Médecins Sans Frontières Delivers Urgent Medical Care To Nepal With Inflatable Hospital

---

Nepal has been hit by two earthquakes in less than four weeks, killing thousands, injuring tens of thousands, and leaving millions more with the burden of rebuilding their lives. As part of the Médecins Sans Frontières (Doctors Without Borders) Emergency Response team, I was deployed within 24 hours of the first 7.8 magnitude earthquake. Our teams soon began medical activities and distributing shelter and food by helicopter to people in isolated villages.

---

[caption id="attachment_12773" align="aligncenter" width="691"] 01-OT-and-the-first-patient-in-surgery-in-the-inflatable-hospital-in-Arughat[/caption]
As Emergency Coordinator I am responsible for coordinating our response on the ground, including managing the delivery and set up of the inflatable hospital. The Médecins Sans Frontières inflatable hospital is a temporary structure designed specifically to allow emergency teams to respond quickly to natural disasters, enabling them to provide people with quality healthcare while damaged health facilities are being reconstructed or repaired.
It is essentially an alternative in the context of natural disaster or armed conflict, when existing facilities are no longer functional. We can react rapidly to care for a large number of injured people under proper hygienic conditions when there are few other options for affected communities.
Getting the hospital to the site and installing it is a major logistical challenge. The first step was actually getting it into Nepal. The hospital itself and supplies of drugs were first despatched from Médecins Sans Frontières’ supply depot in Bordeaux, France on 28 April 2015. Once we received everything on the ground in Kathmandu we then had to decide where it would go. It was decided the hospital was to be set up in the village of Arughat, Gorkha district. Arughat doesn’t have a secondary hospital and only had one dispensary which was destroyed in the first earthquake on April 25th. On the advice of the Ministry of Health, the inflatable hospital was set up here to serve as a secondary hospital with a fully-equipped operating theatre.
[caption id="attachment_12774" align="alignright" width="300"] A patient being treated in the inflatable hospital in Arughat.[/caption]
One of the critical considerations was the fact that this is the only hospital with surgical capacity for the population of Arughat and surrounding villages. Most of the health facilities in Gorkha district had collapsed and the Arughat hospital is helping provide the much-needed secondary healthcare in the area. There are people who tell us they have walked for five days to the hospital, which goes to show just how severely the earthquakes have destroyed the healthcare system.
Once the location was decided the teams then began to receive everything. So we started with the tools to prepare the ground and then set up the tents. After the tents, electricity and sanitation are set up. The rest is a”plug and play” procedure with medical equipment installed. This includes an X-ray machine, ultrasound and oxygen concentrators.
The set up took longer than usual for us due to tough terrain and other logistical challenges. Arughat is a seven hour drive from Kathmandu and the field hospital, including the generator and air-conditioning unit had to be carried in three different trucks. However, once all the components reached Arughat, the setup was completed in 24 hours.
We have a dedicated team that worked on the set up of the hospital. They are on very short assignments at the beginning of the operation as they are working day and night to get the setup complete.
The hospital has been operational since May 8 and consists of an in-patient department with 20 beds, an emergency room, an operating theatre, laundry, sterilisation room and a room for pharmaceutical stock.
Our teams now see patients affected by the two earthquakes as well as people from nearby communities. It has surgical capacity, maternity, emergency and general wards, and a mental health program.
We are also additionally working with the Ministry of Health to offer outpatient services. Médecins Sans Frontières is also supporting drug supply, medical training and the referral system for the hospital.
An average of 100 patients are treated per day in the outpatient department, mainly suffering from respiratory tract infections, diarrhoea, and wounds sustained from the earthquake. In the emergency room, Médecins Sans Frontières is treating an average of 15 patients per day mainly suffering from fractures and wounds. In maternity, we have had three deliveries, including one complication of retained placenta.
There are around 30 Médecins Sans Frontières staff working in the hospital, both international and national. This includes midwives, nurses, doctors, a pharmacist, a surgeon, one anaesthetist and an operating theatre nurse, as well as staff for sterilisation, laundry and cleaning.
The inflatable hospital is not set up with an end date in mind and can function for as long as required. Essentially there is no time limit. However, we know it is a temporary solution so usually we try not to use them for too long. They can also be easily re-used for other medical services with just a few alterations.
It’s been ten years since we first used the inflatable hospital in Pakistan. At that time we were still figuring out all the logistics - from the water, sanitation and electricity to the erection of the tent. And now ten years on we have learnt a lot from our experiences and now able to implement the hospital much faster and anticipate obstacles in advance. While we are always looking for new and innovative ways to respond to natural disasters, the inflatable tent is something we will continue to use for a long time to come.

---

“There are people who tell us they have walked for five days to the hospital, which goes to show just how severely the earthquakes have destroyed the healthcare
system.”

---

Eric Pujot
Emergency Coordinator, Nepal Médecins Sans Frontières (Doctors Without Borders)
Eric Pujot is the Program Manager for Médecins Sans Frontières’ projects in Papua New Guinea, Cambodia, Nepal and the Philippines. He has recently returned from Nepal where he was working as the Emergency Coordinator following the first earthquake. Eric has previously worked in a variety of field positions around the world with Médecins Sans Frontières, including Head of Mission in Sierra Leone.
About Médecins Sans Frontières
Médecins Sans Frontières is an international, independent medical humanitarian organisation that was founded in France in 1971. The organisation delivers emergency medical aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters. Assistance is provided based on need irrespective of race, religion, gender or political affiliation. When Médecins Sans Frontières witnesses serious acts of violence, neglected crises, or obstructions to its activities, it will not be silenced.
Today Médecins Sans Frontières is a worldwide movement with 23 offices, including one in Australia. Médecins Sans Frontières field staff include doctors, nurses, administrators, epidemiologists, laboratory technicians, mental health professionals, logistics and water and sanitation experts. Each year around 2,500 international personnel contribute to a global team of close to 30,000 Médecins Sans Frontières field staff providing emergency medical care in more than 60 countries. In 2014, 191 field positions were held by Australians and New Zealanders.
Australian and New Zealander field staff are currently on assignment in Afghanistan, Armenia, Central African Republic, Democratic Republic of Congo, Egypt, Ethiopia, Greece, Haiti, India, Iraq, Kenya, Lebanon, Liberia, Malawi, Malta, Myanmar, Nepal, Nigeria, Pakistan, Palestinian Occupied Territories, Papua New Guinea, Philippines, Russian Federation, Sierra Leone, Sudan, South Sudan, Syria, Uganda, Ukraine and Uzbekistan.
The inflatable hospital was first used by Médecins Sans Frontières in November of 2005, following the earthquake that devastated Pakistani Kashmir. During the days that followed the earthquake, thousands of injured victims streamed out of the affected region toward Mansehra, where the district hospital was severely damaged. Médecins Sans Frontières opened a temporary hospital in Mansehra measuring over 1000 m², and with a 120- bed capacity, built under nine inflatable tents. This structure, which included four operating suites, an emergency room and an intensive care unit, was erected in two weeks. This was the first time that Médecins Sans Frontières was able to establish a substantial surgical presence following an earthquake. Around 700 injured people received care in this temporary hospital in Pakistan. We have since used these tents in Indonesia and in Southern Sudan in 2006, in Yemen and the Democratic Republic of Congo in 2008, Gaza and Sri Lanka in 2009 and the Philippines in 2013.