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Abstract of Emergency Rehabilitation Service Coalition Report Submitted to Mohp

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Abstract of Emergency Rehabilitation Service Coalition Report Submitted to Mohp Rehabilitation support to Storm Injured People in Bara and Parsa Date of Response: 7th to 19th April 2019 Physiotherapists of Naryani Hospital Conducting the Post Hospital Rehabilitation in Community Snapshot of the Rehabilitation Response 125 in the need received rehabilitation services. Out of 125, 71(57% received rehabilitation services from community. More than 50% of those receiving the rehabilitation in community were initially discharged from the hospital without ensuring any rehabilitation services. 130 assistive devices were delivered (Crutches, Braces, Walker, Walking stick and Wheelchair). 90 devices directly delivered to injured people and 40 handed over to the Naryani hospital for follow up cases. 86 follow up physiotherapy sessions have been conducted for severe cases Completed the line listing of cases receiving rehabilitation and handed over to Naryani Hospital physiotherapy department 68 people need physiotherapy for more than 3 months with atleast one follow up in a week. Rehabilitation service was delivered in government hospital, private hospital and all the affected community Rehabilitation service was delivered in coordination of local health emergency operating centre, local physiotherapists and health coordinator of municipality & rural municipality Introduction Two districts of southern Nepal, Bara and Parsa were hit by a deadly storm on the 31st March 2019. According to the statement from Health Emergency Operation Centre (HEOC) released on the 11th April, storm killed 28 people and injured more than 1110. The powerful storm destroyed local houses and trees causing injuries very similar to those caused by an earthquake. Of the two districts, Bara is the most affected where the largest health facility is only a government district hospital with no surgical and rehabilitation facilities. Storm affected all group of population from children to people with disability, pregnant mother and elderly people. The Birgunj city of Parsa district has a tertiary government hospital plus some private hospitals with provision of surgical as well as rehabilitation facilities. As a consequence, the most severely injured (both Parsa and Bara districts) were brought to Birgunj city for medical treatment. Nepal Physiotherapy Association (NEPTA) requested one of its members for an initial need assessment which showed that fracture and soft tissue injury as the most common injuries. These types of the injury needs rehabilitation service right from the first day in order to ensure wound healing, to prevent disabling complication and to enhance functional activities as early as possible. Map of storm affected districts (Source: National Emergency Operation Center), Source WHO Nepal 1 Ministry of Health & Population (MoHP) and Leprosy Control & Disability Management Section (LCDMS) of Epidemiology & Diseases Control Division (EDCD) identified the unmet need for rehabilitation services for storm injured people in Bara and Parsa Physiotherapist of Naryani hospital, Birgunj expressed the high need of physiotherapy in storm affected district that was also recorded in a health emergency meeting minute held in Naryani Hospital MoHP assigned Humanity & Inclusion (HI), National Disabled Fund (NDF) and Nepal Physiotherapy Association (NEPTA). Coalition (annex 1 &2) of these organizations has delivered rehabilitation services both at hospital and storm affected communities. Functioning of this coalition was guided by local Health Emergency Operation Centre (HEOC) Birgunj, Central HEOC and EDCD that means rehabilitation service is being delivered through one door system of MoHP and its local entities. Services offered: Physiotherapy and Assistive devices (Mobility aids and braces): fitting and user training. Framing rehabilitation service delivery to the local need: Guided by need assessment that was jointly done with multidisciplinary local health team on the 9th April 2019. Coordination for the patient appointment was done through local health coordinator of rural/municipality who is requested to show person in limb cast, implant or with soft tissue injury to be benefited by rehabilitation services. In addition, door to door case hunting was jointly done with health coordinator or person assigned by him/her on the most affected areas Areas covered: Hospital based rehabilitation on Naryani hospital, National medical college, Birgunj health care, LS neuro hospital and Gandak hospital. Community visit to identify and manage the injured people on Bara district- Pheta, Gadhimahai , Subarnapur, Parsauni, Parwanipur, Kalaiya municipality and Pachrauta and Devtal In Naryani and private hospital rehabilitation was done in leadership of their own physiotherapist while response team was providing the back up support and assistive devices for the early ambulation/mobilization of patients. 