAP Foundation, a nonprofit organization providing emergency aid in the region, introduced them to a local medical consultant who helped direct them to clinics, hospitals, and joined them in the relief efforts.

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EACH STORY MORE TRAGIC THAN THE NEXT

They spent the first part of their three-week journey at the Melody Center, a former cinema torched by arsonists, and converted into a rehabilitation facility to house paraplegic women. The young women were at home when the roofs collapsed and crushed their spines; men were out at work, the children at school, and the elderly had likely not survived. The run-down building was overflowing with patients – paralyzed women, some pregnant, lay on beds in every possible corner of the two floors. Dr. Vanek recalled, “I tried to remain professional, but each woman's story was more tragic than the next – they had lost husbands, children, siblings, parents – it was hard to maintain composure.”

The two neurologists also served as a medical drop team, traveling by helicopter to the region of Kohistan, a rural, mountainous area that had been cut off from supplies for nine weeks due to rubble-blocked roads. They delivered food staples – wheat, lentils, rice, and cooking oil – with a World Food Program team, and provided basic medical care. They saw more patients in mountain-based camps set up by HOAP, including one in Jabri in the Frontier province. “There were so many profoundly malnourished and sick women and children,” said Dr. Vanek, who treated severe diarrhea, parasitic infections, scabies, pneumonia, and tuberculosis with drugs both donated and bought with contributions. “We had forgotten to bring flashlights, so we did gynecological examinations by match light on women who were pregnant and hemorrhaging,” she explained.

The two doctors were drawn to survivors with neurological problems – especially those with spinal cord injuries, whom they saw in greater number when they traveled to larger rehabilitation and other hospitals in Islamabad, Rawalpindi, Muzzafarabad, Kashmir, and Peshawar. “There are about 750 paraplegics who need medical care and rehabilitation,” said Dr. Vanek, adding that rehabilitation facilities can only accommodate 130 patients. “It would make a great difference if they could get therapy and training so that they could return to their villages,” she added, acknowledging that many will die of sepsis before resources can be found.

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AID TO SPINAL CORD VICTIMS

“We're trying to acquire raw data to get a handle on the numbers and locations of paraplegic patients so that they do not get lost in the mountains,” said Dr. Vanek. She and Dr. Janjua are creating a grant application to support a medical student or house office in Pakistan who can help them to collect this data. Adnan I. Qureshi, MD, Director of the Cerebrovascular Program at the University of Medicine and Dentistry-New Jersey, agreed to launch it with a small stipend, and they are trying to raise more funds. “We need someone who can visit the major paraplegic centers and the home environments and work with us by e-mail so we can find out what still needs to be done,” explained Dr. Janjua.

It has been difficult for the doctors to readjust when they come home. “I have been haunted by the experience, waking up in the middle of the night, and wondering what has become of the people I met,” Dr. Vanek said. “Did the paraplegic with three small children, who had lost the rest of her family, live or die? I feel guilty just being here, working in such a privileged place,” admitted Dr. Vanek, who is continuing her relief efforts and intends to go back when she can.

Dr. Khan is also trying to arrange a return to Pakistan. “It's not only in the beginning that people need help,” he said. Freezing weather is bringing new illness to the area, and the sick and homeless are in even greater need of medical attention.”

Zahid F. Cheema, MD, Director of the Neuromuscular Section and Clinical Neurophysiology Laboratory at the University of Oklahoma, traveled to Pakistan in December with the Association of Physicians of Pakistani Descent of North America and the Islamic Medical Association of North America.

Dr. Cheema spent most of his time working with the Mobile Army Surgical Hospital established by the US Military in the city of Muzzafarabad, seeing neurological effects of trauma. “I met a 16-year-old boy who had lost both parents, a ten-year-old girl who had lost her mother, a father who had lost his only child…the stories of loss and grief were endless.” He added, “Most of the field hospitals are converted tents. They lack basic equipment and even heating. There is a great need for more volunteer physicians and additional funds.”

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INFORMATION ON RELIEF EFFORTS IN PAKISTAN

The following organizations and Web sites offer updates and opportunities for helping with the relief efforts in Pakistan:

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PALATUCCI ADVOCACY LEADER MOUNTS A CALL TO WESTERN WORLD NEUROLOGISTS

Mohammad Wasay, MD, Associate Professor of Neurology at Aga Khan University in Karachi, Pakistan, has mounted an organized campaign to seek help from neurologists abroad. The Donald M. Palatucci Advocacy Leadership Forum Advocate of the Year (2004) had worked on various projects with the AAN before, but this effort was closest to his heart. As Secretary of the Pakistan Society of Neurology, he sent e-mails and letters asking for help to more than 500 neurologists working in the United States, Canada, and Great Britain.

To further help raise awareness, Dr. Wasay organized a seminar, “Earthquake Victims in Pakistan: What Neurologists Can Do,” for the Pakistan Society of Neurology meeting last December. Attendees agreed that hundreds of people with nerve injuries would be able to resume their normal working lives if their neurological problems could be properly diagnosed and treated. Patients who had sustained traumatic brain and spinal cord injuries need long-term neurological, psychosocial, and vocational rehabilitation, he said. He added that many of Pakistan's homeless needed vaccinations and treatment of widespread post-traumatic stress syndrome and depression.

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ARTICLE IN BRIEF

  • ✓ Neurologists across the US participated in relief efforts under way in the Kashmir region of Pakistan wracked by a devastating earthquake in December.
©2006 American Academy of Neurology