Rehabilitation Disaster Response: Focusing Cyclone SIDR and Savar Building collapse Taslim Uddin Physiatrist and Professor of PMR BSM Medical University, Dhaka. Bangladesh Member, ISPRM Disaster Rehab committee

Introduction Amputations, TBI, SCI, bone fractures are the major problems requiring attention to Medical Rehab professionals Disasters commonly leading to huge onslaught of injuries giving these injuries can be better managed by Rehab team Disaster Rehab Response is a rather newly introduced subject we Need to know more about it Ref: Glob Health Actionv.4; 2011:PMC , Published online 2011 Aug 16. doi: /gha.v4i0.7191

Concern for Disasters : Bangladesh Thickly populated country Poverty Political instability, Poor health sector infrastructure and less health budget Few PRM Disaster movements / Rehab Doctors

Total land area of 147,570 sq km, It is a low-lying country Population: million, with 1,021 people living per square km No. of registered physicians: 64,434 No of Physiatrists : 95, Physiotherapists: ?? No. of physicians per 10,000 population: 3.0 GOV Bangladesh, BMDC, DGHS: 2013

Cyclone SIDR: 2007 Nov, coastal Dist: Bangladesh…………………

Cyclone SIDR: pattern of injuries: N: st conf of AOSPRM proceedings Nanjing, China 2008, J Rehabil Med 2008,suppl 46;124 Nature of injuryPercentage Minor58% Chest injury15% Limb injury13% Abdominal injury10% Spinal injury1.1% Head injury

Rehab Response - post disaster : Medical Teams Primary focus on Medical rehab Services Teams: (volunteer) – Physiatrist – PT – Social worker

Savar (Rana Plaza) Building collapse:2013 the worst workplace disaster

Savar (Rana Plaza) Building Collapse Death :1129 (in the spot and in Hospital) Injury: 2224 ( WHO, 2013 ) number of workers at the time of collapse: time of collapse: am Analysis of 61 cases admitted to NITOR Age : 15 to 50 : mean 26.5yrs : Sex: 15 male : 45 female Injury: limb fracture, soft tissue injury, spinal injury (4), Amputee(3) Outcome: SCI (paraplegia) discharged home, Amputee : provided prosthesis Courtesy : Dept of PMR, NITOR

Amputee : UL and LL

Hospital/clinics offered injury patients Enam medical college hospital; 1000 NITOR New deep clinic 33, Rose clinic-63 Prime diagnostic and consultation center 30, Shima general hospital Savar upazila health complex 30 Deep clinic and hospital 20, Lab john unit 1, unit 11; 26; 21 Rezia, sheba, mukti: 31 Others : CRP, CMH SAVAR, DMCH, NHF, BSMMU a skbd.org;uploads 2013/11

Out come Distribution of relief items and medications Specialist rehab consultation/referral Physiotherapy Training to the general people Training to Religious leaders as the early responders Reporting

Type of Rehab Response/Funds Response: Intermediate/subacute (~3 days – 12 weeks) Funds – Medical supplies: donations from friends/families/pharmaceutical companies – Personal expenses : self funding – Had proposals from IRF, ISPRM and Indv Members: we could not take it because of cumbersome procedure of money transfer

Lesson's learned Physiatrist can better manage the disabilities resulting from disaster trauma: as team leader in the field and thereafter Timely rehabilitation interventions for SCI, TBI, MSK trauma and Amputee can effectively reduce the disability intensity We need to work in a better team and organized way

Recommendations Form a disaster medical rehab response Team: leader, PT, OT, Plaster technician/orthotics/ Nurse/ Social worker Fund: PMR Society liaison with national Budget, Donations Development of education/training course for PRM disaster responders

References/acknowledgements ISPRM Committee on Rehabilitation Disaster Relief (CRDR) NITOR (Prof Habib), WHO2013 askbd.org; uploads 2013/11 Gov of Bangladesh, DGHS, BMDC, ISPRM news and Views 1 st. AOCPRM conference Nanzing IRF Jim Gosney, Farooq Rathothore, Tom Haig