2 Aligning to the local health system Participated & reported on all meeting facilitated by health emergency management centre Provided Humanity & Inclusion vehicle and rehabilitation human resource for health related need assessment (rehabilitation embedded) of affected community conducted by local Health Emergency Operation Centre Collaborated with the physiotherapist of existing hospitals to ensure rehabilitation in his/her ownership Conducted the joint rehabilitation and psychosocial (TPO) field visit in community using HI vehicle Worked in synergy with physiotherapists (Annex 3) of Naryani hospital for the handover of rehabilitation service 3 Preparation adopted for the handover of rehabilitation services o A request letter (Annex 4) was forwarded to medical superintendent of Naryani hospital for mobilizing its 4 physiotherapists both in hospital and in community for the rehabilitation of storm injured who were already discharged. o Medical superintendent has written the formal instructive letter (Annex 5) to physiotherapy department in charge of Naryani hospital to ensure the follow up rehabilitation of injured living in community o On the 17th of April, the health partner meeting of DPHO Bara has also decided to request one physiotherapist to Provincial government and Epidemiology & Diseases Control Division. Handover to the physiotherapist of Naryani Hospital (18 & 19 of April) Meeting with the team of Naryani hospital physiotherapist was facilitated to debrief the need of rehabilitation of injured survivor discharged to community All line listing of cases who received first level of rehabilitation was explained and handed over (individual client assessment sheet, trauma summary sheet of municipality/rural municipality and client database) to Naryani hospital physiotherapy department Jointly two community field visits were conducted with two physiotherapists of Naryani hospital in order to orient the scenario in community and how to work in coordination with health coordinators of rural /municipality Essential assistive devices that might be required in coming days for the injured survivors was also formally handed over to store of Naryani hospital (annex 6 and annex 7) It has been explained to Mr. Uday Mishra (Naryani hospital, physiotherapy team lead) that any extra support need for rehabilitation in coming days should be immediately formalized to medical superintendent then to concern provincial and MoHP entities Based on the number of injured needing rehabilitation services, Naryani hospital physiotherapy team plans a field visit to 3 clusters in Bara: Pheta, Subarana + Pachrauta +Devtal, Parsauni+Parwanipur. A team of two physiotherapists will have a community visit in a vehicle arranged by the Naryani Hospital. 4 Rehabilitation service pathway for community jointly agreed with PT team of Naryani hospital Pertinent issues and recommendations Disaster help desk is required in Naryani Hospital to guide follow up cases. Clear linkage of this desk needs to be created with social service unit which has mandate to coordinate the care for disaster injured A clear consensus needs to be made regarding where the disaster injured case should be sent for the follow up from the community. Especially for those who have received the first level of intervention from private hospital. Dressing should be arranged near to the location of most affected areas. All the injured survivor might not be able to reach the health facility for follow up The need of rehabilitation in terms of intervention time might increase after the removal of cast and implants because it needs more time to mobilize the stiff joints. This might call the back up support to physiotherapy team of Naryani hospital. Bara district hospital is closer by the affected communities where injured people will go for follow up. However, there is no physiotherapy department on this hospital at present. It is also important to depute one physiotherapist in Bara hospital who should work in close coordination with the physiotherapist of Naryani hospital (hub) and also 5 can provide the back up support to rehabilitation team of Naryani hospital. A partner and government health staff meeting held in Kaliya hospital has identified this need.(Annex 8) The backup support needs of Naryani hospital physiotherapy team should be time and again reviewed at the Naryani hospital, provincial and EDCD level. A government focal person with rehabilitation profile needs to be deputed at provincial level and MoHP/DoHs level for the surveillance of rehabilitation work going at storm affected areas. The surveillance information should atleast cover; Rural/ Municipality, Name of Patient, intervention
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