A brief report on the Relief work done by Doctors For Seva in August

2013

Dr. Dayaprasad G Kulkarni

drdaya@doctorsforseva.org

+919632306256

Acknowledgements

• Sewa International • UDAPSS • Youth For Seva • Shivananda Ashram, Gangori • Gayatri Parivar, Haridwar • Seva Bharati, Chennai • Care Vectors • Ekam Foundation • Hindu Seva Partisthana • Cisco Systems, Bangalore • Indian Association of Paediatrics, Bangalore Chapter • Indian Army • Government of Uttarakhand • All the People of Uttarkhand • Himanshu Thakkar

Introduction

• Dimensions of Disaster

• Events in brief

• State of Hydroelectric projects

• Warning signs and role of climate change

• The Team

• Details of Medical camps with images

• List of medicines and Equipment

Dimensions of UKD disaster • Spread across Mandakini, Alaknanda, Bhagirathi, Pinder,

Yamuna, Goriganga basins

• Affected districts include Uttarkashi, Rudraprayag, Chamoli, Pithoragarh, Tehri Garhwal.

• Thousands dead, missing, total upto 10-40K

• Large number of Houses, hotels, buildings washed away

• Roads washed away at 800 places

• Bridges washed away at 147 places

• Over 400 villages cut off

• Agricultural land washed away

• Tourism, hydropower project, roads, communications, pilgrim sites affected, to take years to get back to normalcy

Events in brief • Heavy snowfall in early June. • Heavy Rainfall starts on 15th, continues till 18th. • First signs of floods in Mandakini seen in Rudraprayag dist

on 16th June morning • First wave of flash flood hits Kedarnath around 7 pm on

16th. Second wave at around 7 am on 17th June. • Vishnuprayag gates closed at 11 pm on 16th, river bypasses

the dam during the night. • Gates of Sringar closed at night on 16th June, opened during

early hours on 17th. • Srinagar town faces worst floods in early hours on 17th. • Bhagirathi peak flood of 6900 cumecs on 16th, Alaknanda

peak flood of 11000 cumecs on 17th June. Haridwar-Rishikesh peak flood level on 18th June.

Disaster Vulnerabilities of UKD

• Young, fragile, Himalayan Mountain

• Landslide prone

• Flashflood prone

• Seismic zone IV and V

• Geological fault lines

• Forests and biodiversity based livelihoods

• Changing Climate adding to the risks

Status of Hydro projects in Uttarakhand Basin Existing Hydro

projects Under construction

projects

Proposed hydropower projects

Total Hydro projects

No of projects

Capacity, MW

No of Projects

Capacity, MW

No of Projects

Capacity, MW

No of Projects

Capacity, MW

Alaknanda 32 456.97 16 1291.1 74 5199.25 122 6947.32

Bhagirathi 13 1851.5 13 1084.75 22 801.9 48 3737.75

Ganga Sub basin

4 173.8 2 1.75 - - 6 175.55

Ramganga 12 210.8 - - 20 408.5 32 619.35

Sharda 28 427.75 8 0.375 48 12022.28 84 12450.405

Yamuna 9 478.195 2 0.14 33 2780.85 44 3259.185

TOTAL 98 3598.665 41 2378.12 197 21212.78 336 27189.56

Status of Hydro projects in Uttarakhand-2 Basin Large Hydro projects

(above 25 MW) Small Hydro projects (1-25

MW)

Mini-micro hydro projects (<1 MW)

Total Hydro projects

No of projects

Capacity, MW

No of Projects

Capacity, MW

No of Projects

Capacity, MW

No of Projects

Capacity, MW

Alaknanda 35 6419 61 524.65 26 3.67 122 6947.32

Bhagirathi 10 3469 28 266.7 10 2.05 48 3737.75

Ganga Sub basin

1 144 3 31.2 2 0.35 6 175.55

Ramganga 7 512 14 105.3 11 2.05 32 619.35

Sharda 29 12335.6 20 109.65 35 5.155 84 12450.405

Yamuna 22 3144.75 14 113.3 8 1.135 44 3259.185

TOTAL 104 26024.35 140 1150.8 92 14.41 336 27189.56

A Run of River Project claimed to be eco-friendly but having its own impact

One of the many abandoned tunnels

A typical Hydro project means • A large dam • Tunnel that can be up to 30 km long, Tunnel can be wide enough to

have three trains running side by side, Tunnel is typically blasted through the hills, notwithstanding the contrary claims

• Roads • Township • Mining for sand, boulders • Deforestation • Creation of several lakh cubic m of muck • Big change in micro climate • Drying up of rivers, Destruction of biodiversity • large number of unskilled and Skilled labour mostly coming from

outside • Each of these components have social, environmental, livelihood,

cultural, religious, aesthetic and other impacts. They also have impact on disaster potential, erosion potential, flash flood potential of the area.

