Uttarkhand relief updates 1st spetember 2013 1

A brief report of the medical relief work done by Dr Daya and his team in Uttarkashi. Join us on fb to know more: https://www.facebook.com/DoctorsForSevaDFS

1. A brief report on the Relief work
done by Doctors For Seva in August
2013
Dr. Dayaprasad G Kulkarni
[email protected]
[phone]

2. 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

3. 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

4. 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

5. Events in brief
•Heavy snowfall in early June.
•Heavy Rainfall starts on 15
th
, continues till 18
th
.
•First signs of floods in Mandakini seen in Rudraprayag dist
on 16
th
June morning
•First wave of flash flood hits Kedarnath around 7 pm on
16
th.
Second wave at around 7 am on 17
th
June.
•Vishnuprayag gates closed at 11 pm on 16
th
, river bypasses
the dam during the night.
•Gates of Sringar closed at night on 16
th
June, opened during
early hours on 17
th
.
•Srinagar town faces worst floods in early hours on 17
th
.
•Bhagirathi peak flood of 6900 cumecs on 16
th
, Alaknanda
peak flood of 11000 cumecs on 17
th
June. Haridwar-
Rishikesh peak flood level on 18
th
June.

6. 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

7. 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
Capacit
y, 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

8. 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
Capacit
y, 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

9. A Run of River Project claimed to be
eco-friendly but having its own impact
One of the many
abandoned tunnels

10. 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.

11. The numerous projects back to back along the Bhagirathi

13. 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

14. 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!

15. 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 5
th
and 22
nd
of July 2013.
The second team comprising of Dr Atul Kanikar and Dr. Neeraja has started work from
29
th
July 2013.

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

20. Some images showing the nature of destruction and land slides
One of the many
waterfalls created on a
National Highway.

21. 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

22. 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.

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

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

25. 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.

26. 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

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

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

29. 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

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

31. 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?

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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)

38. 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

39. Thank you to everyone who have
been supporting us in these efforts
Contact [email protected]; [phone]