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The Pakistan Log: Reports by Dr. Azhar Rafiq, NASA Research Partnership Center physician, on a humanitarian medical mission to Pakistan
Editor's note: Scientists at a NASA research partnership center are using space medical monitoring technology to help Pakistan earthquake victims. Two physicians from Virginia Commonwealth University’s Medical Informatics and Technology Application Consortium in Richmond will teach telemedicine techniques in Rawalpindi, Pakistan -- a region hard-hit by a quake that has left 3.5 million homeless. Dr. Azhar Rafiq, one of the doctors, will periodically provide his personal observations of the situation for the NASA Web. These observations may contain explicit descriptions of injuries and other medical conditions.

Dr. Azhar Rafiq of Virginia Commonwealth University’s Medical Informatics and Technology Application Consortium during 2005 tests of medical monitoring technology.  (Image credit: Virginia Commonwealth University) Image at left: Dr. Azhar Rafiq of Virginia Commonwealth University’s Medical Informatics and Technology Application Consortium during 2005 tests of medical monitoring technology. (Image credit: Virginia Commonwealth University)

Saturday, Jan. 21

This morning, we met with surgical residents from three regional hospitals, who described the three days immediately following the Oct. 10 earthquake, when they treated 5,596 patients.

The majority were women and children with broken limbs, spinal cord injuries, and torn skin and muscles. Treatment typically consisted of aligning and stabilizing broken bones with external pins and rods, and plastic surgery with a great deal of skin grafting to help restore outer muscle and skin layers.

In the afternoon, medical students talked about their roles in caring for earthquake victims with broken arms and legs --- many of which had to be amputated. They described women who suffered spinal injuries as they huddled to protect themselves and their children. One student pointed out the high incidence of tetanus, since vaccinations are uncommon in Pakistan’s mountain villages. A psychosocial team reported on the tremendous personal loss suffered by these victims.

Dr. Faisal Murad, a third-year resident at Holy Family Hospital, was working on his laptop the morning of the quake, while his wife worked in the emergency department. Hospital staff already was busy with casualties from a shooting rampage the night before, when someone opened fire on people praying in a local mosque.

The jolt was so strong that Dr. Murad’s laptop fell off the table, the hospital began swaying from side to side, and windows were immediately shattered. A second jolt came several minutes later, and the staff evacuated the entire hospital, moving beds into the parking lot for patients who could not walk. The jolts continued every 10-15 minutes for the next seven hours.

They heard on the news that Margala Tower, a large residential skyscraper in Islamabad, had collapsed, so they prepared to receive the injured from that disaster. A neighboring hospital received the first casualties from an air force base located in the earthquake’s epicenter. Helicopters brought in 20-30 patients at a time, with little or no screening --- they simply loaded the injured on board. All area hospitals soon were overflowing with earthquake victims.

Over 1,000 CT scans were conducted to diagnose injuries the first two days. With no mechanism for information gathering or sharing, treatment teams were in a position of responding as patients entered the door. With telemedicine, they could have anticipated the level of injuries enroute to the hospital. There was no mechanism for the limited staff to quickly clean the wounds of such a large volume of incoming patients; so the staff immersed patients’ limbs into buckets filled with antiseptic.

This was the holy month of fasting, and no one gave up their commitment to fast. They simply kept working around the clock to manage patients as they arrived. While the victims of the shooting incident cried and screamed from the pain of gunshot wounds, the earthquake victims appeared to have no emotion left. They had seen family members die in their arms as they lay in the rubble. Now, the faces of the survivors were expressionless.

Today, many of these people are in large tents serving as field hospitals. Hundreds are paraplegics with no place to go. The challenge now is rehabilitation.

Tomorrow we will take a field trip to Pindi Gheb and visit with physicians who have been working with MITAC, our NASA Research Partnership Center in Virginia. We will attempt to establish telemedicine services in their rural hospital.

Dr. Azhar Rafiq is chief scientific officer for MITAC, one of 11 NASA Research Partnership Centers in the Space Partnership Development Program at Marshall Spaceflight Center, Huntsville, Alabama.

+ Read the Jan. 20 log