<figure><img width="3071" height="2284" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d195f9c7e80680e0ac817jpeg.jpg" alt=""/><figcaption>Chanaute after the flood on the Melamchi River in 2021. All photos: RAJU PANDIT CHHETRI</figcaption></figure>On 15 June, the <a href="https://www.nepalitimes.com/latest/monsoon-hits-nepal-with-a-bang/">Melamchi River north of Kathmandu</a> saw a massive flash flood, killing 25 people and sweeping away 200 houses and 360 hectares of farmlands.Another debris flow on the river on 31 July added to the destruction and misery. The disaster was <a href="https://www.nepalitimes.com/latest/the-monsoon-mess-in-melamchi/">unprecedented in the Melamchi Valley</a>, and caught residents, trout farms, shops along the banks by surprise. Before the communities got a chance to fully rise from the massive double-earthquake in 2015, the region was hit yet again with another disaster.As a resident of the Chanaute, I lost close relatives and neighbours to the flood. My own house and farmland were destroyed. The river sliced through the bazar town, and its 56 houses are now ruined and abandoned. The hopes of my hard-working community have also been dashed.Local entrepreneurs, small shop owners and farmers whose arable land have turned into a boulder-strewn wasteland are shattered. Damage to roads and bridges hascut the valley’s connection to the outside world. Nepal’s most expensive water supply project has been damaged. <figure><img width="1024" height="768" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19639c7e80680e0ac818jpeg.jpg" alt=""><figcaption> </figcaption></figure>Any individual extreme weather event is difficult to directly attribute to the climate crisis. But the intensity and unpredictability of this year’s monsoon has been unprecedented. Manang and Mustang were hit by flash floods at the same time as Melamchi – even before the monsoon officially started. And even after the rainy season was formally over last week, <a href="https://www.nepalitimes.com/latest/post-monsoon-rain-ruins-nepals-crops/">parts of the country were hit by record-breaking rainfall.</a>For the past decade, my career has taken me to numerous international climate summits where we have discussed strong national and international advocacy to address the impact of the climate crisis – especially on developing countries like Nepal.At international climate negotiations under the United Nations Framework Convention on Climate Change (UNFCCC), I have observed climate-vulnerable countries make urgent pleas for ambitious action in tackling the climate crisis. Small, low-lying island states like the Vanuatu, Tuvalu and the Maldives have tried to show the urgency of it all – rising ocean levels will soon submerge their countries.The Philippines and Bangladesh continue to raise concern about the increasing intensity and frequency of typhoons and cyclones. Fragile mountain regions of the world are trying to get their concerns on the agenda.Next week, heads of state from around the world will start arriving in Glasgow for the 26th annual climate summit of the UNFCCC (called COP26). Recent impacts of extreme weather events around the world (wildfires in Siberia and the western US, heat waves in Canada, floods in Europe, landslides and floods in Japan, India, China) are likely to focus everyone’s mind on the climate emergency, and the message that we are all in this together. <figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19669c7e80680e0ac819jpeg.jpg" alt=""><figcaption> </figcaption></figure>Reducing greenhouse gas emissions and adapting to climate impacts to avert and minimise some of the loss and damage will be at the forefront of the negotiations.  