Professional Documents
Culture Documents
Katherine F. Sellards, RN
August , 2017
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 2
Nepal is a developing south Asian country landlocked by China from the north and India
to the south. The land is mostly mountainous with some peaks that range from sub-arctic to
arctic temperatures and about one-third of the country is low lands with sub-tropical to tropical
temperatures. Agriculture is abundant in the low lands and valleys, which drives the Nepalese
economy and holds the largest employment sector. Nepal possesses some of the highest
mountains, including Mt. Everest, and is a main attraction for mountaineers and trekkers.
The geographical location of Nepal makes it highly susceptible to earthquake activity and
has sustained several earthquakes, resulting in mass casualties and destruction in the past
century. On April 25, 2015, an earthquake measuring 7.9 hit the Kathmandu valley, killing
nearly 9000 people and injuring approximately 20,000. Densely populated areas in the valley
were greatly affected destroying homes, accessible roads, sanitation systems, clean water sources
and leveling historical architecture. Days and even weeks later, aftershocks continued causing
more deaths and devastation. The difficult terrain and the massive amount of debris made rescue
The immediate threats to health and disease prevention, physical injuries, rehabilitation
efforts and the possible long-term psychological impacts of earthquake survivors will be further
Nepal has long endured the dilemma of cholera outbreaks across the region that adds to
morbidity and mortality rates. Cholera is an enteric infection caused by the ingestion of
contaminated food and water sources resulting in sudden onset of severe diarrhea leading to
dehydration and possibly death if not promptly treated. Although cholera and other water and
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 3
food borne bacterial outbreaks have been a continuous health concern in Nepal, they are without
pertinent resources for laboratory testing and inspection strategies to locate the sources and route
of transmission of the outbreak (Dixit et al., 2014). Some regions of Nepal lack substantial clean
water sources and proper sanitation infrastructure and when natural disasters occur it can result
in devastating structural damages which can kill and displace thousands of people, making the
World Health Organization report that states that because this earthquake stricken area is already
at risk for disease, and when compounded with the loss of clean water sources, adequate toileting
facilities and remains of bodies not being immediately removed, the risk for the spread of disease
Mariana Palavra, UNICEF spokesperson, which also states that when access to clean water is not
available, people will seek out other sources of water, such as rivers or streams, to drink from
that may have been polluted with sewage or other contaminants possibly from damaged
sanitation systems and the delayed removal of human and animal remains thus, increasing the
risk for disease (2015). Palavra also stated that the upcoming monsoon will further aggravate
the situation, especially for vector-borne diseases such as malaria, dengue chikungunya, and
Japanese encephalitis since Nepal and the earthquake-affected districts are already at risk for
these diseases (2015, p. 770). In a personal communication between Dr. Anup Bastola, STIDH,
and Prativa Pandey, Pandey explained in a correspondence letter, dated three months after the
earthquake, that in three districts, twenty-nine cases of Cholera have been documented and are
being attributed to the consumption of polluted water, poor sanitation and living in heavily
In the hard hit, remote districts where travel was already difficult, the destruction from
the earthquake paralyzed communities, making travel even more difficult and seeking out of
much needed medical treatment nearly impossible to obtain. Not only were emergent healthcare
services delayed, but also preventative care, placing more vulnerable populations such as
expectant mothers, children and the elderly at higher risk for communicable diseases. Another
disease outbreak that is cause for concern among the most vulnerable populations is Hepatitis E,
which is also common in Nepal. It was estimated by a group of infection disease experts that up
to 500 pregnant women could succumb to a Hepatitis E infection (Basnyat et al., 2015).
Trauma
rich in history and ancient architecture. Unfortunately, this district was the one of the hardest hit
earthquake stricken areas, which resulted in collapsing buildings and destroying historical
landmarks. Because of toppling buildings and flying debris, many people in these areas have
sustained major bodily injuries. From research conducted on previous earthquake destruction, it
is predicted that most injuries will result in fractures, burns, soft tissue injuries, traumatic brain
injuries and spinal cord injuries (Zhang et al., 2014). A WHO report (as cited by Sheppard &
Landry, 2015) states that In total, approximately 18,5000 people were injured in both major
tremors, of them approximately 6% suffered spinal cord injuries (SCI), 2% had amputations, 4%
sustained traumatic brain injuries (TBI) and the mass majority (approximately 70%) of the
injuries were fractured. Data collected regarding spinal cord injuries revealed that of the one
hundred and fifteen patients presenting to one spinal cord injury rehabilitation hospital, most
spinal cord injuries occurred in women compared to men and that the most frequent type of
injury recorded was incomplete paraplegia (Groves, Poudel, Thapa, & Baniya, 2016).
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 5
treatment for ocular traumas at the Tilganga Institute of Ophthalmology (TIO) in Kathmandu.
