The MSF team which has been in the hardest hit area of Nepal, the Ghorka District, is bringing in surgical reinforcements to help with the injured there. The Gorkha District Hospital suffered significant damage from the earthquake with the in-patient department destroyed. On Wednesday a truck carrying a rapid surgical intervention kit left Kathmandu for Ghorka (200km north-east) as the road has been re-opened. A surgical team is also on their way to set up and begin responding to surgical needs from the surrounding area.
 
MSF has been assessing the needs and capacity in four hospitals in Kathmandu, with a focus on trauma and nephrology departments to understand the capacity to deal with 'crush syndrome'. That is the condition which threatens the renal system of people who have been buried under heavy rubble. Generally these hospitals are overstretched after dealing with influxes of wounded following the earthquake, but also trying to continue to deal with regular patients with chronic illnesses. Kathmandu Teaching Hospital has been receiving an increased number of patients requiring dialysis - mostly chronic rather than people with crush syndrome - coming from other hospitals. There are currently 200 patients on their list needing dialysis and they are utilising 8 machines to meet the demand. MSF made a donation of wound-dressing kits to two hospitals and is looking into options for supporting specific hospitals in Kathmandu according to the need. 
 
Another MSF team has been at the Tudikhel makeshift camp in the centre of Kathmandu. The water and sanitation situation is concerning, with people having limited access to clean drinking water and the public toilets overflowing. Currently a team of doctors from Bir hospital (located opposite the camp) have set up a makeshift consultation area and are managing primary health care needs. Many of the people in the camp are from in and around Kathmandu, but there are also a number of migrant workers who can no longer stay in the temporary accommodation they normally stay in in the city. As well there are others in the camp who have come from outside Kathmandu after their villages were destroyed in the earthquake. MSF is looking into the water and sanitation situation in the camp urgently. 
 
A similar situation faces people in the makeshift camp in Bhaktapur (40km east of Kathmandu), where more than 1500 people are staying. MSF is again preparing to work on the water and sanitation issues because people are having to collect rain water and they lack latrines. The team also donated dressing and first aid materials to the hospital in Bhaktapur. 
 
MSF currently has 61 staff members in Nepal with more specialists and medical kits on the way.
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