However, as the incoming president of COP26, the United Kingdom and the leaders of the industrialised world will have to face a new reality – to address the destruction unleashed by the climate crisis with rehabilitation, migration and financing.Industrialised countries have long brushed aside these issues, diluted their commitments to merely focusing on the weaker goal of reducing greenhouse gas emission, and providing token climate financing to allow low-income countries to adapt.In fact, addressing the <a href="https://www.nepalitimes.com/banner/disasters-in-nepal-come-in-waves/">loss and damage from disasters</a> like the one that hit Melamchi and parts of the Himalaya will be one of the main pillars of the COP26 in Glasgow. Nepal’s delegation will be led by Prime Minister Sher Bahadur Deuba, and he is expected to speak about this year’s climate-induced disasters starting with <a href="https://www.nepalitimes.com/banner/wildfires-ravage-nepal-mountains/">winter drought</a>, <a href="https://www.nepalitimes.com/banner/nepal-is-going-up-in-smoke/">nationwide wildfires</a>, and floods.Nepal will have strong moral grounds to persuade world leaders that low capacity vulnerable countries need help to deal with a crisis that is not of our making. Himalayan glaciers are shrinking and receding fast, extreme weather trends are more pronounced, and this is impacting on infrastructure projects and threaten to undermine decades of progress in achieving the UN’s Sustainable Development Goals. <figure><img width="4000" height="3000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161128/636d19699c7e80680e0ac81ajpeg.jpg" alt=""><figcaption> </figcaption></figure><a href="https://www.nepalitimes.com/here-now/nepals-glacial-lakes-in-danger-of-bursting/">A 2020 study by ICIMOD and UNDP</a> has shown that 47 glacial lakes in the Kosi, Gandaki and Karnali basins are in danger of bursting. Although 21 of these lakes are in Nepal, the others also drain into tributaries of rivers flowing into Nepal. These are ticking time bombs.<a href="https://www.nepalitimes.com/banner/climate-change-is-a-disaster-in-the-nepal-himalaya/">Glacial lake outburst floods</a> have been hitting Nepal’s Himalayan valleys with increasing frequency. In 2012, an <a href="http://archive.nepalitimes.com/article/nation/Anatom-of-a-Himalayan-tsunami,1330">avalanche on Annapurna</a> unleashed a catastrophic flood on the Seti River that killed at least 70 people. In <a href="http://archive.nepalitimes.com/blogs/kundadixit/2014/10/16/after-the-storm/">2014, a deadly post-monsoon blizzard</a> spawned by Cyclone Hudhud swept through the mountains catching many trekkers unawares. The Tarai have seen increasingly destructive floods in the past five years, and <a href="https://www.nepalitimes.com/banner/disastrous-management-in-nepal/">Bara district was hit by a rare tornado in 2019</a> that killed dozens.In Glasgow, Nepal will have to make a compelling case for <a href="https://www.nepalitimes.com/banner/himalayan-floods-a-sign-of-worse-to-come/">loss and damage compensation</a> for disasters like these. COP26 will be a make-or-break summit for reducing global carbon emissions by 45% by 2030. Nepal will also need to do its bit to achieve its updated Nationally Determined Contribution target to reduce emissions by 2030 by switching to renewable energy, and attain net zero by 2050.Glasgow will be an opportunity to link global targets to local impact, and to find ways to address the disproportionate destruction caused by climate crisis on the poorer parts of the poorest countries.Raju Pandit Chhetri is a resident of Chanaute in Nepal’s Melamchi Valley and works on climate change issues.

