Simon Greenfield / Paramedic / West Midlands Ambulance Service
Simon Greenfield is an Emergency Care Practitioner with the West Midlands Ambulance Service Hazardous Area Response Team. He joined Humanity First Medical in 2010 after seeing their report on the Haiti earthquake. Despite a young family and an impending wedding, Simon deployed to Gorkha with Humanity First Medical in response to the April earthquakes in Nepal this year. His story encompasses the highs, lows and administrative frustrations common to humanitarian work. In a short deployment, his team of twelve treated over one thousand people.
Within a few short minutes of the Nepal earthquake on 25 April this year, the Global Disaster Alert and Coordination System (GDACS) issued a ‘Red’ alert meaning that due to the depth, magnitude and vulnerability of the population, the likelihood of a high humanitarian impact was high. Reports soon came in of heavy damage to roads and buildings and multiple casualties, particularly in the rural areas but also in the capital. The Nepalese government put in a call for international assistance, as it quickly became apparent that hospitals were struggling to cope and with the multitude of aftershocks, as well as the damage to the roads delaying search and rescue operations.
On that sunny Saturday morning, I was packing and moving boxes with my fiancée Lucy, in the process of moving to our new home that weekend. Late morning, I received a phone call from a colleague from Humanity First (HF), an international NGO, telling me that international assistance had been requested for Nepal and that HF were in the assessment stage of putting a medical team together for deployment.
Lucy was within earshot of the conversation and obviously knew what was being said. I put the phone down, briefly told her what had happened, and without any hesitation she simply said to me “go”. Within a few minutes, an official HF email had been sent out asking for availability from its personnel to be a part of a team to deploy at short notice. A few frantic emails and phone calls were sent and within an hour, I had been granted permission to take leave from work at short notice. I replied to the email as being available.
The next few hours were spent packing, moving and cleaning the old house, interspersed with nervous conversation (mainly on my part) about going out to a disaster zone. I kept looking at the news and checking for updates on my phone; casualties started low then as the hours ticked by the numbers of those injured or killed grew constantly. By late afternoon the death toll was reported to be about 4000. In my mind I knew that HF would send a team, and in the late evening an email confirmed that we would deploy.
I have been in the ambulance service for over nineteen years and have been involved in humanitarian work in one form or another for well over a decade in countries such as Sierra Leone, Chad and Mozambique. But this was the first time that I had been to a disaster. My thoughts and emotions mixed excitement with fear and anxiety. We would be going into the unknown, with the risks of further aftershocks, landslides, dealing with human suffering at its worst and the fact that we could become casualties ourselves ever present. Would I cope? How would I feel once there? Would I be able to offer some support, comfort and care to those that needed it?
The next couple of days were spent sorting the new house, building furniture, packing for my trip and trying to spend what quality time I could with my family before travelling to London on the Tuesday morning, ready to fly out from Heathrow that evening. Lots of hugs and cuddles were given to Lucy and my seven-month-old son. I played Star Wars with my older stepson, explaining to him what I was going to do and showing him on a globe where I was going.
I truly realised the support that I had from my family the afternoon before I left. After school, my own Jedi Knight said proudly that he had told all of his school friends that I was going to “go and save some lives”. The support from my family, friends and colleagues was astounding.
Tuesday afternoon was spent at the Humanity First HQ in London. All the team got together, equipment sorted and we held a full briefing. There were twelve of us, including surgeons, a GP, A&E consultant, paramedics, a firefighter, pharmacist and a logistics support member. We set off to Heathrow, our spirits high and hopeful that we would be able to do some good when we arrived.
Twelve hours later, we were in Kathmandu and registered with the government as a UK Foreign Medical Team (FMT). We were given accommodation on the outskirts of the city, a local family providing us with a roof over our heads while we checked equipment and gained as much information as possible about the country, infrastructure and casualties.
It’s important to note that in a disaster a foreign team can’t just turn up. The affected country has to first ask for help. Once there, the FMT can’t just pick where they want to go, go there and get on with the job. Much time was spent form filling, registering with the Health Ministry and attending meetings hosted by various United Nations departments and the World Health Organisation.
A walk around Kathmandu was eye opening. The city is full of history and culture but the forces of nature had shown no mercy. The earthquake did not discriminate. Ancient temples and modern buildings were destroyed, people were sleeping in open spaces, scared of going inside in case there were further aftershocks and buildings were cordoned off in case of further collapse. The smell of funeral pyres filled the air, following the mass cremations of those killed. Yet everyday life went on. People going about their business in the markets, the constant sound of vehicle horns and the chaos of traffic that you would encounter in any city the world over. All of this was mixed in with groups of police and soldiers searching buildings and clearing debris, dust filling the air. The experience was sobering.
Within a couple of days we were on a hired bus, the roof laden with our medical kit, tents and supplies, heading into the province of Gorkha at the request of the Health Ministry, close to the epicentre.
After a few hours travelling along winding roads, we reached the town of Gorkha and the local hospital. A Swiss Red Cross team were already there working closely with the staff. The hospital was well maintained, staffed and seeing a steady flow of patients. All appeared to be in good order. After a few discussions it was decided to carry on deeper into the province, higher into the mountains to a village called Badasse.
