The Kashmir 2005 earthquake

The specific skills of reconstructive surgeons are particularly suited to Earthquake of disaster response.

Newcastle plastic surgery team, including Omar Ahmed (third from left) collaborating with local staff.

The aim of all the relief teams was to prioritise care for those whose needs were most urgent, to save lives and salvage limbs. The ambition was to be able to train local teams in wound management and to establish links with local plastic surgeons for safe aftercare.

The “team of the week” in each designated hospital was tasked with dealing with the surgical management of a significant volume of patients. Each team also documented each procedure and updated the database of patients, and made plans for future operations. Regular evening ward rounds were conducted, and regular meetings took place between ward-based doctors, consultant anaesthetists, trauma surgeons, and plastic surgeons, to plan surgery for each day.

The plastic surgery procedures performed included wound debridement, skin grafting, local flaps, and occasional microsurgical free flaps. Many cases also involved fracture fixation. A large number of patients of all ages were treated, with a total of around 700 operative procedures performed by various plastic surgery teams over a 2-month period in one unit, the Al Shifa Eye Hospital alone. Many more were carried out by surgeons in other designated hospitals. The acute relief effort lasted for over 2 months.

Omar Ahmed (left) performs lower limb reconstruction in Rawalpindi

BAPRAS members and non-member plastic surgeons, were involved in the Kashmir earthquake response, including, Umraz Khan, Omar Ahmed, Haroon Siddiqui, Michael Schenker, Muhammad Riaz, Mohammed Ali Jawad, Abid Khan, Khalid Khan, Waseem Saeed, Cameron Raine, Taha Usmani, Umar Daraz Khan, Irfan Khan, Azhar Iqbal, and Danish Imran. The involvement of Tim Goodacre further enhanced links between BAPRAS and local plastic surgeons.

A number of local presentations and articles have described the humbling experiences of British-based doctors and plastic surgeons in particular, their reflections, and the lessons they learned and imparted.

These experiences helped develop a robust and lasting link between BAPRAS and the Pakistan Association of Plastic Surgeons (PAPS), with some senior plastic surgeons maintaining biannual visits to teaching hospitals. They also contributed to the establishment of POPS (Pakistani Origin Plastic Surgeons) UK, whose aim is promote the specialty and support plastic surgery training in Pakistan.

The disaster also led to much improved processes and pathways in the United Kingdom to support international disaster zones. There is an ongoing need for more robust international registration and credentialing of healthcare professionals traveling to disaster zones and more direct management and oversight of their activity. When a disaster of the scale of the Kashmir earthquake occurs, even the smallest act of kindness can make a significant difference to the lives of the suffering.