1. EARLY DISASTER REHAB RESPONSE : NEPAL 2015 EQ LESSONS LEARNT IN THE FIELD Professor Taslim Uddin, MBBS, FCPS Faculty of Medicine: Dept of PMR BSM Medical University, Dhaka-1000. Bangladesh Email: taslimpmr@gmail.com

2. Introduction FMTs working onsite at the ground immediately after the disaster have multiple challenges that needs to be notified for future reference Bangladesh FMT Nepal EQ2015 disaster Rehab Response : in-depth and Challenges

3. EARLY DISASTER REHAB RESPONSE: NEPAL 2015 EQ: Bangladesh FMT Process Initial planning, fund raising and FMT organization Process of FMT registration International, disaster affected country and local health center Communication : very promising and really required

4. Planning meetings and Mission needs assessments FMT accreditation by WHO and MoHP Nepal

5. Nepal, Ban, India (SAARC countries) : Geo-location

6. Bangladesh FMT in Nepal EQ Dr AMS Maharajan Dr Jas B Gurung, Dr Raju Dakhal Mrs. Sheela G Dakhal

7. EARLY DISASTER REHAB RESPONSE : NEPAL 2015 EARTHQUAKE LESSONS LEARNT IN THE FIELD: inputs for Do, and Don’t’s Huge inputs, links with varied suggestions; professionals with earlier experiences Do,s and Don’t,s in the field made easy access to Nepal Disaster Rehab

8. FMTs worked in Nepal Earthquake ( A section of ?128 FMTs) Medical Emergency Response Team (MERT) Bangladesh Association of Physical Medicine and Rehabilitation Medical Help World Bharatiya Jain Sanghathan Mercy Malaysia CBM International Nepal Disaster and Emergency Medicine Centre for International Studies and Cooperation OATH Chandrajyoti Integrated Rural Development Society (CIRDS) Plan International Chiang Mai University Maharat Hospital Royal Melbourne Hospital ChildFund International … WHO

10. Musculoskeletal (MSK) and limb injuries literacy and Human development Index of the disaster affected community Most of the earth quake injuries (70%) both in the developed and developing countries are involving limbs and MSK ( Rehab FMT trained in MSK preferred to be deployed in EQ) SCI much less in the developed country disasters in the recent days References: 1. Orthopedics, October 2000; (23): 10: 1085-87 2.World J Surg. 2014:38(10): pp2543-50 3.MSK injuries following EQ: Published Online: February 11, 2015: doi: org/10.3920/978-90-8686-806-3_15

11. FMT Reporting/ attending meetings FMT keeping records and daily reporting : despite of the workloads and poor internet, Attending to other centers and MoHP for FMT meetings … roads,vehicles

12. Flights were off for days, Less spacious, damaged Kathmandu airport, waiting hrs to land the flights and getting the luggage : no second airport

13. Nepal EQ 2015: Bangladesh FMT activities Medical consultations indoors and OPDs Triaging and facilitating for step down cares preparing to receive the incoming patients Clinical round teaching and Health education Online tele-rehab Multidisciplinary professional clinical meetings for care, referral and discharge Meetings with local administration facilitating capacity building Psychosocial support to the health staff and patients

15. Patient received with limited/no information of surgical procedure Reports on polythene X -ray jacket

16. FMT Personal issues Residence : no building without a crack! Hundreds of aftershocks even in the middle of night Disruptions of electricity, internet problems of having safe water and food Transport : vehicles damaged, drivers injured

17. working station matters Shortage of essential health staffs Inadequate hospital beds with rehab equipments Shortage of essential supplies like urinary catheters /dressing material and pain medications Limited/lack of lab investigation/imaging tools with technicians/technologists

18. Rehabilitation Facilities Limited options for referral to other specialty/step down care / home discharge/community Rehab No centre for “medical rehabilitation under one roof”

19. Concerns of Rehab FMTs in the field: after shocks Earth quakeIntensity RSAfter shock Pakistan 2013 Kashmir valley : 24 September : 7.728 September : 6.8 Nepal 2015 Kathmundu Valley: ≥1200 25 April, 2015: 7.912 th June 2015: 7.3 (largest): 100? Deaths NZ 2010, Darfield September 2010: 7,1 minimal live loss and injury February 2011 - 6.3 Christchurch earthquake : 180 deaths6.3

20. “The poor to die” and the rich to escape: Majority of the damaged houses were stone/brick masonry structures with no seismic detailing, whereas the most of RC buildings were undamaged: university of Canterbury Eng Dept.

21. Other concerns: Infectious diseases One of the eight stool sample collected tested positive for vibrio cholera (other centre) ……WHO

22. Conclusions Improvements in Nepal EQ FMT accreditation compared to previous earthquake Rehab Disaster Response Very useful international linking and professional inputs in the real time We need to be prepared to face the next natural disasters that going to strike (where / when)..Taiwan..then??

23. Acknowledgements Dr Jim Goseny for continuous support, Dr Fary Khan for kind oversee Committee for Rehabilitation Disaster Relief ISPRM BAPMR and BSMMU SAARC Rehab Forum and Dr Farooq Rathore SIRC Nepal AOCPRM2016 President Prof Raynald Rey

24. Recommendations 1. FMT deployed for medical Rehabilitation as an Early responder needs special attentions and training on specific areas. 2. A data base of disaster rehab experts who can be mobilized as FMT on a short notice is required 3. FMT trained in MSK rehab should be preferred to be deployed in the field as early Rehab responder 4. Development of working guideline for smooth functioning of rehab FMT

25. Ms Valerie : known as the Mother Theresa of the paralyzed HE presenting ASCoN Star Award in recognition of her hard work and dedication to those with spinal cord injuries everywhere

26. Welcome Nepal PMR: Nepal EQ is the turning point like the World War injuries for the PMR in the US/UK mmm