We had no idea what we would find. Reports stated that there was significant damage, that a high number of casualties were likely and that so far, no medical teams had yet reached the area. It was definitely the place to get to, but getting there was the issue. There was no tarmac beyond Gorkha. We were faced with dirt track roads barely wide enough for a single vehicle, rutted, rocky and crumbling. The only way to get there was by a mountain bus in a treacherous three hour journey. The hazards to the team were high, from aftershocks and landslides to the poor state of the vehicles. We felt the benefits outweighed the risks. We were there to do a job and we intended to get on with it.
A few hours later we arrived at Batase, after a bumpy, nerve wracking but scenic ride through the hills of Nepal. Some villagers and a small unit from the Nepalese army who were helping to clear the crumbled buildings met us. The school had been damaged and many of the houses had been destroyed. We were told that the injured had been treated locally or taken by their families to the hospital in Gorkha. However, it was possible that there was a need for medical assistance in the area. The sun was setting, so we decided to camp for the night and prepare a medical centre the next morning. It was hard to assess the level of need, but we intended to stay and offer assistance to those who needed or wanted it.
It turned out that word had spread. Early the next morning, we were met by a small group of villagers requiring medical assistance. The group steadily grew, until it became apparent that we would be doing what we came to do. We built our medical centre with tarpaulins, para-cord and bamboo sticks with the help of the locals and the army and by lunchtime, over one hundred people with a whole host of injuries and illnesses were waiting patiently to be seen – young babies and the elderly, mobile and infirm, male and female.
Our makeshift medical centre had a reception and seating area, triage and basic assessment, pharmacy, consultation and majors’ area with full resuscitation facilities. On that hillside deep in Nepal, we were able to provide an A&E department with the full scope of medical care to people who had been subjected to one of the Earth’s most powerful and destructive events.
By the end of that first day there was a quiet sense of achievement and comfort knowing that we had given help, support and treatment to well over one hundred people. The spectacular lightning storm that evening with a similarly striking sunset was surreal; in one direction the setting sun casting a warm glow over the terraces of the hills, in the other direction a partially collapsed school and homes flattened. There was frustration. Some of the patients told us that medical aid was still needed further on. Nearly a week after the earthquake there were still villages that hadn’t received any help, medical or otherwise.
The problem was getting to them. The roads were treacherous at best. The aftershocks were frequent and at times gut wrenching in their intensity. We felt one aftershock that caused a landslide in the next valley, sweeping three buses off the road. Helicopters were the only other real option but they were caught up with red tape. Our contacts in the cluster meetings in Kathmandu begged for the use of a helicopter and we even marked out a landing pad in the hope that sometime soon our request might be granted.
The next few days were physically and mentally challenging. Still, ninety-degree heat, humidity, a hole in the ground as a toilet, dodgy bellies and a tap to wash under were minor discomforts compared to what the Nepalese had been through. By then, we had provided care to over a thousand people on that hillside, so we didn’t mind the discomforts.
Many patients presented with respiratory or mental health problems. They were scared about further quakes and many didn’t know what had happened to their families. There was trauma, infected wounds and dental issues. Whatever the injury or illness, concern or anxiety, we did all that we could to assist – from IV fluids to pain relief to simply holding a hand – we tried to give what was needed. The strength and resilience of the people was humbling. They walked through the mountains overnight for many miles, were carried on others’ backs or on makeshift stretchers to reach us. No one complained. No one pushed or shoved. They waited patiently to be seen and gave their thanks when they left.
On our fifth day at the village, despite repeated requests for the use of a helicopter, we were told that it would be best to return to Kathmandu and hopefully catch a helicopter there. We set off as a team of four early the next day on a six-hour bus journey back to the capital, leaving the rest of the team to carry on with the work in the mountain. The plan for us was to get a helicopter to Lapu and carry out an assessment of the area, looking at food and shelter as well as medical need.
The journey back was cramped and hot on a public bus; people standing and clinging on to the roof. It was a true adventure, taking in the sites and imagining what it would be like to explore this stunning country.
We spent the following day at the cluster meetings trying to get a helicopter. However it soon became apparent that there would be no helicopter. The initial response phase seemed to be coming to an end. The concern of the UN and government was that in a few short weeks the monsoon season would have started. Food and shelter was gradually becoming the priority with medical aid taking a backseat. We trekked back to the house where we were staying to meet the rest of the team, after they had spent the day treating even more patients.
The flight home was tinged with mixed emotions of sadness at leaving, not knowing what was going to happen to the people we had met, and the happiness at seeing our families. We had seen devastation and heartbreak. The elderly man who had walked through the night, bent double with age, using a walking stick, sent to get to us just to hear someone say you’ll be ok. The toddler with fear in his eyes. The snoring in our communal tent and endless mickey-taking. The images of the crashed buses and lorries on the mountain sides. The thoughts of going into the unknown and apprehension at the start of the trip from that first phone call. But, we had done it. We had given some support, comfort and care. A group of strangers with a common goal going out to help complete strangers.
Why did I do it? We are lucky in this country. We have the resources, knowledge and expertise. We have a health and welfare system. We have a special number that anyone can call at any time in times of distress in the knowledge that someone will come to help. And we have our families who support us on every step when we go into the unknown. Our families who will always have that help and support when needed. Many countries, for reasons of politics, economy or geography are not so lucky. Would I do it again? Try and stop me.