Initially, there were approximately sixty patients that presented to the TIO, which had suffered
ocular injuries, presumably from falling earthquake debris. Of those cases, chief ocular
findings at the time of presentation were blurring of vision (35 cases), red eye (15 cases), cut
injury (5 cases), diplopia (3 cases) and a foreign body (1 case) (Pradhan et al., 2017, p. 2).
Additionally, closed globe, open globe, and corneal ulcerations were injuries that were found to
be the most common among ocular injury victims, some of them having to undergo surgery to
save the eye itself and the vision. However, none of the victims were stricken with bilateral
Psychological Impact
For the victims of the Nepal earthquake, after the realization of the destruction of their
homes, communities, markets and cultural monuments begin to set in, overwhelming emotions
can begin to emerge. Although, there is not much research that has been done regarding the
stress disorder and depression from past earthquakes in other regions will be reviewed.
Studies conducted after a major earthquake in China, the Wenchaun earthquake of 2008,
evaluated the prevalence of post-traumatic stress disorder in adolescents. In one such study,
research concluded that the severity level of PTSD and depression symptoms among adolescents
is dependent upon the level of damage to homes, injuries to self and family members or being a
direct witness to earthquake destruction (Zhang et al., 2011). Goenjian et al., further
corroborates these findings by stating that the youths that were exposed to more graphic images
of the earthquake destruction experienced more PTSD symptoms than those who did not have
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 6
direct exposure (2011). Other factors that were found in predicting the level of PTSD and
depression symptoms were being female and belonging to a multi-child home. Reasons found
for this are that females presumably have different coping mechanisms for managing emotions
and are of a lower socioeconomic class (Zhang et al., 2011). Furthermore, it was also concluded
that females have experienced reminders of the earthquake more frequently than males causing
more symptoms of PTSD (Goenjian et al., 2011). It was stated, that the possible reasons that
children with siblings were found to be experiencing more symptoms were due to the parents
being less attentive in comforting all the children as opposed to just one (Zhang et al., 2011).
Additional studies evaluating PTSD and depression in adults and the elderly show similar
results to the effects on adolescents. In the adult and elderly population, females were found to
have a higher prevalence of PTSD and depression symptoms, level of symptoms were dependent
upon whether there was a direct or indirect exposure to earthquake destruction, injury to self or
to family members and socioeconomic class (Zhang, Shi, Wang, & Liu, 2011; Guo, He, Qu,
Wang & Liu, 2017). It was suggested that the elderly may be more at risk for a higher
prevalence of psychological disorders due to decreased sensory and motor function, poor
physical health and low socioeconomic status may further decrease the ability of the elderly to
cope with disaster and to resume a normal life (Zhang, Shi, Wang & Liu, 2011, p. 62).
preparedness to learn more about the suggestions put forth that would help emergency workers to
prepare for future natural disasters. In saying that, there are some situations that could remain
problematic, such as the rural districts of Nepal that even under normal circumstances are
difficult to get to and in the event of landslides makes rescue work more unmanageable. In
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 7
response to the risk for spread of infections, particularly from water borne sources and/or oral-
fecal routes, one should steer clear of drinking from water sources that may be at risk for being
contaminated. Pandey (2015) suggests that water should be boiled or treated to prevent an
outbreak of a bacterial infection and that bottled water would be a better choice if available.
However, since access to bottled water can be somewhat difficult to obtain, the addition of
certain agents to water, such as chlorine and potassium permanganate tablets, could be used to
disinfect water (Gulland, 2015). Bagcchi (2015) also endorses the use of these agents for water-
purification as well as the simple preventative measure of hand washing. Observing the basic
practice of hand washing would reduce the spread of infections, especially in cases where
displaced citizens are living communally in temporary shelters because of the loss or instability
of their homes. Additionally, the establishment of rapid response teams for early detection of
potential outbreaks and alerting those in high-risk areas would decrease and control the spread of
pathogens (Bagcchi, 2015). Furthermore, the use of vaccines, notably for cholera and Hepatitis
E are highly recommended for early prevention when outbreaks have been detected.
The destruction of homes and overcrowding of shelters then leads to lack of adequate
toileting facilities to serve the mass population. It was suggested that to reduce the threat of
transmission, the emergency relief workers must ensure proper sanitation by placing adequate
number of mobile toilets, digging trench and pit latrines for safe excreta disposal (Gulland,
2015, p. 2).
hospitals, health care workers and essential medical resources needed to care for the victims in
need of emergent care and the number of injured far outweigh the resources that are available.