The numerous projects back to back along the Bhagirathi

Warnings ignored • Need for proper EIA for all major interventions

• Needs for CIA

• WII study

• Conservation of rivers/ RRZ/ River bed construction/ Mining of sand, boulders

• CAG report on Hydro

• CAG report on Disaster Preparedness

• Climate change studies

• Changing weather patterns

• Glaciers study

• 4X4 study

• Recent disasters

• DMMC reports: 2012 disasters

Role of Climate Change • Himalayas facing higher temperature increase than global average;

irregular rainfall with more high intensity rainfall events, retreating glaciers increasing the possibilities of landslides and moraine flow into the rivers; increased frequency of flashfloods and landslides;

• Himalayan region is named as one of the 4 most vulnerable regions of India from CC perspective

• UKD is experiencing climate extremes for some years. • This year: very early, very heavy, very widespread monsoon; 1356%

rainfall across state in June 13-19 week; Role of Glaciers; Snow fall followed by rainfall; Cloud burst, flash floods

• Scientists are telling us that every weather extreme has CC impact. Secretary, Union Ministry of Earth Sciences accepted the CC impact in this event, but what are the implications? None so far? Vulnerable sections not even identified.

• NAPCC, National Mission on Sustainable Himalayan Ecosystem, UKD state APCC: Do we see any sign of these? Do we see any impact of these on environmental governance in UKD?

• GOI is certifying every hydro project applying for CDM credits as sustainable development everywhere, including Uttarakhand!

Our team comprised of Dr. Dayaprasad G Kulkarni, 2 Local Pharmacists – Bheem and Brijesh, Volunteers Ajit Negi and Lokender, Umed and Deepak at base, Winnie Chang, coordinator Varun. This team walked for days covering 75 kms and about 25 villages, carrying rations and medicines, treating over 500 patients, distributing kits to ASHA workers, health assistants and PHC staff between 5th and 22nd of July 2013. The second team comprising of Dr Atul Kanikar and Dr. Neeraja has started work from 29th July 2013.

Names of villages with approx. population where medical camps were and will be conducted

Some images showing the nature of destruction and land slides

One of the many waterfalls created on a National Highway.

The first base camp in Sanglai; School converted to clinic; Village pradhan with his family (Our Host); Anuja, 11 std student carrying loads of fodder on her back

Camps catering to villages of Bhukhi, Kujjan, Tihar, Gunga, Garam Pani, Sanglai

The amazingly hardworking, happy, content, generous people of the hills. We have a lot to learn from them and have an opportunity to define “Development” according to what they think it is and not

impose what we think is best for them.

Camps in the villages of Huri, Gangnani amd Bhangeli. Independence day with the children in Bhangeli

Some of the treacherous paths and the various modes of transport that we had to take during our 15 days, 75 kilometer journey

Register of patients maintained where possible

Seeing patients in Vagori village at the Harshil helipad a few kilometers from the Indo-China Border with the soldiers from Gharwal rifles keeping a close eye on the proceedings. We were also lucky to have the famous Harshil apples and Rajma. Sadly, the orchards are overflowing with ripe apples and other fruits but no tourists to buy them and no roads to send them to the markets. This also means a loss of an entire years earnings.

The people of the hills are extremely hard working, specially the women folk. They are also happy and kind people untouched by the nuances of urbanisation. Here are some of our hosts at various points in our journey who Graciously shared their homes, food and knowledge with us

Traditional Wool work, Advisors and guides, abandoned vehicles and landslides

Medicines and kits distributed to the ASHA, Health Assistant and nurses at various villages and health centers

Outcome

• Over 1000 patients reached out to • Medicines distributed to all patients • Kits with basic drugs distributed to AHSA, Health Assistant, Nurse in

every village • Training was provided to volunteers and health workers about

emergency care and first aid • Safe Delivery kits distributed • Established a personal network with over 25 villages for future

interventions • Networked with other organisations working in the area • Worked closely with the state • All local volunteers engaged who could in turn support their

families with the honorarium

Next Steps

• Team of doctors to visit at regular intervals for follow – up. (1 Pediatrician and Gynaecologist already on a 10 day visit from 29th August)

