We had long been working to develop a mechanism under the health system to cope with unforeseen disasters. This very mechanism was activated when the earthquake struck the country on April 25.

Emergency drugs and kits had been placed at various stations inside the Kathmandu Valley and health personnel had been trained on a regular basis to respond to disasters. Also, the work of structural and non-structural retrofitting of hospital buildings was underway. The buildings that we had retrofitted did not sustain damages. Non-structural tasks, including safeguarding of heavy equipment and goods inside hospital buildings, were also conducted. Long before the devastating earthquake, the Health Ministry had initiated a concept of hub hospitals with designated six hospitals—Tribhuvan University Teaching Hospital, Maharajung, Bir Hospital, Civil Hospital, Patan Hospital, Nepal Army Institute of Health  Sciences and Bhaktapur Hospital. The idea was these hospitals would work autonomously and manage other nearby health institutions based on their respective geography during the time of disaster.

Hence, during the earthquake, these hospitals were aware about their roles and acted accordingly. Also, we had developed special identity cards for doctors and health professionals so that they could immediately begin their work regardless of the location they were in.

Just an hour after the earthquake, the Health Emergency Operation Centre (HEOC) was set-up, which coordinated the entire health responses undertaken in the aftermath. The HEOC stationed inside the Health Ministry began its coordination with multiple partners and government agencies.

We had a treatment guideline in place, as foreign medical teams (FMTs) began arriving in large numbers. These ensured uniformity in the healthcare response. As we reflect back now, given the scale of the disaster, only around 40 persons had to undergo amputation surgeries, while just over 150 individuals suffered from spinal injuries. We were able to save many limbs and other organs because of the guidelines that had clearly underlined the procedures that doctors had to adopt.

We began calling various districts, asking them to immediately take patients to nearby health institutions and government-run speciality hospitals. We also immediately made a decision to summon all the doctors and health professionals to work. Those who did not comply with our directives were sacked. Around 20 health professionals still remain suspended.

In the evening of April 25, we got a call from the TUTH requesting operating materials as they had ran out their stock. Immediately, we managed to track down a storekeeper at Nakkhu and delivered the goods to the TUTH. We also immediately decided to conduct free treatment for the injured, and the government immediately approved this decision.The next day we began sending coordinators to the hub hospitals to coordinate with the ministry and hospital administration. It was because of this effort we were able to figure out the needs of hospitals, and deliver materials accordingly.

We established Foreign Medical Coordination Cell at the airport to help health service personnel arriving from abroad acquire visas and clear customs and other tasks. We sent coordinators to all the 14 districts to help with the deployment of the foreign medical personnel.

I think the one-door policy that we adopted in disseminating information and mobilising the FMTs and other medical supplies helped us work swiftly and minimise any confusions.

However, despite all the efforts, we realised how ill prepared we were to cope with disasters outside the Valley. In the districts, it was hard to transport emergency drugs. We have now begun focusing on enhancing capacities of health institutions and personnel in the districts. We are also planning to stockpile drugs in these regions that could be used in the times of disaster. Building resilient health facilities is our priority.

(As told to Manish Gautam)