1. Rehab in Natural Disasters : Focusing South East Asia Regional Cooperation Taslim Uddin Physiatrist and Professor of PMR BSM Medical University, Dhaka. Bangladesh Email: taslimpmr@gmail.com

2. Back ground Significant advances have been made improving health & QOL outcomes for disaster related injuries However, the advances have not impacted on majority pts because of unequal opportunities More, this disparities are compounded when a new disaster strikes.

3. Introduction Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the years Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries(TBI), spinal cord injuries (SCI), and long bone fractures New approaches, cooperation's and collaborations have been suggested in Medical Rehabilitation in natural Disasters. Ref: Glob Health Actionv.4; 2011:PMC3160807, Published online 2011 Aug 16. doi: 10.3402/gha.v4i0.7191

4. Concern for SEA Disasters Thickly populated countries Poverty Poor health sector infrastructure and less health budget No or few PRM professionals Less attention in the specialty by the stake holders and less organized PRM leaders

5. SEA Cooperation in Disaster Rehab 1. Huge potentialities exist in the regional cooperation of disaster rehab management at south Asia and SAARC region 2. Regional leaders can handle the problem better

6. Disasters: Bangladesh J Rehabil Med 2008,suppl 46;124 Cyclone SIDR: 2007 Nov, coastal Dist – No of injuries: 14, 649

7. 9.1 mag. Tsunami 2004, 230,000 dead, 500,000 injuries: 14 countries Unconfirmed source

8. Recent EQ :Death and injuries Ref: spinal cord 2013, Rehab cluster 2015. Pakistan (kashmir valley) 2005 India (kashmir valley) 2005 China 2008 Haiti 2010 Nepal (Kathmundu valley) 2015 Death/ injury 733381360875642225708000 plusDeath 128309630036841230000021,925Injury

9. Nepal EQ 2015: Rehab concern Total Injury: 21,925 (26/5/15) in both earthquakes. 1,500 - 2,000 with ongoing nursing and rehabilitation needs 70% of injuries are factures Amputee : 40-60 Spinal cord injury 200-300. Ref: WHO, HEOC, FMTs, Rehab cluster

10. Nepal EQ 205 value of early and frequent communication among several experts across the world Individuals: Asia spinal society International society, eg HI National PRM Societies Regional PRM societies ISPRM Huge inputs, links with varied suggestions; earlier experiences and Do,s and Don’t,s in the field in disaster rehab made easy access to Nepal Disaster Rehab

11. . FMT Registration: BAPMR reported on 30th April 2015 SIRC and others doing Spinal rehab: turned to acute care Hospital Military Hospital and others doing Amputee Rehab

13. Onsite Early Rehab Response: Nepal EQ Onsite early Rehab responders face challenges and dilemmas that are often quite different than those encountered at home

14. After 12 th May 2 nd EQ, SIRC is currently treating many more patients than it was designed to cope with Nepal quakes: Treating the spinal injured, www.bbc.com/.../blogs-ouch-32847101: British Broadcasting Corporation: May 26, 2015. retrieved on 6 th June 2015 ( produced with kind permission)

15. Bangladesh Rehabilitation FMT [6-11 May 2015] 240, Patient consultations IPD,OPD Psychosocial support Health education Online tele-rehab FMT meeting participation

16. Important! The role of members sharing multiple memberships at ISPRM, IRF, AOSPRM; ISCoS and disaster committee and AOSPRM.

17. Physiatrist in Nepal : wait another year or more to get the first physiatrist: very promising and committed personnel No PMR society Good Spinal injury rehab center:www.sirc.org.np) CP and pediatric rehab center, Military Rehab and orthotics and Prosthetics

18. Concerns of Rehab FMTs in the field Earth quake intensity RS After shock Pakistan 2013 Kashmir valley 24 September : 7.728 September : 6.8 Nepal 2015 Kathmundu Valley 25 April, 2015: 7.912 th June 2015: 7.3 (largest)

19. Value of Early Rehab in Disaster Response Medical rehabilitation of SCI pts in Pakistan, China and Haiti EQ resulted in reduced hospital length of stay, better functional outcomes, and reduced medical complications. __________________ Arch Phys Med Rehabil. 2008;89:579–85 J Rehabil Med. 2012;44:200–5 J Rehabil Med. 2012;44:534–40 Disabil Rehabil. 2010;32:1616–8.