• Engage with local volunteers to train and equip local health centers to cater to their needs

• Connect with partner organisations to implement long term, sustainable and multi-dimentional interventions

• Reach out to Rudraprayag and Chamoli Districts

Questions to Ponder • On vulnerabilities of different regions. • On Environmental Governance and vulnerabilities • Developmental impacts and the disaster potential of a given area • Role of disaster preparedness, warning, forecasting, information

dissemination, mitigation and management in decision making processes

• Do we even have credible disaster management mechanism in place? • How does our environment impact assessments, environment

appraisal committees and environment ministry consider these issues?

• Do we have credible cumulative impact assessment mechanism? • What space rivers need to flow and what we need to ensure that the

beauty (the river) does not become beast (disaster)? • What sort of accountability and participatory norms do we have? • Do our environmental governance institutes have capacity learn from

such events? • What is our track record in this regard?

List of Medicines Perinorm inj -200 Voveran inj-200 Ambroxal Pd - 600 Asthalin Pd -600 Eye ointment- 2000 Famotidine-2500 Omeprazole-1000 Ranitidine tabs-1000 Becosule caps-4000 M2Tone Tabs -3000 multivitamin drops 2000 Scabin lotion-600 Cinerazine tabs - 1000 Albendazole-1500 Ciplox Tz -2000 Norflox Metronidazole suspension-2000 Norflox Tz-1000 Amoxy syp pd-300 Cetrizine-2000 Cephalexin oral suspnsn-200 Pentid-3000 Roxid 150 tabs-3000

Cephadroxil 500&250mg-1500/1500 Oflox-oz-3000 cetrizine syp-3000 nasal drops-200 amlodipine-1500 Betnesol-3000 anticold syp-3000 dicycline drops-2000 norflox syp-2000 Colimax-2000 domostal drops 2000. cyclopam inj -120 paracetamol inj-600 Dry cough syp-300 mikacin 125 inj-100 mikacin 250 inj- 100 Dexomethasone inj-120 Etophylline inj-150 Cefixime-3000 Salbutamol-5000 Ofloxacin-3000 cefalexin 250 mg- 3000

List of medicines sent to the Bhatwari camp at the request of the government for the 4

day camp – 2 sets • Tabcalcium 1500, • Digene 1000, • B complex 1500, • SypAlbendazole 20, • M Vit drops 20, • azithromycin10, • Alprazolam 100, • Vit D3 sachet 1000, • inj neurobion 50amp, • Multi vitamin syp10 • Doxycycline 500 • Salbutamol 1000 • Paracetamol 2000 • Cetrizine 1000 • Eye and ear drops 100

List of instruments and kits

Delivery basic set

Forceps, Sponge Holding, 200mm

Needle holder, Mayo, 160mm

Scissors, Mayo, Curved, 150mm

Scissors, Epiotomy, Braun-sadler, 145mm

Scissors, umbilical, 105mm

Speculum, vaginal, Auvard

Speculum, vaginal, Sims

Bowl, lotion, s/s, 6 liters

Instrument Container, s/s, with cover,300x200x50mm

Kidney dish, 24cm

Dressing instrument set

Forceps, dissecting, Straight, 1/2 teeth, 130 mm

Forceps, sinus, 180mm

Forceps, Dissecting, Straight, Plain, 115 mm

Forceps, Sponge holding, 200mm

Scissors, Mayo, Straight, 150mm

30. Scissors, dressing, Straight, 165mm

Scissors, ligature, spencer, 130mm

Bowls, lotion, s/s, 5 liter

Bowl lotion, s/s, 0.2 liter

Kidney Dish, 24cm

Instrument container, s/s with cover, 300x200x50mm

Minor surgert set

Dressing Scissors 6" sharp/blunt

Iris Scissors 4.5"straight

Mayo Scissors 5.5"straight

Stitch Scissors 5.5"

Gillies Dissecting Forceps 1:2 teeth 6"

Dissecting Forceps 5” block end

Halstead Mosquito Artery Forceps 5" straight

Mayo Hegar Needle Holder 6" with TC

Gillies Skin Hook

Kilner Retractor

McDonald Dissector

Volkmann Scoop, medium

No.3 scalpel handle suitable for blades #10 - #15

Probe

Abdominal Gynecological Instrument Set

Knife Handle No.3

Knife Handle No.4

Knife Handel No.7

Forceps Holder, 8"

