RESUMO
POST-EARTHQUAKE NEPAL: ACUTE-ON-CHRONIC PROBLEMS It has been over 8 months since the 7.8-magnitude earthquake devastated Nepal, resulting in almost 9000 deaths, over 23 000 injured and over 2 million displaced people. With the breakdown in sanitation post-earthquake, the summer and the monsoon rains could potentially have unleashed many infectious diseases in this hilly terrain. Fortunately, Nepal has so far not witnessed any widespread outbreak of disease and active surveillance for diseases is going to be critical. The winter months faced the problems of countering cold and hypothermia especially in the far-flung high altitude earthquake-ravaged villages. But thousands of orthopaedic injuries brought on by the earthquake were a good example of acute-onchronic health problems in Nepal. Rampant infectious diseases which pre-date the earthquake such as tuberculosis, typhoid, typhus, brucellosis, etc. make Nepal a place for helping and studying people with these ailments. Widespread non-communicable diseases such as diabetes, myocardial infarction and renal failure are vying with infectious diseases to cause untold harm and suffering. With focus on the acute health problems caused by the earthquake, many chronic health issues are generally neglected. The earthquake attracted worldwide attention to Nepal and over US$ 4 billion has been pledged to help Nepal ‘build back better’. These funds should help the government in implementing universal health coverage in keeping with the UN’s emerging Sustainable Development Goals, so that patients can deal with the acute problems along with chronic diseases. One of the biggest health problems in Nepal is in dealing with catastrophic illnesses (defined as severe illnesses requiring prolonged hospitalization and recovery) since there is hardly any provision of health insurance. This problem has been exacerbated by heart-wrenching poverty induced by the earthquake. I relate below the story of a patient in our hospital who had a successful outcome despite a devastating illness. Unfortunately, most patients with such illnesses are not so lucky in our part of the world.