Rehab in Natural Disasters : Focusing South East Asia Regional Cooperation

Taslim UddinPhysiatrist and Professor of PMR

BSM Medical University, Dhaka. BangladeshEmail: taslimpmr@gmail.com

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.

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

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

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

Disasters: Bangladesh J Rehabil Med 2008,suppl 46;124

• Cyclone SIDR: 2007 Nov, coastal Dist

– No of injuries: 14, 649

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

Unconfirmed source

Recent EQ :Death and injuriesRef: spinal cord 2013, Rehab cluster 2015

.

Pakistan (kashmirvalley) 2005

India (kashmir valley) 2005

China 2008

Haiti 2010

Nepal(Kathmundu valley) 2015

Death/injury

73338 1360 87564 222570 8000 plus Death

128309 6300 368412 300000 21,925 Injury

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

Nepal EQ 205 value of early and frequent communication among

several experts across the world

Individuals: Asia spinal society International society, eg HINational PRM Societies Regional PRM societiesISPRM

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

.

• 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

Onsite Early Rehab Response: Nepal EQ

Onsite early Rehab responders face challenges and dilemmas that are often quite different than those encountered at home

After 12th May 2nd 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 6th June 2015 ( produced with kind permission)

Bangladesh Rehabilitation FMT [6-11 May 2015]

• 240, Patient consultations IPD,OPD

• Psychosocial support

• Health education

• Online tele-rehab

• FMT meeting participation

Important!

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

• 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

Concerns of Rehab FMTs in the field

Earth quake intensity RS

After shock

Pakistan 2013 Kashmir valley

24 September : 7.7 28 September : 6.8

Nepal 2015 Kathmundu Valley

25 April, 2015: 7.9 12th June 2015: 7.3 (largest)

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.

Important!________________________

• Poor disability and Rehab statistics Reporting• lack of research in PMR and other physical

disabilities• Few disaster rehab reporting

The emerging specialty of disaster rehab and the work being done________________________________

• Most useful international linking • Publications • Collaborations

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

The need to integrate PMR in the disaster management plan at __________________________

• Society and Institutes • National • International level

SAARC and other Regional cooperation initiatives

.

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).

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

SEA and SAARC: regional locations

‘SAARC “ idea of regional cooperation : coined during 1980 by Bangladesh President Ziaur

Rahman with following countries

Active Members: Afghanistan Bangladesh BhutanIndiaMaldivesNepalPakistanSri Lanka

Observer members :Myanmar China EEU Japan Korea USA

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 2nd IRF world Conference held in Dhaka : Thnx IRF

Challenges

1. Clearly cooperation in disaster rehab is lacking

2. Mutual cooperation, data and experience sharing , exchange visits and online collaborations

3. Others

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

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)

Pakistan, Bangladesh, India, Srilanka, Nepal and others

2nd IRF World Conference 2012: PMR leader making machine

Pioneer meeting of SAAC Rehab Forum

• 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.

.

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

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

Acknowledgements

ISPRM Disaster Rehab committeeJim 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

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