A friend, Suresh Mahajan, read a
piece out of the Age of Voltaire, by Will and Ariel
Durant, which though three centuries old, couldn't possibly
describe the scenes of the Gujarat Earthquake more accurately:
"At 9.40 am on all All
Saints' Day, Nov. 1, 1755, the earth shrugged its shoulders in
Portugal and N.Africa; in six minutes, thirty churches and a
thousand houses were demolished, 15,000 people were killed, and
15,000 were fatally injured, in one of the most picturesque
capitals in the world. There was nothing unprecedented in such
wholesale slaughter, but there were some attendant circumstances
that troubled the theologians. Why had the Great Inscrutable
chosen so Catholic a city, so holy a festival, and such an hour,
--when all pious citizens were attending the Mass? And why had he
spared, amid the general ruin, the house of Sebastiao de Carvalho
de Mello--the Marquis de Pombal--the ruling minister who was in
all Europe the most fervent enemy of the Jesuits?
In an angry reaction against
his own early optimism, Voltaire composed (1756) his greatest
poem--"On the Lisbon Disaster, or An Examination of the
Axiom 'All is Well' ".
A hundred thousand luckless by
Devoured, who, bleeding, torn, and still alive,
Buried, beneath their roofs, end without help
Their lamentable days in torment vile!
To their expiring and half-formed cries,
The smoking cinders of this ghoulish scene,
Say you, "This follows from eternal laws
Binding the choice of God both free and good"?
Will you, before this mass of victims, say,
"God is revenged, their death repays their crimes"?
From "The Age of
Voltaire" by Will and Ariel Durant, pg. 722.
Voltaire questioned why cities
like Paris and London, which surely had more sin than a pious
city like Lisbon, were never attacked by earthquakes. The analogy
was close. Kutch which has been reeling in drought for the last
two years, now got a "bonus" (in the words of the
locals) in the form of an earthquake.
But that was not all. Man was to
finish God's incomplete task of destruction.
The last place I thought I'd learn
a lesson in medical ethics was in this scenario. A reconstruction
of the events of the Earthquake from day One has its own story to
The Earthquake strikes taking down
all communication lines. News about the extent of the damage,
travels by road away from the epicenter. The survivors quickly
realize that there is no way the destroyed city can cope with the
casualties. They start to evacuate using every available moving
vehicle, carrying the injured and abandoning the immobile and the
The government and the trust
hospital doctors working around in the neighbouring areas,
abandon their posts and stations and rush in with their
ambulances and paramedics, carrying a basic set of supplies.
Hopelessly equipped (even in peacetime situations), the first
line doctors find themselves inadequate, except to triage the
serious patients and advise transfer to facilities downstream.
That was the need of the hour. It would have been foolish to
attempt anything heroic.
Within hours of the quake, at
every district hospital, private practitioners move in and man
the hospitals to help the casualties. There are hundreds of
operations performed through the day and night. Doctors coming in
from all parts of the country are told that they are not needed.
Most relief teams are told to go elsewhere. At the same time the
blood, drugs and implants they bring along are more welcome than
them. What were all these surgeries that were done? One would
have expected External fixators, Steimann pin insertions,
amputations and debridements. Essentially, clean-up jobs,
chop-offs and plastering. But instead there were plating of
femurs (of 3-year olds!), Austin-Moore head replacements (of
70-yr olds), nailing of tibias and plating of Radius-ulnas. All,
elective and cold surgery, which could have waited for days, if
not a month, was being done in the mayhem. Surgeons fiddled while
Kutch shook. A huge majority of the fractures were compound and
contaminated with collapsing mud-walls and cowdung. Most of the
patients were women and children. All that metal through their
marrow, sent all the muck through virgin tissue. Before the end
of the week, there was pus pouring out of the operated sites.
Almost anyone who stayed long
enough to see the aftermath of the heroic surgeries, saw more
than the quake. Not so strangely, there were wounds which did
extremely well. They were operated by the lesser mortals, the
Opthalmologists, Paediatricians, Gynaecologists, who turned
Orthopaedic Surgeons overnight. They did Guillotine amputations,
debridements and put on slabs of Plaster of Paris on all mundane
wounds while the great masters nailed bones. All these patients
went home without complications by the seventh day. The cursed
stayed back with their fancy indwelling metalwork.
And we would like to believe that
the Politicians were the only ones getting mileage out of the
earthquake and its misery. It was horror tourism at it best.
Doctors arrived in hordes, carrying Video equipment to capture
the graphic display of misery and show them back home. That was
an end in itself. Most relief teams arrived with 12-hour
commitments, in a hurry to lend their surgical expertise. There
were no takers for post operative care. These fly-by-night
operators insisted on operating and were gone with their
photographs within two hours after surgery, leaving us to take
care of their handiwork. The lack of accountability was
remarkable. They left a trail of business cards, with degrees and
addresses of distant lands, or famous Indian metropolitan cities.
They couldnt let their practices suffer, but they had come
to do their bit. The burden of taking them around the wards and
being forced to cater to them was the last straw on the
camels back. The staff who had worked night and day were
already at the point of exhaustion. This was the consistent
experience across all the centers. Every hospital has similar
horror stories to trade.
Surgery is so much fun, that all
too often we tend to lose sight of its raison d'etre. What is
appropriate surgery in a disaster situation is a moot point. With
our inherent inability to work as team, whether in hockey or in
medicine, this chaos is the inevitable outcome. Coordination,
cooperation and preparedness are alien words in our dictionary
where medicine is practised with personal triumphs. Doing the
right thing in such situations is a matter of training,
experience and humility. I must remark that in the squalor, I met
some remarkable people. They took orders from the local
superintendent, avoided local politics and were careful of
cultural sensitivities. They had no axe to grind and did the
dirty work of dressing the wounds. Barring a rare few, most of
them were from the University hospitals of India and abroad. They
could give their time, commitment and they all followed
protocols. They were relieved by fresh groups of well-balanced
teams and there was a good system of handover. These are
ingredients of the future disaster management squads, to prevent
further catastrophes. There is hope for us, if we decide to get
organized and cooperate.