Sit Rep from Injury Rehab Sub Cluster: 09/06/2015

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1 Sit Rep from Injury Rehab Sub Cluster: 09/06/2015 HOTLINES Handicap International: (NTC) (NCell) or (provides advice and signposting to rehabilitation services including outreach, mobile teams and assistive devices) open 8am - 8pm IOM: Patient transport and step down within Kathmandu Open 8am -5pm Key Information: Up to 1,500 people with injuries who have long term care or rehabilitation needs amputees spinal cord injuries 36: number of spare beds in Kathmandu for step down patients 16: number of facilities in KTM valley providing rehabilitation services to earthquake victims 7: number of districts out of 14 most affected with current rehabilitation services Government Plan for Rehabilitation Response : Daya Pant, Disability and Rehabilitation Focal Point As mentioned in the last meeting and previous situation-report. This plan has been through thorough review processes in the last week by sub cluster members and stakeholders. It has now been proposed formally to the MOHP and the disability and rehabilitation unit are awaiting feedback. International organisations are invited to a meeting at the Leprosy Control Division on Wednesday 10 th June at 1pm, to identify which activities in the immediate injury rehabilitation plan they will support. Confirmed dates and venues for the upcoming workshops (to work on the medium and long term rehabilitation strategy) will be announced by the disability and rehabilitation focal unit as soon as possible, and disseminated via the sub cluster Please contact for further information.

2 Update from the Army Hospital and the Army Rehabilitation Centre The army hospital itself has been damaged severely by the 12 th May earthquake and almost all services are now operating from tents. In total they have treated approximately 250 earthquake cases. This includes 7 amputees (five lower and 2 upper limb) and 5-6 spinal cord injury patients. The army rehabilitation centre continues its request for large tents to be able to accommodate step down civilian patients. Earthquake Injury ID Card HEOC have developed and printed the injury identification card which will be issued to patients who have been injured in the earthquake, giving them access to free follow up services. This has yet to be rolled out within the facilities, and it is unclear as to what the exact process of issuing the card will be, but likely to be issued centrally from the MOHP itself. Questions raised by the sub-cluster members include: When and how will distribution occur? How is it ensured that the cards are signed by the hub director and HEOC? How are patients to be informed that they need a card? How long will patients be entitled to free treatment, and is rehabilitation certainly included with the card? The sub-cluster is currently liaising with the MOHP and HEOC to encourage the swift roll out of the process. In the interim, all professionals are reminded of the importance of gathering patient s information including telephone numbers on discharge so these can be followed up.

3 FMT group and rehabilitation teams As announced in the final FMT group meeting on Monday 1 st June - the FMT co-ordination cell is scaling down. It will continue to work with FMTs still operating, and will support existing teams. For new incoming rehabilitation teams the process is currently: 1. Ensure letter of recommendation from host organisation is scanned to 2. Complete FMT registration form, and send copies of professional registration and passports to FMT co-ordination cell. 3. Dr Krishna and his team at the NHRC building FMT room will continue to facilitate this registration process until the response by HEOC ends. Following this, it will be the Policy Planning and International Co-operation Division (PPICD) which will deal with registering new health professionals. Step Down / Rehab Beds inside Kathmandu Over the last 10 days, bed availability in the Kathmandu based step down facilities has decreased from 100 free beds to around 30. Both the rehabilitation professionals working on the ground, as well as IOM are finding it increasingly hard to place patients. Particularly patients without caregivers, patients with traumatic brain injuries and patients with co-morbidities. Cuban FMT now based at Aryuvedic Hosptial, Kirtipur. Currently less than 5 beds available for rehabilitation referrals, delay in expanding facilities. For referral please liaise with Zener Gonzalez Anandaban TLM Hospital, Laltipur offers nursing and rehabilitation step down. This has not be so well used as a step down facility due to its location in Lalitpur, but now patients are being encouraged to move there for the excellent rehabilitation services offered. They currently have 17 free beds for patient needing step down care. They will also accept patients who do not have carers, and who have co-morbidities. Please contact: Dr.Indra Napit (Orthopedic surgeon), Medical Director of Anandaban Hospital ( or ) Spinal Injury Rehabilitation Centre (Sanga) SIRC requested that facilities send the patients who are stable for transfer as soon as possible. Presently they have 106 patients. They are opening a 20 bed step down unit, but at present all 5-6 patients will be from the SCI unit, and then SIRC may be able to open these beds up to other patients. They take patients without caregivers. Please contact Nepal Youth Foundation: Report that they have admitted 142 people over all, and discharged 94. They have 48 remaining with their caregivers. They are only accepting patients with caregivers. Now that malnutrition is becoming more of an issue, they are having to balance their core work of nutrition rehabilitation with caring for injured people. Contact Lalit Gahatraj: or

