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Doctor near Mount Everest offers insight on Nepal quake

Renee Salas at Everest Base Camp five days before the avalanche.Salman Bhai/handout

Dr. Renee Salas, an emergency medicine physician at Massachusetts General Hospital, has been in Nepal since March 1 as a part of a two-year fellowship in wilderness medicine, a discipline focused on medical treatment in austere and resource-limited locations. The 34-year-old Michigan native has been working at the Himalayan Rescue Association clinic in Pheriche, a village below the Everest base camp. She sent the Globe an e-mail Tuesday morning detailing her experiences. Here are excerpts.

This was my first experience with an earthquake, and the severity of the earth’s movement was astounding. I felt as if I was on a boat at sea. . . . We ran outside to see nearly all of the buildings of the small village of Pheriche crumbling, at least partly. About a third were completely destroyed. In the midst of screams and dust clouds, we quickly circled the village after the earthquake vibrations had settled to see if there were any injured. Amazingly, the only injury was one small head laceration. . . . The village came together as everyone comforted one another and assisted those who had completely lost their houses. Some even began rebuilding their stone walls after the initial waves of aftershocks. . . .

“We then began to assess the damage to the clinic. Thankfully, [the quake had] affected only a portion of the living quarters and left the patient treatment area unaffected. The numerous aftershocks we experienced caused the village to remain outside for a good portion of the day. Unfortunately, it was snowing with moderate winds, which made this situation more difficult.

“The first patients from Everest base camp were two climbing Sherpas who arrived about nine hours after the earthquake as they had immediately descended via foot and by horse. We saw and treated them — one moderately injured who was admitted overnight and one minor who was treated and released.

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A helicopter evacuation of Everest base camp to Pheriche in the days following the Avalanche. Renee Salas

“We were awakened the next morning a little before 6 a.m. to the sounds of helicopter traffic heading up the valley. We received word that they would be evacuating all of the critically ill and wounded from [Everest base camp] to our facility and quickly began preparing for the possibility of significant patient volume. Our clinic has two inpatient beds, one consult room bed, and another extra bed in our research room. [Three physicians, joined by a fourth from Everest] quickly mobilized the sunroom into a patient facility, and the owner of the Panorama lodge next door, whose lodge was one of only two that had been unaffected by the quake, graciously donated his dining room. We received approximately 10 critically ill patients first and placed them in the clinic and sunroom — many on makeshift beds placed on the floor. There was a mix of Nepalis and international patients from around the world. . . .

“In total, we saw and evacuated an estimated 73 patients, including many ‘walking wounded.’ . . . Our resources here included intravenous fluids, medications, and an ultrasound. However, we are a remote post without access to blood products or the ability to perform subspeciality procedures that many patients required. Luckily, the weather cleared, and we were able to arrange further evacuation. . . .

“The local and international community here in the region came together in a way unlike anything I have experienced. Locals from the village and neighboring town of Dingboche assisted with patient transportation, arranging supplies, and giving patients and volunteers tea and food. International trekkers with nonmedical backgrounds who were in the region assisted selflessly with patient transport and donated first aid supplies and materials. We had numerous international physicians, nurses, and EMTs who spontaneously arrived and quickly set to work seeing patients, checking vital signs, and administrating medications. When the last patient was evacuated, the nearly 100 to 200 people who had assisted all cheered and hugged one another. . . .

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“We have remained [open] and continue to see locals and trekkers until our job here is done. This will likely be until Everest base camp is cleared and then [we] will convene with our Everest ER friends and colleagues and determine the next best course of action. . . . There have been continued aftershocks that have served as jarring reminders that the danger is still ongoing. . . .

“As food and water resources dwindle and the lack of sanitation grows, the risk of epidemics is high, which will turn an already dire situation into a nightmare. The country will require basic needs, such as food and water, and medical and infrastructure personnel and supplies.”