20. Important ! ________________________ Poor disability and Rehab statistics Reporting lack of research in PMR and other physical disabilities Few disaster rehab reporting

21. The emerging specialty of disaster rehab and the work being done ________________________________ Most useful international linking Publications Collaborations

22. Plus advantage _________________________ Many members of the ISPRM disaster rehab committee are from this region and have contributed towards the knowledge data base of disaster rehab Farooq Rathore is the leader : publications and communications

23. The need to integrate PMR in the disaster management plan at __________________________ Society and Institutes National International level

24. SAARC and other Regional cooperation initiatives.

25. ASEAN Association of Southeast Asian Nations (ASEAN) developed during 1967 Objectives are to promote regional economic growth, political stability, social progress, and cultural developments. REF: D. J. Steinberg, ed., In Search of Southeast Asia (rev. ed. 1987).

26. SEA: SAARC SAARC nations comprise 3% of the world's area and contain 21% (around 1.7 billion) of the world's total population South Asia home to nearly 42 percent of the world’s poor people Political, religious, ethnic, and linguistic diversity differences made the region one of the most disadvantaged areas in the world. Communication and accessibility means are very poor. Ref: Harvard Asia Quarterly Summer 2013, Vol. VX, No.2: 37- 45

27. SEA and SAARC: regional locations

28. ‘ SAARC “ idea of regional cooperation : coined during 1980 by Bangladesh President Ziaur Rahman with following countries Active Members: Afghanistan Bangladesh Bhutan India Maldives Nepal Pakistan Sri Lanka Observer members : Myanmar China EEU Japan Korea USA

29. Rehab in the Region Absence of a PMR society in most of the SAARC countries and small number of physiatrists for a large number of populations This was raised during 2 nd IRF world Conference held in Dhaka : Thnx IRF

30. Challenges 1. Clearly cooperation in disaster rehab is lacking 2.Mutual cooperation, data and experience sharing, exchange visits and online collaborations 3.Others

31. Following established regional organizations can be involved Networking at national PMR/personal level National PMR societies/ forum SAARC treaty including the SAARC Rehab Forum ASEAN community AOSPRM WHO SEA regional committee

33. The SAARC Rehab Forum is a Google Group. Online interactive forum for Rehabilitation Medicine Physicians working in South Asia Aim is to share knowledge, exchange ideas, develop PMR in South Asian region, Strengthen the academic programs and share opportunities for scholarship, training and collaborative research. Ultimately producing quality leaders in PMR It was formed after a brain storming session at the 2nd IRF Conference and BAPMRCON conference in Dec 2012. Dr Farooq Rathore from Pakistan was the moderator of the group. Current membership stands at 30 PMR physicians and residents from Bangladesh, India, Pakistan and Nepal ( Including one member from UK -- Dr Sakel)

34. Pakistan, Bangladesh, India, Srilanka, Nepal and others 2 nd IRF World Conference 2012: PMR leader making machine

35. Pioneer meeting of SAAC Rehab Forum

36. Rehabilitation Disaster Relief ISPRM Committee on Rehabilitation Disaster Relief (CRDR), a standing ISPRM committee which also collaborates with the WHO Liaison Committee on WHO disaster-related disability initiatives. Mission: To provide technical resources for optimizing the health, functioning and quality of life of persons who sustain injuries or impairments due to a large- scale disaster.

37. . The ISPRM CRDR has stated that disaster rehabilitation is an emerging subspecialty within physical and rehabilitation medicine (PRM)

38. Conclusions South Asia needs more attention because of its backwardness in many areas of disability movement A data base of volunteer Physiatrists urged to be maintained by National PMR society, AOSPRM, ISPRM and their move should be facilitated National PMR societies and the Gov of the country can be oriented regarding the opportunities and the challenges of Disaster Rehab specially on Early response

39. Acknowledgements ISPRM Disaster Rehab committee Jim Gosney, Farooq Rathore, Farry Khan, Raju Dhakal, Andrew Haig, Sakel MO, Peter Wing, Claire IAPMR, IRF, SIRC, AOSPRM, WHO/MoHP -Nepal/UK-EMT/HI Injury Rehabilitation Sub Cluster

40. A good news to share