Forceps Holder, 10"

Forceps Holder, 12"

Mayo Disc. Scrs, 6 3/4" Str

Mayo Disc. Scrs, 6 3/4", Cvd

Metzenbaum scrs, 7" Cvd

Halstead Mosquito Fcps, Straight, 5"

Halstead Mosquito Fcps, Curved, 5"

Forceps, Kelly, 5 1/2" Str

Forceps, Kelly, 5 1/2", Cvd

Forceps, Rochester-Pean, 6 1/4", Cvd

Forceps,Rochester-Pean, 10 1/4", Cvd

Forceps, Rochester-Ochsner, 10", 1x2 th

Forceps, Mixter, 9"

Forceps, Foerster SPonge, 9 1/2"

Forceps, Allis Tissue, 6", 4x5th

Forceps, Allis Tissue, 10"

Forceps, Babcock Tissue, 6 1/4"

Forceps, Babcock Tissue, 8"

Forceps, Backhaus Towel, 5 1/4"

Forceps, Thumb Dressing, 5 1/2"

Forceps, Tissue, 5 1/2", 1x2 th

Forceps, Russian Tissue, 8"

Forceps, Adson Tissue, 1x2th, 4 3/4"

Retractor, Balfour

Retractor Richardson, 1"x 3/4"

Retractor Richardson, 1 1/2"x1 1/2"

Retractor, Army set of 2

Retractor,Ribbon, 3/4"x13"

Retractor,Ribbon, 1 1/4"x13"

Retractor,Ribbon, 2"x13"

Retractor,Deaver, 1"x9"

Retractor,Deaver, 1"X13"

Retractor,Deaver, 2"x12"

Retractor, Goelet

Forceps, Lahey Gall-Duct, 7 1/2"

Scissors, Metzenbaum, 9" Str, TC Insert

Scissors, metzenbaum, 9", Cvd, TC Insert

Needle Holder,Mayo Hegar,7",TC Insert

Needle Holder,Mayo Hegar,8",TC Insert

Needle Holder, Mayo Hegar, 10 1/2",TC

Tube,Yankeur Suction, 11 3/4"

Tube,Poole Suction,Straight

Forceps,Schnidt, 7 1/2"

Forceps, Tissue, 8"

Knife Handle No.4L

Mayo Diseecting Scrs, 9",Cvd, TC Insert

Tissue Fcps, 12", 1x2th

Tissue Forceps, 2x3 T, 5 1/2"

Rochester-Ochsner Fcps 8", Str

Foerster Sponge Fcps, 9", Str, Serr

Heaney Needle Holder, 8", Cvd, TC

balfour retractor or pozzy retractor or O"Sullivan-O"Connor Retractor

Allis Tissue Fcps, 7 1/2", 5x6 th

Graves Vaginal Speculum, Medium

Tenaculum Fcps

Vulsellum Forceps

Jacobs Vulsellum Forecpes, Str

Heaney Hysterectomy Fcps, 8 1/4",

Heaney Hysterectomy Fcps, Cvd, single th

Nebulizer 1

Thermometer 2

Mucus sucker 2

Pediatric stethoscope 1

Torch with extra batteries 2

Measuring tape 1

Baby weighing scale 1

Prescription pads 10

O.P.D. Register 1

Other equipment for pediatric use

Medications/drugs (Injectables/parenterals) for pediatric use

Candid-V gel 50

Lignox gel 5

Tenovate 20

Candid pessary 20

Clintas-CL pessary 10

Betadine ointment 5

Caladryl lotion 5

Betnovate-C 10

Candid skin cream 10

Zocon dusting powder 20

Siloderm cream 20

Candid mouth paint 20

Annovate cream 10

Fusidin cream 10

T-bact ointment 10

Fusibet cream 10

Medications/drugs for local application

Drug Bottles

(Suspensions)

Tablets

Crocin/Metacin/Febrex 125,

250mg

100 each 500mg- 300

tablets

Combiflam 100 100

Febrex plus/Wikoryl/Sinarest 100 500

Cyclopam 20 50

Colicaid drops 50

O2H 200

Bendex 100 100

Taxim-O 50mg, 100mg D.T. 100 each

Oflox 100mg, 200mg D.T. 100 each

Visyneral-Z drops 100

Azithral 100mg, 200mg 100 each

Azithral 250mg, 500mg 100 each

Oflox/Ciplox eye drops 100

Sofracort eye drops 50

Clavam BiD 50

Roxid/Roxeptin 50mg, 100mg D.T. 50 each

Easum powder (50 packets)