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Think globally in Glasgow, and act locally

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73eb9c7e80680e062365jpeg.jpg" alt="" width="1500" height="911"/><figcaption>Photo: NATIONAL TRAUMA CENTRE</figcaption></figure>Speeding along a narrow winding mountain road in Dhading, a heavily intoxicated truck driver lost control of the <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">vehicle</a> and it overturned, killing seven and severely injuring 34 passengers hitching a ride.This was a mass trauma incident that required immediate attention, but <a href="http://nationaltraumacenter.gov.np/" target="_blank" rel="noopener">Nepal’s only trauma care centre</a> was located in Kathmandu, 90km away via bumpy roads jammed with traffic.Read also: <a href="https://www.nepalitimes.com/?p=40249&amp;preview_nonce=aefd82ecbe&amp;preview=true" target="_blank" rel="noopener">injured use Internet to reach physiotherapists in Nepal</a>, Sonia AwaleMost passengers from the truck accident were taken to nearby hospitals in Dhading, but the 21 most critical patients were airlifted or driven in ambulances to the National Trauma Centre in Kathmandu.“It had already taken a while to bring the patients to the Trauma Centre, so we had to act quickly once they were here,’’ recalls Pramod Yadav, acting medical superintendent at the facility.The standard protocol for trauma care is the triage system -- determining the priority of treatment based on the severity of injury. Doctors at the National Trauma Centre quickly designated yellow, green and red codes to patients to ensure that those in critical condition were taken care of first, and fast.Read also: <a href="https://archive.nepalitimes.com/article/nation/accident-prone-Mugling-Narayangadi-highway,3828" target="_blank" rel="noopener">Unblocking an artery</a>, Sanjeev SharmaOn-call doctors were contacted and began assessing the patient’s injuries. But without a functioning MRI and a faulty CT machine, some had to be sent to private clinics and later returned to the hospital.This is a recurring event for patients seeking immediate care at the government-run Trauma Centre where patients in critical condition have to be moved about from one facility to another for tests.“We cannot afford an MRI machine, it is very expensive to repair our CT machines, we have limited trolley beds and only 11 ICU beds when we need more than 50,” says Yadav. “We are requesting the government for Rs420 million to become a real trauma centre, especially since we are the only one in the country.”There were 60,000 severe trauma injuries in Nepal in the last year, a 3,000 increase from the previous year, and a whopping 27,000 over the year before that. Like with all government-run medical centres, the Trauma Centre lacks resources, is under-staffed, and is incapable of handling this exponential increase.“In the last two, three years, falls, physical assault, <a href="https://www.nepalitimes.com/banner/nepals-deadly-roads-take-their-toll/" target="_blank" rel="noopener">road traffic accidents</a>, sports injuries and <a href="https://archive.nepalitimes.com/article/nation/burning-in-the-aftermath,3757" target="_blank" rel="noopener">burns</a> have been the leading causes of trauma,” lists  Siddhartha Dhungana, the Medical Record Officer at the National Trauma Centre. “Head injuries and multi-organ failures have been the highest causes of death in these cases.”Most hospitals in Nepal, like the National Trauma Centre, follow the World Health Organisation’s trauma protocol. During a trauma case, medical personnel are contacted as soon as possible, patients are screened, their needs are identified and necessary care is given.Although the government has not developed a standard care protocol for trauma like it has for cancer patients, private hospitals have implemented and refined their own systems based on WHO guidelines.<a href="http://archive.nepalitimes.com/article/nation/politics-behind-epidemic-of-hospital-vandalism,3578" target="_blank" rel="noopener">Om Hospital</a>’s Continuing Medical Education Program is at the forefront of teaching trauma care to new doctors and providing courses on improved techniques to existing doctors.“We make sure that the ABCs of trauma care are followed strictly and that blood is readily available be it from our blood bank or staff-chain blood donors,” says Binod Adhikari of Om, which handles dozens of cases every day and has systems in place to coordinate between doctors, nurses and critical care anesthesiologists to provide emergency care to patients.<h2>Ambulance chasers</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109101132/636b73ee9c7e80680e062366jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Most of Nepal's ambulances are just jeeps with stretchers, with no life-support systems or medical attendants. It was only in 2011 that Nepal’s first emergency medical service was established. Supported by the Patan Academy of Health Sciences and the Stanford University School of Medicine, Nepal Ambulance Service (NAS) has since trained more than 100 emergency medical technicians (EMTs) and ambulance drivers and operates the <a href="http://archive.nepalitimes.com/news.php?id=18888#.XjvhpTIzaUk" target="_blank" rel="noopener">'Dial 102' service</a>. NAS operates mainly in Kathmandu Valley, Pokhara, Chitwan, Butwal and Bhairawa.“Before this, only few private hospitals had ambulances and they were used mainly for patient transfer rather than pre-hospital care,” says Hari Khadka, a paramedic at <a href="https://www.grandehospital.com/" target="_blank" rel="noopener">Grande International Hospital</a> and a member of the first EMT batch of NAS. “Ten years ago, there was simply no concept of pre-hospital care or paramedics in Nepal.”Now, many hospitals have their own EMS systems with mostly Type 3 ambulances that have first aid kits and basic medical supplies. <a href="https://www.nrcs.org/" target="_blank" rel="noopener">Nepal Red Cross Society</a> (NRCS) operates 283 ambulances nationwide. Although not every ambulance carries a paramedic, every driver has received first aid training.“We have five Type 2 ambulances and a paramedic in each vehicle,” says Bipul Neupane of NRCS. “We send these ambulances to patients who need basic life support systems.”But for patients needing critical care in remote areas, there is no recourse but expensive helicopter medical evacuation.Like Type 1 ambulances, some of these helicopters can have doctors, ventilators, advanced life support, and EMTs.“EMS has helped save many lives in Nepal but it isn’t always the best option considering the geography of Nepal and the condition of the roads,” says Sanjaya Karki, Head of the Emergency Department at <a href="https://www.nepalmediciti.com/" target="_blank" rel="noopener">Nepal Mediciti Hospital</a>. “Helicopter Emergency Medical Services ensure that we can get to critical patients as quickly as possible and provide the best pre-hospital care.”

It’s an emergency: Nepal needs to improve trauma care

<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221104141136/636515d79c7e80680e02c1dejpeg.jpg" alt="" width="640" height="480"/>The Ministry of Health and Nepal Ambulance Service have agreed to set up a training institute. The government has also decided to pool ambulance services under a single operating number 102 Ambulance Service to manage an emergency call centre.

Emergency prep

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