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Aardbeving in Nepal RDRTF
3rd Communication Report by W. VAN BIESEN - ISN/ RDRTF (Renal Disaster Relief Task Force) after the Nepal earthquake on 25/4

Dear all,
This is a further update on the RDRTF activities in Nepal.
It seems that the situation has stabilised more or less. There seems
to be sufficient functional dialysis seats, and thanks to the good
coordination of the NSN and its members, there is now a more fair
dispersion of patients. The quality of medical care in the different
centres has been judged by our local MSF scouts who have visited the
different hospitals over the last days as "very high standard". This
opinion has been acknowledged by many other sources.
Regarding casualties we have the following information:
Tribhuwan University Teaching hospital (TUTH) treated 1100 disaster
victims till now; 135 surgeries already done;> 100 waiting for
surgery; 2 more team of orthopedic surgeon are joing from tomorrow to
cope up. 9 patients developed AKI and needed hemodialysis . The
dialysis unit is also providing dialysis to chronic patient from other
centers till these centers restart.

Army Hospital: 250 inpatients, 100 surgery already done, > 100
Waiting for surgery. IsraelI army surgery team helping from today; 2
AKI managed conservatively

Bir hospital: 2 AKI(crush), for whom IPD was done, one transferred
to Grande Hospital for hemodialysis

GRANDE Hospital: 2AKI (crush) patients receiving hemodialysis
There were the last two days plans to send a team assembled by prof Dr
K-U. Eckardt (Erlangen Germany) to Kathmandu. These plans were far
advanced, and the team was ready to take off. However, based on the
above information, and in conciliation with the different partners
involved (RDTRF chair, MSF, prof K-U. Eckardt, Prof Dibya as local
representative of RDTRF) it was decided that sending a team is
currently probably not very useful. The RDRTF team wants to express
its gratitude to the team of prof Eckardt, who has devoted lots of
energy in the preparation of this mission so far.

Meanwhile, a group around prof Vivekanand Jha and dr Oommen John is
in the process of developing a web-application based on the short
version of the Crush guideline. This application will be soon
available online free of charge, and can be used on different
platforms (PC, laptop, tablet, smartphone). This initiative should
make the crush recommendations even more accessible, and allow rescue
and health-care workers on the field to check them at any place and at
any time.

Thanks to all for your suggestions and support so far
Wim Van Biesen, chairman ISN/RDRTF

2ND Communication Report by W. VAN BIESEN - ISN/ RDRTF (Renal Disaster Relief Task Force) after the Nepal earthquake on 25/4

Dear all,
Just to provide some background and up-to date information on the situation in Nepal:
1/ regarding AKI cases, we have the following reports:
• in Pokhara (150km Northwest of Kathmandu) there are casualties in three main hospitals, and one nephrology service: Western Regional Hospital: 27 patients admitted, Gandaki Medical College: 30 patients admitted, Manipal Teaching Hospital: 15 patients admitted. In these centres, only 1 patient actually has started dialysis, and 20 are being designated as high risk for AKI, so are being followed-up by the nephrologist dr Klara Paudel.

• there are two patients with crush syndrome AKI taken care by NKC team, one patient on dialysis due to hyperkalemia at NKC@Sumeru another patient on ventilator support @Norvic

• Till now there are two AKI due to crush injury in Bir hospital. Acute PD has been started in of both. One of them has been transported to TUTH and Dr Dibya.

2/ Some dialysis centres have been damaged. For that reason many chronic patients have been delocated to other still functional centres. This caused some overload in still working centres. We are currently trying to make the orgainsation more efficient by aiming at a more equal distribution. Most centres are doing 2 hourly dialysis for 4 shift and cover all patients of previous days. All nursing staff and patients are scared of further earthquake during dialysis.

3/ the team of dr Sanjib Sharma (Dharan, Nepal) has sent nursing staff to the TUTH hospital in Kathmandu, and are considering sending out staff also to Pokhara

A first team of MSF Belgium, our logistical partner has arrived in Kathmandu and has already visited the TUTH hospital, where the RDTRF activities are coordinated.

Taking all these into account, the RDTRF will take the following steps in the coming day(s)
• try to get a small team of one or two nephrologists and one or two nurses on the ground in Kathmandu, mainly to help organising and dispatch care for dialysis patients, so the local nephrology community can focus on real patient care
• locate and inventarise need for disposables, and provide them where needed and possible
• further increase in all hospitals taking in injured patients the awareness of crush syndrome and how to recognise patients at risk
As the major problem at this moment seems to be "mobility" and "accessibility" due to the local geographics and destruction of roads, and as the situation is poor in terms of logistics AND as there is sufficient local expertise in the Nepalese nephrology community, we have decided that sending more than one team is not efficient at this stage. Of course, the situation might change in the near future if more AKI cases appear, and as local people might get progressively exhausted.

1st Communication Report by W. VAN BIESEN - ISN/ RDRTF (Renal Disaster Relief Task Force)

Dear all,
You might all be aware of the earthquake in Nepal. The death toll of this earthquake and following avalanches is high, and climbing.
Fortunately, the local nephrologists seem to be very well prepared, and are currently organising themselves to cover up for the chronic patients and the management of additional crush syndrome/AKI patients.
Some dialysis units have been damaged, but are now in the process of restarting/repairing damage. Other units are fully functional.
In this setting, there seems to be no added value to send in a team from abroad. However, this might change in the next days, if crush/AKI would increase, and/or some shortage of local nursing/nephrologists might develop, in view of the stringent and dire conditions in the disaster area.
We at RDTRF headquarters are compiling all information we receive from different sources, and will keep you informed about the evolution. Our logistical partner, MSF Belgium, will be present on the ground in Kathmandu as from this morning, so we hope to get even more detailed information in the coming hours.

Thanks to all for your commitment and interest
Kind regards,
Wim Van Biesen, chairman ISN/RDRTF