When Disaster Aid Isn’t Helpful

3 days into the worst earthquake in Nepal since 1934

Death tolls rise, damage becomes apparent and remote communities are still being reached for the first time. Worse still, citizens and foreign aid workers can’t begin the recovery efforts properly as after-shocks still rattle affected areas.

When a healthcare system is already underdeveloped and poorly equipped to deal with the day-to-day care of its people, the impact of a disaster is ever more profound.

Disasters are occurring more frequently on a global scale and you’d think our responses would become more practised. The international community has learnt many a lesson since Haiti, yet in our haste and zeal, have quickly forgotten many a lesson too.
The forgotten truths of disaster relief work are evident in the non-self-sufficient teams of under-qualified and improperly trained volunteers with inappropriate skill sets who now flood to help. Their well-meaning sorties are at first indistinguishable from the professional and appropriate teams sharing this mission. Unfortunately, our usual attitude of ‘the more the merrier’ is a luxurious falsehood that cannot be afforded in times of disaster.

Emergency rescue workers clear debris in Basantapur Durbar Square  (Photo by Omar Havana/Getty Images)

Emergency rescue workers clear debris in Basantapur Durbar Square (Photo by Omar Havana/Getty Images)

When resources are spread so thinly and chaos abounds; the missteps of the misguided cause unintended harms to the afflicted. It is incredulous that there still exists a dearth of global regulation when it comes to international aid missions. You see, the painful and truth is that positive intentions are not satisfactory. The hubris of our privileged culture lends disquiet and discomfort to this sort of criticism. How dare I criticise the heroes on the ground!? Upon which mighty-high horse do I stand?!

It is uncomfortable for me as well.

As someone who has previously volunteered with excitement, joy and enthusiasm in less developed areas of Nepal, I too fell folly to the image of the foreign saviour.
The ‘do the best I can’ attitude. The unconscious incompetence borne of a society where, in almost every other case, doing something is better than nothing.
The uncomfortable question I ask of you is this:

Who do you think Nepal really needs?

May I be so brave as to suggest that who Nepal needs, what a people in crisis need, are not the do-gooders? Rather, it is the professional that should be sent. And along with the professional, the financial support for the local people to help themselves.
I’m talking about the ethically accountable organisation with quality assurance, and data. Organisations with experience and expertise in the field. Teams backed by a large network of logistical support, and in communication and concert with local and national parties.

A crisis is not the right time for a novice to gain experience, nor a amatuer enthusiasts to whet their appetite.

Nepal needs these humble heroes who are often not featured in the news till days or months later. Not the shiny logos and flashy media team, the retired volunteer or the passionate student.
Instead, the Organised. Pre-Planned. Experienced.

A diverse team of specialists, logisticians, administrators, epidemiologists, sanitation experts….
Then and only then, once these men and women are involved, are rescue and medical aid teams appropriate.

What good is a surgeon without a supply of sterile water to scrub with?
A medical team without their own supply of food?
A rescue team with no medical facility to deliver patients to?
What good is a field hospital to the starving, yet uninjured child?
So often the well-intended help becomes an unintended burden.
I’ll put it simply: it’s not fair for us to do this.

Emergency workers and bystanders clear debris while searching for survivors under a collapsed temple in Basantapur Durbar Square. (Photo by Omar Havana/Getty Images)

Emergency workers and bystanders clear debris while searching for survivors under a collapsed temple in Basantapur Durbar Square. (Photo by Omar Havana/Getty Images)

Disaster relief should involve us financially supporting the people affected, not third parties providing inappropriate aid.
Medicines Sans Frontiers are the perfect example of disaster relief done RIGHT, along with the peak rescue bodies and medical aid teams sent by countries such as Australia, New Zealand and a host of others. Teams who train year round for exactly this scenario and who are constantly reflecting on the impact of their efforts.

These are the heroes we should be supporting with our praise, and our coins.
This form of assistance is sustainable, multi-phased and diverse.
Attention is not given solely to the current disaster, but also on educating and upskilling local teams; empowering them to become more resilient for the future.
Care is not just delivered, but monitored too – recognising threatening trends before they become epidemics.

It’s not as simple as “doing the right thing” when doing so, can often be the wrong thing in the long run.

As always, Dhanyabad.

You can donate directly to the people of Nepal here (via Nepali Red Cross Society) Here via the American Red Cross who are collecting funds on NRCS behalf, and here to MSF.

Feature image from NBC News

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Talking Israeli EMS and Rural Nepal with Mitch Thomas on his Podcast

I was delighted to Join Mitchell Thomas @JrParamed from the ‘Down Stairs Care Out There Blog’ on his brand new Podcast to talk about my experiences in Nepal at the Chisang Clinic as well as In Israel with Magen David Adom – the National Ambulance Service.