This is true, not only in the immediate aftermath of the disaster, but also in the long-term care of
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 8
people that have sustained lasting disabilities from their injuries. In the aftermath of the Nepal
earthquake, researchers are endorsing the importance of rehabilitation services for those
recovering from physical injuries sustained in the earthquake. Landry, Salvador, Sheppard and
Raman (2016) examine how initiating rehabilitation in the early stages of recuperation can
support a better management of patient flow through hospitals from the time of admittance to
discharge, decreases the chances of secondary complications and facilitates patients adjusting to
a new disability. However, Landry et al. (2016) does point out that Nepals infrastructure was
difficult for people with disabilities to maneuver before the earthquake and for the rehabilitation
process to be effective, the rebuilding of the environment must be supportive of the newly
disabled.
Rebuilding and repairing infrastructure and physical rehabilitation of injured patients are
critical for the future of Nepal, however the psychological aspects cannot be overlooked. It is
important to note that with any healthcare treatments, incorporating the patients cultural,
spiritual and religious beliefs within the plan of care is a beneficial aspect of healing. For
instance, someone with a strong cultural, spiritual or religious background may have more of a
support system, or overall faith, that will offer comfort and will guide them through their
respect cultural and religious belief. Because religion is a central part of Nepalese culture,
integrating consideration of religious beliefs into the psychological assistance for survivors may
facilitate the relief work (Hu & Su, 2015, p. 353). Zhang et al. (2012) continues this idea by
proclaiming that not only is culture-specific interventions necessary for emotional healing, but
that early introduction of the interventions is necessary to decrease the symptoms of depression
and PTSD. As stated earlier, there is limited research focused on the psychological impact from
RECOVERY OF NEPAL AFTER 2015 EARTHQUAKE 9
the Nepal earthquake. Nevertheless, researchers from prior studies agree that continued research
regarding long-term effects of mental health after natural disasters should be conducted to assess
and expedite the emotional healing process of the survivors and as a nation (Guo et al., 2017;
Conclusion
The amount of devastation in the wake of the earthquake reaches far beyond what could
be covered in this informative paper, which highlighted only a few health risks, physical injuries
and possible psychological impacts endured by the survivors of the earthquake. To review, early
detection of infectious diseases and educating people on avoiding questionable drinking sources
would greatly reduce spread of pathogens. Impressing upon the importance of how early entry
into rehabilitation services would facilitate recovery from physical injuries and integration of
newly disabled people back into the community. Lastly, increasing the awareness of the
psychological impacts on survivors, how PTSD symptoms can be delayed up to a year after the
References
Bagcchi, S. (2015). Risk of infection after the Nepal earthquake. Lancet Infectious Disease,
Basnyat, B., Dalton, H. R., Kamar, N., Rein, D. B., Labrique, A., Farrar, J., & Piot, P. (2015).
Nepali earthquakes and the risk of an epidemic of hepatitis E. Lancet, 385 North
Groves, C. C., Poudel, M. K., Thapa, B. P., & Baniya, M. M. (2016). Spinal cord injuries related
Gulland, A. (2015). Nepal earthquake gives rise to fears over poor sanitation. BMJ: British
Guo, J., He, H., Qu, Z., Wang, X., & Liu, C. (2017). Post-traumatic stress disorder and
depression among adult survivors 8 years after the 2008 Wenchuan earthquake in
Hu, X., & Su, Y. (2015). Psychological rescue work ahead for Nepal: lessons from the
Wenchaun earthquake. Journal of Psychiatric & Mental Health Nursing, 22(6). 353.
doi:10.1111/jpm.12253
Landry, M. D., Salvador, E. C., Sheppard, P. S., & Raman, S. R. (2016). Rehabilitation
following natural disasters: Three important lessons from the 2015 earthquake in
Pandy, P. (2015). Letter from Nepal, August 12, 2015 Cholera in post-earthquake Kathmandu.
Pradhan E., Limbu, B., Thakali, S., Jain, N. S., Gurung, R., & Ruit, S. (2017). The impact of
ocular trauma during the Nepal earthquake in 2015. BMC Ophthalmology, 17(32). 1-6.
doi: 10.11186/s12886-017-0429-z
Sheppard, P.S., & Landry, M.D. (2016). Lessons from the 2015 earthquake(s) in Nepal:
doi:10.3109/09638288.2015.1064482
Zhang, Z., Ran, M., Li, Y., Ou, G., Gong, R., Li, R., & ... Fang, D. (2012). Prevalence of post-
Zhang, Z., Shi, Z., Wang, L., & Liu, M. (2012). Post-traumatic stress disorder, anxiety and
depression among the elderly: A survey of the hard-hit areas a year after the Wenchuan
earthquake. Stress & Health: Journal Of The International Society For The Investigation
of trauma patients following the Lushan earthquake. PLoS ONE 9(5): e97416.
doi.org/10.1371/journal.pone.0097416