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Profile: Nepal earthquake nurse

“I landed late at night and didn't know what to expect… I was instructed to get to a hotel [located in Patan, a city situated in the south-central area of Kathmandu Valley], so I got in a taxi - it was pitch black as most of the lights had gone out because the city power had been affected. I just spent the whole journey craning out of the taxi window to look at the damage, and the amazing thing was - there wasn't much. By the end of that journey I was thinking 'this is no where near as bad as I thought it was going to be',” says Emma Pedley a Medecins Sans Frontieres (MSF) volunteer nurse.

Pedley worked in Nepal for four weeks following its devastating magnitude 7.8 earthquake that struck Saturday 25 April 2015, which according to World Health Organization (WHO) resulted in 8,898 deaths and injured 22,309 people. The depth of the earthquake was estimated to be between 10 to 15km. Additionally, the epicentre of the quake was approximately 77km northwest of Katmandu, Nepal's capital and around 73km east of Pokhara, another Nepal city with a large population.

Pedley worked as part of a team to provide remote clinics in villages that had been cut off from healthcare. This involved: distributing health kits, vaccinating children and adults against diseases such as tetanus, providing acute care and retrieving acute patients.

Twenty six' hospitals were damaged by the quake. A further 1,085 healthcare facilities were affected with 402 of these being completely destroyed according to the WHO. Additionally, the WHO states: “Nepal is predominantly rural,” the people living in these areas rely on local healthcare facilities, with some having to travel one-to-four hours for their nearest health post. Therefore, with the majority of these being destroyed support was vitally needed.

Humanitarian help was key and MSF, an established international medical humanitarian organisation that has been running since 1971, was already prepared to help. “We didn't lack for anything we needed, that is largely down to the MSF logistics chain, as it happened based on previous similar emergencies they said we need basic health kits, dressing kits, emergency surgery kits and these are pre-prepared and stuck on a plane,” explained Pedley who has a real affinity with the country having previously worked there.

Although, she was at the heart of the disaster only a few months ago Pedley claims humanitarian nursing wasn't initially the path she planned to take.

“I had a bit of interest in it but I wasn't convinced it was for me”. Pedley who lives in Bath, Somerset began her nursing career when she graduated in 2001 with a diploma in nursing studies from Canterbury Christ Church University. Following this she worked at William Harvey Hospital in Ashford, working in acute care including the A&E and intensive care departments. During this time she was inspired to travel: “I always knew I wanted to travel with nursing, and it's an incredibly easy profession to travel with because people get sick everywhere.”

Therefore, in 2004-2006, aged 24 she decided to backpack around Australia, New Zealand and South East Asia, while continuing nursing through agencies on her travels and says: “I couldn't count how many [hospitals] I worked at.”

During this time Pedley had her first experience in Nepal where she did some voluntary work in 2006 for three months. While working she stayed with a host family that lived outside Kathmandu city but still within Kathmandu Valley, and explains it was this experience that made her fall in love with the country. 

It was this that crystalised her intention to continue humanitarian nursing. Pedley returned to the UK in 2006 and began working exclusively in A&E at Wexham Park Hospital in Slough, where she undertook a diploma in tropical nursing at the London School of Hygiene and Tropical Medicine in 2007.

The next step was to get hands on humanitarian nursing experience to give her the opportunity she wanted.

“I had spoken to a couple of agencies like MSF and Merlin and I knew they preferred people to have more developing world experience, and I had only spent three months doing voluntary [work] in Nepal.”

She therefore, returned to Nepal in 2008 for five months voluntary work, and her passion for the country grew, speaking of this time she says: “I didn't work in a hospital [I worked for a] voluntary organisation that placed western volunteers in children's homes and schools. We were working on improving health conditions in the children's homes, vaccination, health promotion, sanitation and a lot of health education.”

Nepal has a population of 27,797,000, a life expectancy at birth of around 68 years of age and a 25% rate of poverty. Nepal is also a low income country with its economy being heavily dependent on agriculture and forestry. The country is approximately 147,000 square kilometres, but is highly vulnerable to natural disasters such as flood, landslides, earthquakes, fires and epidemics.

After returning from Nepal Pedley settled in Bath and began nursing in the intensive care and A&E departments at Bath's Royal United Hospital while completing several public health modules as part of a masters course at the University West of England to which she claims “was my platform for applying for MFS”.

Now in 2015 she has completed three MSF missions in South Sudan, Central African Republic and of course, her recent mission to Nepal.

In South Sudan in 2013 Pedley ran an inpatient department at a hospital in Nasir a small town in Upper Nile state about 30km from the Ethiopia border. “It was so hard, I really loved it and I really grew into it tremendously, but when I first took it on it was very overwhelming. I managed a team of 36 national staff with varying levels of education. It was just challenge after challenge, we were trying to improve hospital conditions.” Pedley outlines one of the problems was staff not differentiating between the severity of the cases in front of them. “They would know what to do but would do the same things in the same order for every patient… so there was a lot of teaching and training,” says the MSF nurse.

Her second mission to central African Republic was working in Zemio, a town near the Congolese border, where she worked in the local hospital about which she says: “Again I was [an] inpatient nurse but I was also the more senior medic in our hospital and I was the medical vocal point for the project, so I also ran the medical supply and the pharmacy.”

But Pedley always knew she wanted to return to Nepal because she was sure there was going to be an earthquake.

