1. Disaster management and preparedness
Bhagawan koirala
Professor, IOM, TU

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

3. 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

4. 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

5. Difficult rescue

6. Difficult rescue/ poor knowledge of patient transport

7. Difficult rescue/ poor knowledge of patient transport

8. 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

9. Acute phase

10. Acute phase

11. Acute phase

12. Need for open space

13. 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

14. 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?

15. 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?

16. Private hospitals

17. 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

18. 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

19. Facilitate rescue Open space in villages
Community spaces plus rescue spots

20. Step 1 and 2 of preparedness

21. Step 3 and 4

22. Step 5 and 6

23. 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

24. Chautara hospital

25. Step 7

26. 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

27. Current focus
Government
NGOs
Individuals
Academia

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

29. 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