Editor’s note: The International Reporting Project is an organization that supports journalists on travel fellowships, often focused on matters of aid and development. This year, IRP fellows went to Nepal to report on the country’s efforts to improve health. Melody Schreiber, program manager for IRP, describes how the trip agenda shifted violently – and how our focus will need to be shifted back again to Nepal’s long-term recovery.

By Melody Schreiber, special to Humanosphere

Last Sunday morning, after the first night of camping outside in Kathmandu, I woke up to storm clouds overhead.

The man a few feet away didn’t.

Like many other guests at our hotel, we heeded the Nepali government’s warnings about aftershocks, and we spent the chilly night huddled on the ground or on makeshift beds, searching for sleep.

Waking after fitful dreams, I saw a woman running to a prone figure nearby. She administered CPR and checked his pulse—nothing. He was pronounced dead of an apparent heart attack.

That’s when it hit me: I had survived the earthquake. Surviving the aftermath is a different matter.

If I succumbed to Kathmandu’s legendary air pollution and had an asthma attack, or if my taxi was in a car accident, or if I drank tainted water—I was on my own. If I could make my way to one of Kathmandu’s six chaotic hospitals—via roads blocked by rubble and debris—perhaps I could find care in time among all of the other sick and dying. Perhaps.

When an already-strained health system is buffeted by disaster, everyone suffers. As the chart below shows, from a Global Burden of Disease profile of Nepal, health indicators are poor.

Economists have already predicted that the quake may have set Nepal’s development back by a decade. In a country already teetering on the edge, such a disaster has long-ranging and widespread effects.

Nepal is one of the poorest and least-developed countries in the world. Even before the quake, the numbers were stark: One-quarter of the population lives under the poverty line. One-quarter of the economy is supported by remittances from migrant laborers abroad.

Two-thirds of Nepalis don’t have access to safe drinking water. Two-thirds don’t have access to toilets and basic sanitation. There are twenty-five hospitals in the entire country, and all of them scramble for resources, even under normal circumstances.

“The Ministry of Health and the whole health sector was not adequately prepared,” says Sushil Baral, executive director of Health Research and Social Development (HERD). “In the absence of strong health systems, it’s unthinkable to provide health services.”

Now Baral is urging the government to prepare for possible outbreaks throughout the country: swine flu, diarrheal disease, respiratory diseases and infections.

“This has taught us how prepared our health systems are,” Baral says. “If the system cannot cope with 10,000 seeking treatment, one can question our preparedness.”

“This is a call to reform the health system.”

“The Ministry of Health and the whole health sector was not adequately prepared.”

For the last five years, Dr., a medical educator and neurologist at the Tribhuvan University Teaching Hospital, has tried to establish a policy for deploying medical professionals to rural areas in times of tragedy.

“Those who learn, serve. Those who serve, learn,” he says.

Currently, the staff at Tribhuvan don’t serve officially—there’s no policy in place for how they may apply their knowledge.

“If it had been working properly, so many lives could have been saved,” Agrawal says, his voice heavy with regret.

Malku Tamang, 70, was living in a tiny village called Bhalje in the Nuwakot district. Bloody gauze circles the crown of Tamang’s head, and her right wrist, broken, hangs limply; she’s waiting for a cast.

“The whole of her house collapsed into her,” says her granddaughter. Tamang was rescued within half an hour, but there was no vehicle in their village.

“They cried out for a whole day for her rescue,” the granddaughter says, trying to attract the attention of helicopters circling the rural areas, looking for the wounded. Finally, a military helicopter brought the injured woman to Tribhuvan University Teaching Hospital.

Now that their house is gone, Tamang’s entire family is living in a makeshift tent. They don’t know what’s next. Whatever they do, they’ll be starting over from nothing.

Like so many other disasters, the quake has disproportionately affected the poor. Of course, Nepalis from all walks of life were affected—both physically and emotionally—and that damage is not to be diminished. But houses made out of mud or cheap materials crumple quickly, and those scratching out a living in poverty are left with even less than before.

According to the Nepal Risk Reduction Consortium (NRRC), more than 70,000 homes were destroyed and another 530,000 homes damaged across the 39 affected districts in Nepal.

“This has been a good lesson for us,” says Bigjan Raj Sharma, chief of police of the Kathmandu Valley. “We are not prepared for this level of disaster.”

Aryal, the chief of police for the entire country, sees this disaster as an opportunity to do better in the future. “It’s time to prepare,” he says. “It’s time to train more people for disaster relief.”

“What has happened has already happened,” Aryal says. “But we must prepare for the future.”

Such plans could help strengthen hospitals and other necessary infrastructure that the country so desperately needs—that it needed, in fact, long before the earthquake struck.

But if these funds are directed only toward disaster relief—more helicopters, more search and rescue teams, a stronger military to coordinate the efforts—Nepal will only sink deeper into its systemic health and development issues.