Independent 24th November 2005

Amid the chaos, doctors strive to heal the wounded

By Arifa Akbar in Rawalpindi

Danesh Aurangzeb’s greatest ambition is to hold a pencil and write his name. A few weeks ago, that seemed an impossibility for the six-year-old as he lay on the floor of his classroom in Balakot, his hands crushed beneath a concrete beam torn from the roof by the earthquake in Pakistan.

Rescuers who struggled for 24 hours to free him considered severing his hands to get him out alive. When he was taken to hospital in Abbottabad, doctors amputated two fingers and put him on a list for surgery to have both mangled hands removed.

He was spared that fate by a group of volunteer British surgeons who took time off from their jobs to travel to Pakistan to help relieve the suffering. Danesh was the first of scores of children whose limbs they would save.

Asad Syed, an orthopaedic surgeon from Bradford, said he was inspired to go to Pakistan after watching a news bulletin on the second day of the disaster. “It showed an orthopaedic surgeon in Pakistan, who sent a message to Britain saying, ‘I don’t want your pounds. I can’t put your pounds on my patients. I want your doctors’,” he said.

His story is typical of the nine doctors, including Waseem Saeed, a plastic surgeon from Leeds, and Amjid Mohammad, an accident and emergency specialist from Bradford, who travelled to the disaster zone. They were shocked by huge numbers of amputations performed in the immediate aftermath of the earthquake and say that many could have been prevented with greater expertise.

Pakistan has only 65 plastic surgeons, said Col Mamoon Rashid, from the Combined Military Hospital in Rawalpindi, who is providing care for Danesh. And none of them was in the northern territory of Azad Kashmir when the earthquake hit.

The British doctors have been forced to return to the UK after running out of holiday allowance and are seeking government support to get back to the earthquake zone. The Pakistan High Commission has appealed to the Department of Health in London to release the medical specialists from their NHS commitments but have so far been rebuffed.

While the wrangling goes on, hundreds of other earthquake victims are going without the specialist care that saved Danesh’s hands. Critics of the international response to the crisis have pointed to the refusal to expedite the British doctors’ desire to return to voluntary work in Pakistan, as typical of the inefficient and parsimonious approach of donor countries.

Patricia Hewitt, the Secretary of State for Health, has declined to intervene. A spokesman said it was up to individual hospital trusts. “The decision to release staff from their NHS duties to help in circumstances such as these, including those who have volunteered, rests with individual NHS organisations,” he said.

“Trusts are independent organisations and the Department of Health doesn’t employ NHS staff directly so cannot make decisions around terms of release.”

Mr Syed, who works at Bradford Royal Infirmary, is appealing to the Government to donate funds towards setting up an artificial limb centre in Pakistan, and said he was keen to return to the region next month to continue giving emergency medical relief.

St James’s University Hospital, where Mr Saeed works, donated essential surgical materials to the group of doctors, and the doctors wives’ collected funds from the wider community to finance the two-week trip.

Among the group of children who they successfully managed to take off the amputation list in Abbottabad was Imran Abid, eight, whose leg was saved. His father, Abid Hussain, 34, walked with his injured son on his shoulder from their ruined home in Muzaffarabad to Abbottabad, only to be told that his son would face an amputation. “I was so upset when I heard,” he said. “I was desperate about my son keeping his leg. When the English doctors told me his leg could be saved, I was so relieved and happy.”

Another injured child, Javeria Afzal, seven, was also taken off the amputation list. Her leg had been buried in rubble at her wrecked school in Balakot. Her mother, Shagufka Afzal, 27, wept as she told of her daughter’s trauma and the effort of the British surgeons. “They came like saviours,” she said. “I am so pleased my daughter will be able to walk again.”

Samiera Ajmal, a doctor in Pakistan who was the first plastic surgeon to reach Abbottabad and worked with the British team, said that when she arrived, many limbs had been amputated in the rush to save lives, but any damage had been “inadvertent” due to the limited specialist expertise of the doctors there.

Mr Syed said the high level of amputations could have been prevented. “We operated on more than 100 patients who, in other people’s hands, would have had hands or legs chopped off,” he said.

The Red Cross is planning to set up a dedicated prosthetic centre in Muzaffarabad.