International collaboration in rehabilitation disaster relief

James Gosney MD MPHChairman - Committee on Rehabilitation Disaster Relief (CRDR)

International Society of Physical and Rehabilitation Medicine (ISPRM)

Symposium – ‘Disaster Rehabilitation’

JARM 52nd

Annual Meeting (JARM 2015)Niigata, Japan May 29, 2015

2015 Nepal Earthquake

Table 1: 2015 Earthquake in Figures Daily Situation Update Report (DSUR) [20 May 2015]

• Richter scale (25 April 2015) - 7.8 • After shock Richter scale (12 May

2015) - 6.8• Districts intensively monitored from

HEOC/MoHP - 15 • Deaths - 8622 • Houses damaged - 757,253 • Public HFs damaged fully - 456 • Public HFs damaged partly -

690 [MoHP]• Major surgeries done - 2000 • Psychosocial counseling - 5324• FMTs in field/districts - 50 • Total persons in FMT - 1,169

Ministry of Industry (MoI), Ministry Of Home Affairs (MoHA), Ministry of Health and Population (MoHP)

• Critical patients triaged through airport - 442

• Dead body received - 8,622• Dead body handed over - 8,586• Health workers’ death – 9• Health workers injured - 63• Health workers’ missing - 2• FCHVs’ death - 10• Districts with temporary hospitals - 7 • Temporary hospitals in operation - 11 • Amount disbursed & spent by MoHP

(63037000 NR, 75487921 JPY, 620126 USD)

Government of Nepal(GoN), MoHP, Health Emergency Operation Center (HEOC), Kathmandu Nepal

Health Sector Response: Overview [DSUR; 20 May 2015]

. First earthquake response meeting convened on 12th Baisakh at 1pm and HEOC activated

. Hubs within Kathmandu valley activated

. High level committee formed

. Central team formed and mobilized

. District teams mobilized

. Outbreak surveillance established and operated

. Medical teams deployed

. Logistics support provided to districts and hospitals – medicine and other

. Health education and information center established and operated within HEOC

. Financial support provided to district health offices/district public health offices and hospitals (public and private)

. Hotline established (Toll free number: 1660 01 33 444)

. Daily Press Release intiated by MoHP

GoN, MoHP, HEOC, Kathmandu Nepal

Nepal Earthquake 2015: Humanitarian Response - Health [Situation Report #17 (21 May 2015)]

Needs:As of 21 May, the Ministry of Health and Population reports 456 health facilities are destroyed and 690 are damaged. Most of the damaged facilities are primary health care centres, village health posts and birthing centers.

There is a need to manage post trauma injuries, restore disrupted primary health care services and rehabilitate support for patients who are discharged from hospital.

Response:As of 19 May, 16,808 injured people, including 3,215 injured by the 12 May earthquake, have received treatment (1,962 of the injured have undergone major surgeries).

Gaps & Constraints:There is an ongoing need of tents for curative and maternity services for health facilities in all affected districts.

United Nations Office for the Coordination of Humanitarian Affairs (UN/OCHA) – Nepalwww.unocha.org/nepal; https://vosocc.unocha.org/Documents/att39454_pet8lx.pdf

Medical Team Deployment [DSUR; 20 May 2015]

National Medical Teams (NMTs)– Number: 47 (deployed through MoHP)

– Sources: academic institutions, hospitals, small group of self-organized individuals

– Specialty skill(s): surgical, medical, orthopedics, gynecologists, obstetrics, psychiatrists, and psychosocial counselors

– Mechanism: coordination with DHOs and district hospitals in affected districts to serve populations injured

Foreign Medical Teams (FMTs) – Number: 128 (38 countries); 50 (20 May 2015)

– Composition: 1,169 persons (429 doctors and 262 nurses)

– Mechanism: deployment to earthquake affected districts

Table 3. 5: Temporary field hospitals

District Location SupportDeployment/

Operation startdate

Operation end/departure date Remarks

Kathmandu Sinamangal Indian Army 27 April -

Extended after12 Mayearthquake. Some of the team members areworking in Dolakha

Nuwakot Bidur Qatar Crescent 03 May 30 July

Sindhupalchowk

Barhabise Japan, JICA 01 May 12 May

Now working at Dhulikhel hospital from 14 to 18 May

MelamchiCzech Republic 30 April 30 May

Japan Redcorss 01 May 01 July

Chautara Norway 30 April 05 Aug

Sipaghat (15 bed) Thailand 30 April 28 May

Kavre Dhulikhel Chinese Medical Team 04 May 21 May

GorkhaGorkha Swiss Team 27 April 30 May

Aarughat MSF France 30 April 01 Oct

Rasuwa Dhunche (50 bed) Canada 05 May 05 Aug

Dhading Salyantar Chinese Red Cross 08 May 30 May

Source: Health Emergency Operation Center (HEOC)

WHO FMT Registration Form FMTs planning to respond to the April 2015 Earthquake, Nepal

• Date/time of offer

• Country/Agency: Government (civilian or military), Non-Governmental (NGO)or International Organization, and country of origin

• Recent disaster deployment experience

• Recent disaster experience (related to earthquake in particular)

• Experience working in Nepal (and national partner organizations)

• Name, position and contact details of focal point Headquarters/Team Leader

• Type of FMT: Type 1 - outpatient care, Type 2 - emergency surgical care, Type 3 - referral level care, specialist cell capability

• Outpatient/inpatient/surgical capacity (per day)

• Length of stay

• Number of International staff/type: doctors, nurses, allied health personnel, logistics/operational support, administration/other staff

• Number of National staff and type required

• Time to deploy/be operational

• Agreement to comply with FMT guiding principles and standards: [http://www.who.int/hac/global_health_cluster/fmt_guidelines_september2013.pdf]

Adapted: http://www.who.int/hac/crises/npl/registration-fmt/en/

WHO FMT Coordination Meeting

Disaster rehabilitation continuum by time post disaster and stage

Adapted from Fig. 1. A suggested plan of rehabilitation interventions after a natural disaster in the article. "Medical Rehabilitation After Natural Disasters: Why, When, and How? Arch Phys Med Rehab Vol 93, October 2012.