“One of the things I had been doing massively while I was part of the coordination team doing voluntary work in Nepal [2008] was earthquake awareness, we were aware that [an] earthquake was a big risk for Kathmandu City. I knew the earthquake was coming to Nepal [and] I always thought when it did I would go back, I happened to be perfectly positioned to go back with the perfect organisation [MSF], which was wonderful,” says Pedley.

The earthquake hit Nepal on 25 April at 11:56am leaving thousands in need of urgent help. On 26 April 2015 the government of Nepal asked for international humanitarian support in the most affected areas. The WHO identified 14 areas that were most affected theses included: Gorkha, Kathmandu, Sindhupalchok and Latipur.

MSF was quick to respond to the emergency with Pedley eager to be a part of this. Pedley heard about the earthquake over Facebook and immediately contacted MSF's emergency out of hours human resources department to put herself forward for the mission, and was subsequently put on a flight by the Sunday evening.

Pedley felt a real urgency to get out there “on the ground” as journalist reports and photos were showing images of a destroyed Kathmandu - a cityscape she knew well. “I just thought we need to be there and doing something.

“I knew the country and I spoke some of the language, and my family were actually a lot more relaxed about me going there than they would have been to an ongoing conflict somewhere else or [to work with] Ebola [patients] or something like that. Obviously with earthquakes you get aftershocks but the disaster had happened and was over so there is the perception that your risk is less.” After a difficult flight that included stopping in Deli for 24 hours because Kathmandu airport was shut down due aftershocks, Pedley finally arrived rough and ready for the mission.

But the emergency wasn't what she was expecting: “It wasn't straight in doing trauma surgery and things like that because Nepal has an okay health system, a decent education system, doctors and nurses and functioning hospitals. With the hospital there was no denying it, they were busy and they were overwhelmed, but they were functioning.

Many of my colleagues had been in Haiti and Pakistan after the earthquakes there and it wasn't comparable really… yes a lot of the villages were destroyed but their could have been a greater loss of life” says the volunteer nurse.

Pedley quickly came to realise that help was needed in remote areas where people were shut off from healthcare. “MSF had done assessments of the hospitals… they were well supplied and working well. What wasn't happening was people weren't getting to the remote areas. So MSF's focus very quickly became the rural and hilly areas north of Kathmandu. Access was a massive challenge you are in the Himalayas the roads are narrow, masses of landslides and there were so many areas that were just completely cut off from normal transport such as foot or bus. So the team I was with relied primarily on helicopter transport,” says the nurse with more than 15 years' experience in the profession.

During this time she would be flown by helicopter to different villages that had no access to healthcare, she did this roughly every other day for four weeks. When arriving at the village, Pedley and the team with would establish a safe place for the remote clinic, these were usually temporary homes the residents had built and on more than one occasion under a shaded tree because they always had to “go with what you have”.

The MSF team Pedley was working with would begin by seeing pregnant women and children and then any other injured or wounded adults. Pregnant women would be supplied with tetanus injections, birthing kits - clean gloves and a blade to cut the umbilical cord with. A lot of children Pedley saw had respiratory infections like pneumonia, “which can of course can be treated with a simple course of amoxicillin but they had no access to it because their health center had also been destroyed”.

Another main part of her role in Nepal was to retrieve acute patients, “One day we heard there was a woman in obstructed labour, [a major cause of both maternal and newborn mortality]. We picked her up and took her back to Katmandu where she delivered a baby boy a few hours later. This was amazing as she was in massive distress when we picked her up. We did what was needed.”

Pedley feels that had the earthquake struck at another time the crisis would have been much worse.

“The timing of the earthquake was freakishly luckily, it had been during the day, on a dry day, so people were outside. When we went and did the remote clinics people said: 'We were so lucky we weren't inside that house, we have lost our animals and our food stocks are crushed but we are alive and our children are alive'.”

However, Pedley does feel the biggest effect the earthquake has left is psychological damage for the people of Nepal, magnified by the aftershocks including a jolt on 11 May that measured 7.3 on the Richter scale.

“The psychological shock that people were experiencing was probably the worst thing to see. These people are as tough as nails and to experience a tremor when you're doing a clinic and see everyone around you just freeze and kneel to the ground with panic on their faces was the hardest thing to watch. People were saying we are too scared to rebuild because if there is another earthquake it will kill us,” says the A&E nurse.

This isn't surprising as it's estimated 80% of homes in the 14 most affected areas are thought to be severely damaged and at least 2.8 people million being left 'displaced' from their homes. 

The remote clinics MSF were providing did try and tackle this. “Generally speaking, after two or three hours running a clinic in the community our mental health officer would do some group counselling sessions and talk about the normality of emotional trauma and how to encourage people to look to the future. By the time the helicopter came to pick you up again the villagers were so grateful, we had usually managed to see everyone that needed to be seen, and everyone had some attention, and [they then] knew the world cared about them and that made a tremendous difference to their mental health,” says the nurse aged 35.

After returning from Nepal Pedley feels satisfied with what she achieved but was “very sensitive” to the idea of an aftershock. “I didn't like it when a bus went past me… you take a little bit of an emotional toll after such work but nothing that isn't worth it.”

Pedley is now moving to Amsterdam, Netherlands to start a new role as international training officer at MSF's Amsterdam office which involves her delivering in house training. Although she had already applied for the position while in Nepal, a helicaopter crash in which three of her colleagues died prompted her to make this move.

Her role in Amsterdam means that Pedley will be taking a step back from hands on nursing.  “I am officially going to stop being a nurse, and it is so weird…[but] in some ways it is a very natural step.”

It is only after 15 years of fulfilling her desire to travel with this profession that she now feels ready for something new.