Simyl-MCT oil 20

Zerolac infant formula (20 tins)

Monocef 250mg, 500mg 50 each

Clavam 300mg 50

Amitax 100mg, 250mg 50 each

Oflox (100ml) 20

Isolyte-P (500ml) 50

R.L. 20

D.N.S. 20

Budesal respules (0.5mg) 100

Water for injection (10ml) 100

Dexona 5

Effcorlin 5

Avil 5

Febrinil (Paracetamol) 20 ampoules/ 2 multi-dose vials

Calmpose 4

Gardenal (phenobarbitone) 4

Epsonil 4

Jonec 25mg pediatric suppository 10

Name of the equipment Quantity Remarks

B. P. Apparatus 1

Stethoscope 2 One with pediatric chest piece

Thermometer 2

Weighing scale 2 1 adult and one baby weighing scale

Light source 3 2 torch and one electrical source

Surgical gloves no 6 and 61/2 200 each Surgical autoclave will be useful

Speculum 4 Cusco’s, 4 Simp’s Electrical/stove sterilizer necessary

Volsellum 2

Betadine liquid 4

Spirit 4

Sterillium 4

Hydrogen peroxide (H2O2) 2

Cotton and dressing pads (sterile

packs)

100

Disposable syringes 2 ml and 5 ml 200 each

Disposable syringes 10 ml 25

Simple rubber catheter 10

Infant feeding tube no 8 20

Urinary pregnancy test kits 100

Prescription pads 10 (100 pages

each)

Ante-natal check-up cards 200 If available

Disposable caps and masks 200

Electrical/heat sterilizer 1

Mucus sucker (rubber bulb) 2

Cord clamps 10

Foley’s catheter no.14 10

Surgical scissors 2 straight, 2 curved

Scalpel with blades 2 10 extra disposable blades

Suture material 1-0 Cat-gut, Vicryl,

linen

5 each

Sponge holding forceps 2

Surgical gowns, towels, sheets 4 each Disposable towels & sheets are available

Uro-sac (urine collecting bags) 5

Dynaplast, paper and cotton sticking 5 each

I. V. sets (JMS) 100

Pediadrip I.V. set 10

Veinflow/Intracath no. 18, 20, 22, 24 20 each

Venafix/easyfix 100 strips

Scalp vein set (Top) no. 22, 23 10 each

Proctoclysis/glycerin enema 20

Gynecology and Obstetrics

Inj. Tetanus toxoid (refrigeration needed) 10 multi-dose vials

I. V. Fluids (RL, DNS. D-5%, Isolyte-P) 2 boxes each

Hemaxoel (plasma expander) 2 bottles

Pitocin 100 ampoules

Prostodin 10 ampoules

Methergin 30

Trenexa 10

Ethasyl 10

Tramadol 10

Voveran 10

Paracetamol (Mol) 5

Lasix 5

Lignocaine 2% 1 vial

Sensurcaine 5% heavy 1 vial

Adrenaline 5

Effcorlin 5

Dexona 5

Rantac 10

Emeset 20

Perinorm 10

Kapilin (Vit. K) 50

Sterile water for injection (10 ml) 100 vials (plastic)

Metrogyl (100 ml) 20

Oflox (100 ml) 20

Taxim (0.5, 1 gm) 50

Amitax (250, 500 mg) 30

Moxclav/clavam (0.3, 0.75, 1.2 gm) 20

Monocef (0.5, 1 gm) 20

Polybione 50

M.V.I. 20

Neurobione 20

Jonec 100mg suppository 20

Drugs and medications (Injectables)

Acknowledgements

• Sewa International • UDAPSS • Youth For Seva • Shivananda Ashram, Gangori • Gayatri Parivar, Haridwar • Seva Bharati, Chennai • Care Vectors • Ekam Foundation • Hindu Seva Partisthana • Cisco Systems, Bangalore • Indian Association of Paediatrics, Bangalore Chapter • Indian Army • Government of Uttarakhand • All the People of Uttarkhand • Himanshu Thakkar

Thank you to everyone who have been supporting us in these efforts

Contact drdaya@doctorsforseva.org; +919632306256