Development and purpose: MoHP (Health Cluster Lead Agency), and the WHO (Health Cluster Co-lead) support formalization of injury rehabilitation as a sub-cluster for the response to the Nepal Earthquake. Coordination and operationalization of this rehabilitation sub-cluster is led by MoHP with a strategic group of key stakeholders directing the long term rehabilitation strategy.

Coordination meeting areas of coverage:

• Step Down / Rehab Beds inside Kathmandu: Aryuvedic Hosptial, Anandaban TLM Hospital, Spinal Injury Rehabilitation Centre, …

• District level rehabilitation: Green Pastures/INF, Gorkha District Hospital, Dhulikhel Hospital,…

• Community Based Rehabilitation/Identification of those injured in the community

• Amputee and P&O Update

• Equipment

• Government Plan for Rehabilitation Response:

– 3 stages: short, medium and long term rehabilitation response and capacity building

– 3 levels of support: Kathmandu, district level, and community-based services

– Considers staffing and funding required to meet current increased needs and to create a more integrated, sustainable, and multi-level rehabilitation sector for the future

– Disability focal point now established within MoHP (Curative Division)

Adapted: Injury & Rehabilitation Sub-cluster Situation Reports [11/22/25 May 2015]

Injury Rehabilitation Sub Cluster (IRSC)[WHO/MoHP/UK-EMT/HI]

Injury data extrapolated from published information from a leading orthopaedic hospital which has published surgical records whereby 79% of patients had fractures, 6 % dislocations, 4% fractures with significant soft tissue injury, 3% spinal fracture, 2% peripheral nerve injury, and less than 1% had amputations or spinal cord injury (IRSC Situation Report; 22 May 2015).

Diagnosis No. of patients Percentage

Fracture 339 69%

Wound 45 9%

SCI 30 6%

Unknown 27 5%

Head Injury 22 4%

Amputation 11 2%

Burn 4 1%

crush (without fracture) 7 1%

Stroke 2 0%

peripheral nerve 1 0%

Spinal Injury Rehabilitation Center (SIRC)Bangladeshi Rehabilitation FMT [6-11 May 2015]

• 240 patient encounters

• Psychosocial support

• Health education

• Training of junior rehab doctors & SIRC staff

• Online tele-rehab

Unconfirmed FMT exit report data

Spinal Injury Rehabilitation Center (SIRC)Australian Rehabilitation FMT [8-15 May 2015]

• 360 patient encounters

• Psychosocial support

• Training of junior rehab doctors & SIRC staff

• Triage & treatment protocol

• Supplies & equipment

Unconfirmed FMT exit report data

Role of ISPRM CRDR (to date)

CRDR leadership team:

• Assessed ISPRM policy for Nepal response

• Advised rehab FMTs on registration and reporting procedures

• Liased with IRSC on response issues including referral of FMTs

Individual CRDR members:

• Coordinated Australia & Bangladesh FMTs

• Implemented earthquake relief funds for SIRC

• Participated in SIRC online tele-rehab

Role of ISPRM CRDR (future)

• Establish formal ISPRM policy on rehab disaster relief with primary emphasis on education/training

• Development of ISPRM guide for rehab doctors in FMT leadership roles (ISPRM workshop, June 2015)

• Consultation on development of ’WHO Minimum Standards and Recommendations for Rehabilitation in Emergencies: Guidance Document for FMTs’ (first consultation, June 2015; completion, late 2015)– FMT staffing configuration

– Technical rehabilitation standards for all-hazard disaster

– Standards for rehabilitation in outbreak response

– Requirements for disability inclusive response and accessibility

– Requirements for deployment

– Patient assessment and data collection

– Referral and coordination mechanisms

– Rehabilitation equipment and resource requirements

– Research and development

Resources

Blog SCI Nepal (SIRC): http://spinepal.orthopaedics.med.ubc.ca/2012/03/16/blog/

Classification and minimum standards for foreign medical teams in sudden onset disasters. WHO. 2013.

GDACS Virtual OSOCC disaster information summaryhttps://vosocc.unocha.org/rss/vo_3299clvp.html

Guidance note on disability and emergency risk management for health. WHO. 2013.

ISPRM CRDR webpage: http://www.isprm.org/collaborate/who-isprm/rehabilitation-disaster-relief/

Trauma Protocols/Guidelines On Medical, Surgical and Rehabilitation Management of Expected Injuries during an Earthquake Scenario. Prepared as part of the ‘Enhancing emergency health and rehabilitation response readiness capacity of the health system in event of high intensity earthquake’ Project. European Commission Humanitarian Aid and Civil Protection (ECHO). 2011https://vosocc.unocha.org/Documents/att38967_4z9fxh.pdf

User friendly protocol/guidelines on post-trauma care in a large scale disaster scenario (amputation, open fracture, and spinal cord injury) 2013. ECHO. 2013

Acknowledgements

Australia Rehabilitation FMT

Bangladesh Rehabilitation FMT

Spinal Injury Rehabilitation Center (SIRC)

WHO/MoHP/UK-EMT/HI Injury Rehabilitation Sub Cluster

Arigatō!

HEALTH

REHABILITATION