What was intended to be a short chat turned into a whole day affair with Mitch and I having to pause multiple times for food, coffee, laughter, ambient noise, coffee, passers by interrupting the recording…. did I mention coffee?

It was an absolute privilege and pleasure to be able to share my life changing experiences with Mitch and his audience and have a good laugh with someone I consider a genuine friend and colleague.

The Two Podcast Sessions are below:

Session 1         Session 2 

Please head over to Mitch’s Site for the show notes


A Few Pics from Inside Ambulances in Israel with Magen David Adom

Click to view slideshow.

Some Highlights from The Chisang Clinic in Nepal

Click to view slideshow.


A Huge thank you to Mitch for having me on the Podcast with him,

Looking forwards to many more long talks over caffeine mate!


As always,

Aidan – Little Medic.







The post Talking Israeli EMS and Rural Nepal with Mitch Thomas on his Podcast appeared first on Little Medic.

Blog 3 from Nepal – The Magic of Ultrasound

Ill try and keep this post short and sweet.

One of the challenges we faced in Nepal was the provision of Ethical Care.
This is a country where individuals can claim to be doctors and ‘prescribe’ Ayurvedic therapies in place of actual treatment, or even use fuzzy television screens as pretend ultrasounds to diagnose “bad blood on the uterus” or “cold water”.

In response to this, the need for maximal transparency and robust ethical standards in healthcare was and is vital.

Its for this reason that I can’t begin to communicate the enlivening experience of working at the Chisang Clinic: a Truly Ethical clinic.

The Chisang Clinic

The Chisang Clinic

I have never, and I say this with utmost confidence, Never, volunteered or been associated with an organisation whose moral stance on everything from operative costs and patient care was so completely humane and compassionate.Hajur Ama - Grandmother One of many elderly women whose treatment is completely subsidized by the clinic.
And Dr Karki is to thank for this.

Medicines are sold at almost cost price; the poor, elderly and “untouchable” castes are offered reduced costs – if not free care. And there is complete transparency; with a governing committee made up of local, district and national shareholders in Nepal.


Hajur Ama – Grandmother
One of many elderly women whose treatment is completely subsidized by the clinic.






But my favourite part; ultrasound is provided for free along with antenatal care and advice.

Its only because of the generosity of our incredible donors as well as the support of Sonositeuss Australia that the Chisang Clinic is now performing ultrasound scanning in Rural Nepal- adding a new dimension to the level of care already being provided.

Here’s a highlight of what we achieved with ultrasound in just the 3 weeks that I was at the Clinic:

  • More than 20 obstetric ultrasounds
  • 2 women with possible life threatening placenta praevia’s referred to P1010129a district hospital for OBGYN review


  • 2 kidney stones clearly diagnosed and referred
  • 3 women confirmed and counselled about an unknown hysterectomy performed during P1010196C-Section.




  • 2 patients cleared of pneumothorax
  • 1 patient’s diuresis titrated based on IVC fluid status




  • 2 men referred to district centres for suspected benign prostatic hyperplasia
  • 1 Ultrasound guided diagnostic needle aspiration of an abscessP1010174
  • 1 Ultrasound guided IM injection of NSAIDs
  • More than 14 Kidney ultrasounds screening for nephrolithiasis and 3 diagnosed and referred cases of hydronephrosis.
  • P1010395
  • 3 cardiac Ultrasounds to screen for gross abnormalities, 1 resulting in LVH diagnosis and referral.
  • 1 US indicated referral for Polycystic ovary syndrome

Alka and Yamunah beaming after a great day of OB Ultrasound









But what further sets the clinic apart from the rest, are the efforts that are taken to be transparent and educate patients – slowly but surely improving the local health literacy.

We created diagrams and charts to SHOW patients exactly what we were examining and why.


Diagrams with Minimal text in Nepali to illustrate to patients which organs can and cannot be ultrasounded – both encouraging transparency, and educating patients so that they are less vulnerable to quackery and can make more informed decisions. Pictured above in the centre are diagrams explaining that generalised abdominal pain cannot be ‘seen’ as a physical manifestation on ultrasound – as many local quacks would have patients believe.


A whole family from over 50km away who had travelled to the clinic for their young daughter’s OB ultrasounds but ended up bringing along other family members to have their ailments and illnesses ‘checked out’ while they were there.
A great way to encourage and improve health literacy!

And our efforts were rewarded with a surge in presentations from all over the district!








Watching on as a mother sees – with her own eyes- the flutterings of a tiny heart on a screen for the very first time is such a wonderful experience. Her eyes light up, a smile appears on her face, eyes wrinkling and a gasp of air escapes her lips in delight.
I only wish everyone who helped to make this possible could see it for themselves.

Yup! ultrasound Does save lives, and for me, the experience of being able to provide a new level of care and reassurance to my patients was pretty magical.


As always,

Aidan – the Little Medic.





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