Disaster management and preparedness Bhagawan koirala Professor, IOM, TU

The big one hits .. Ghantaghar stopped 4/25; 11.56

The scale of health issues 8792 deaths 22270 injured Psychological trauma Poverty, malnutrition Disease outbreaks Long term disabilities 61 districts affected (14 districts badly) 3 public Hosp, 12 PHCs and 417 HPs damaged private hospitals 16 completely damaged 64 partially damaged

Improving on the rescue and transport Educate the security forces and civilians on safe transfers Have spine boards in all choppers and ambulances Develop skills for ambulance staff for on site treatment

Difficult rescue

Difficult rescue/ poor knowledge of patient transport

Difficult rescue/ poor knowledge of patient transport

Acute phase Govt hospitals: triage/emergency treatment/outreach Private hospitals: triage/emergency treatment/ outreach camps NGO hospitals: triage/emergency treatment/outreach Other NGOs did relief works: food, shelter, outbreak prevention

Acute phase

Acute phase

Acute phase

Need for open space

Issues as I saw them Overall good work.. To be improved: Few limbs and life loss after admissions To be improved: Preparedness: hub hospitals/satellite centers Preparation of rosters ID for staff Prepositioning of logistics Simulation training: more frequent Trauma protocols: more uniform application

Issues as I saw them Alternate channels of Communication for hospitals Triage area: More open space Info management: dedicate non technical staff for record keeping Expert manpower: enough we have, but could use ex pats also Supply not enough: ? private shops in loop water supply: Deep boring: is power backed up?

Issues as I saw them Oxygen supply: plants in hospitals; or liquid oxygen. Fuel: Emergency stock should be a routine Power back up: in all the service areas and in Open space Staff on duty/ on call Food for patients, families and staff hygiene and sanitation for patients and families Volunteers: How do we have a standby team? Army? Police?

Private hospitals

Ensuring minimum standards in hospitals Infection prevention Minimizing complications Proper information sharing Timely intervention Expertise in selected fields: complex trauma/ Polytrauma/free flaps Acute and long term rehab

NGOs and Private Sector Hundreds of NGOs: ANMF- US/Nepal Karuna : Mission rebuild Hundreds of Private organizations FNCCI Thousands of individual volunteers Challenge of coordination between them

Facilitate rescue Open space in villages Community spaces plus rescue spots

Step 1 and 2 of preparedness

Step 3 and 4

Step 5 and 6

After the earthquake Outbreak control Psychosocial counseling Follow up treatment Physical rehab Institutional strengthening Rebuilding infrastructure Revitalizing Health Services Shelters/water/food/minimum personal items

Chautara hospital

Step 7

Current focus Acute phase relief activities in 42 locations Public health issues Physical and psychological rehab Institutional strengthening Govt facilities rebuilding Revitalizing disrupted health services

Current focus Government NGOs Individuals Academia

Revitalizing health services Providing additional equipment to HPs, networking, telemedicine Supporting district health system

summary Unprecedented devastation: generated a good sense of responsibility among Nepalese citizen, NRNs and ex pats as well. We need to look at our strength and weaknesses and try to fix them now A balanced approach of government planning, coordination, quality check combined with implementation work by govt itself and NGOs is necessary Should not just catch up but have to improve upon previous level of infrastructure and care