Caring for Nepal

One doctor’s journey to help a nation shaken to its core.

By Robert Calandra, Contributing Editor

Shortly before 1 p.m. on May 12, Pravin Dugel, MD, felt the earth move.

He was standing outside an operating room on the 5th floor of the Tilganga Eye Institute in Kathmandu, Nepal, when a 7.3-magnitude quake turned walls and ceilings into chunks of cement and brick. They fell to the ground, all around him.

“It’s a kind of terror that I had never felt before,” says Dr. Dugel, managing partner of Retinal Consultants of Arizona. “You feel completely helpless, and you realize that this can be the last time you see anything. You can’t help but re-evaluate where you are in life and what is important and what is not.”

Descending five flights of stairs, Dr. Dugel helped guide patients, many elderly with poor vision and bad gaits, escape the shaking building.

Little girl outside Tilganga clutches a dear friend minutes after the second earthquake.
COURTESY PERRY ATHANASON

Dr. Dugel had traveled to Nepal after the larger earthquake on April 25 killed 9,000 and injured more than 23,000. Born in Nepal, Dr. Dugel’s connection to the country runs deep. Although his parents fled the country for political reasons when he was four years old, his large extended family still lives there. They have all survived.

“I felt I had to go there and witness what happened so I can at least be a voice,” he explains. “The saddest part of this is that the people who are affected the most really have [none].”

A colleague’s role

Dr. Dugel has another “very close connection” in Nepal: his dear friend, a general ophthalmologist named Sanduk Ruit, MD. They met several years ago, when Dr. Dugel learned of Dr. Ruit’s Himalayan Cataract Project. These so-called eye camps reach people in the country’s most remote regions. Since then, Dr. Dugel has returned to Nepal twice yearly to work with Dr. Ruit.

“His cataract model has been so successful that it is being utilized in many other countries now,” Dr. Dugel says. “In addition, he has set up a surgical technique to remove cataracts that is very cost effective and modern. He is a remarkable human being.” [For more information, go to http://www.cureblindness.org/who/dr-sanduk-ruit/]

With diabetes growing at a rate of more than 100% in developing countries like Nepal, Dr. Dugel is working with Dr. Ruit to create a similar retina surgery network.¹

“He asked me to help him with retina because, as far ahead as cataract may be, retina is fully behind,” says Dr. Dugel.

USC to the rescue

On April 25, Dr. Dugel met with the University of Southern California’s Keck Medical School, his alma mater. Carmen A. Puliafito, MD, dean of the Keck Medical School, Rohit Varma, MD, director of the USC Eye Institute, and Mark S. Humayun MD, asked Dr. Dugel how USC could help.

“I said, ‘What we have to do is set up a trauma unit,’” Dr. Dugel remembers. “And within four hours a trauma unit was organized.” Nepal got this help, he says, “because USC wanted to do it.”

Dr. Dugel contacted Dr. Ruit, who told him that the destruction was “the worst thing I have ever seen” and that he was re-purposing his cataract network for relief work.

“The parts that were most affected by the earthquake are not the parts you hear about, which is Kathmandu,” Dr. Dugel says. “It’s the remote areas … Those are the areas that no one can get to. But Dr. Ruit can get there through his cataract network.”

Dealing with the senses

Soon after landing in Nepal, Dr. Dugel, along with four USC physicians, two nurses and a mountain of medical supplies drove more than six hours into the remote countryside close to the earthquake’s epicenter. Their vision and olfactory senses recorded memories.

“After a while you saw nothing because all the buildings had been devastated,” Dr. Dugel says. “When you get out [of your vehicle] you see these devastated villages and smell the rot of dead bodies. It was very impactful. There are no cameras there. There are no reporters there.”

Dr. Dugel and the USC team distributed food, clothing, blankets and tents to people who had lost everything. And there was the fear of aftershocks, which meant everyone slept in tents, including medical staff. “The whole nation was terrified,” he says. “There were huge compounds of people sleeping outside.”

And the team provided medical care, whether that meant emergency eye surgery or putting a BandAid on a child’s wrist. “We did whatever was needed.”

The personal impact

Dr. Dugel heard many stories of loss and deprivation, but one story stayed with him. One night a woman named Chotin Sherpa came with her son to see him. She said her husband, Dorji, had gone to work on April 25, the morning of the first quake. After it struck around noon and he did not return home, she and her daughter went to his place of employment.

The quake had razed the building. They began digging with their hands.

Miraculously, they found Dorji. But he was wedged under a wooden beam. With no one to help, the two women struggled for hours to move the beam. Aid arrived around 3 a.m., but not with an ambulance. Dorji was carried to a hospital. It was a moot visit; no supplies were there. He died hours later.

Top left: One of many villages destroyed by earthquakes; photographed while riding to deliver supplies. Top Right: Tent city in Kathmandu. Middle Left: Villagers from three areas converge to receive supplies (near Tibet border). Bottom: (left to right), Dr. Sanduk Ruit, Dr. Reeta Gurung, Dr. Pravin Dugel and Mr. Kedar Acharya (Assistant to Dr. Ruit).
ALL IMAGES COURTESY PERRY ATHANASON

“There is no doubt that … were there infrastructure available this man would have lived,” Dr. Dugel says.

As Chotin spoke to Dr. Dugel, her son Sonam, a strapping 20-year-old, sat silently, staring at the ground. Where, Dr. Dugel asked, had he been and why hadn’t he helped?

He had been in America, finishing up his second year of college, Dr. Dugel learned. “Apparently they had saved every penny they had so he could be educated.”

Sonam, on an engineering scholarship at the University of South Alabama, received a text message to come home. By the time he did four days later, his father was dead.

When Dr. Dugel asked when he was returning to school, Sonam said he wasn’t. He was responsible now for his sister and mother and had taken a job as a laborer.

“What the earthquake has done is damaged not only one generation but several generations,” Dr. Dugel says. “This guy was … [en route to] getting a U.S. engineering degree. He’ll never get it. He’ll be carrying cement on his back in the hot sun for the rest of his life.”

Continuing to rebuild

Dr. Dugel plans to return to Nepal sometime this fall. With the country still in tatters, and the monsoon season approaching, Dr. Dugel fears that an already dreadful situation will become dire.

Dr. Pravin Dugel (center) works with Tilganga Retina Team just before second earthquake hits.
COURTESY PERRY ATHANASON

Mudslides and landslides occur during monsoon season, meaning further destruction. “And that is when all the disease sets in ... It’s frustrating because it’s ‘out of sight, out of mind.’” OM

Contributions for Nepal relief can be sent to USCEyeGiving.org.

Contributions for Sonam to finish his degree can be sent to ProjectSena.org

REFERENCES