4 Hope Hermitage, Lazimpat - will accept elderly, particularly vulnerable, unaccompanied people who must not have high rehabilitation or care needs, as accessibility in the building is an issue. Please contact Pramila Thapa : Patanjali Yogpeeth: Mandikhatar. Is now closing down and not accepting new injured patients. It is looking to move the longer staying patients to other facilities. Nepal Orthopaedic Hospital, in Jorpati has MSF-F supporting a 53 bed step down facility, which at present will only take patients from the hospital itself, or from other MSF facilities. They will let the group know if it will be possible to refer external patients soon. A discussion was had by all stepdown providers about some of the major problems arising with discharging patients appropriately: 1. The need for a centrally co-ordinated system of availability and list of criteria for each place Action : HI/IOM and UK-EMT to create a live document (posted on humanitarian response website) for all to refer to with current step down status (5 days) 2. Need to identify facilities that accept patients without caregivers Action : HI/IOM and UK-EMT to add criteria to the above live document 3. Many of these patients are difficult to discharge from the stepdown as they have no appropriate home to go to, shelter issues were raised multiple times. Action: IOM and HI will continue to record and feed shelter needs of injured people in to the shelter cluster. 4. The need for specialist rehabilitation services for traumatic brain injured patients, both immediately and in the long term. Any organisations able to offer this, particularly with the support of INGOs, please contact the subcluster. Spinal Cord Injury Working Group Contact: Esha Thapa : The SCI working group meets on Friday at 10am at the NHRC. The group shared some essential free online resources to the group (see attached presentation) which can be used by any of the multidisciplinary team who are unfamiliar with working with SCI patients. An initial visit by a team from the SCI network, to share multidisciplinary training and further build links will be undertaken 13 th - 17 th June to Green Pastures Hospital and to Chitwan Spinal Injury Centre.

5 Reconstructive Surgery and Rehabilitation Working Group Contact: Dr Shankar Man Rai: Dr Shankar Man Rai presented on the possibilities, challenges and requirements for rehabilitation for reconstructive surgery. He emphasised that whilst they have performed over 200 major surgeries since the earthquake, there is current capacity at Kirtipur Hospital for microsurgery and free flaps, and that with the current expected climb in post-operative complications - clinicians are advised to refer if their patient requires reconstructive surgery. Sushma Koirala hospital, which supports the spinal injury rehabilitation centre with plastic surgery input will also be invited to participate in this working group. Prosthetic and Orthotic Working Group Contact: Amit Ratna Bajracharya (P and O Society) Mapping of 11 facilities for prosthetic provision is complete, NDF, the Army Rehabilitation Centre and Green Pastures have been identified as the main proposed providers of prosthetics for those injured in the earthquake. These centres have already identified and are in the process of obtaining the supplies needed to action this. The P and O working group have almost finalised a referral pathway to propose to the MOHP to ensure the adequate follow up of patients from tertiary hospitals, and help the P and O facilities and government better plan the long term care needs for these patients. Amputee numbers expected remain between 40 and 60 for now. More comprehensive mapping of the orthotics services is being carried out this week. Any patients suffering amputation, and not having been given information on whether they are suitable for a prosthesis should be directed to Handicap International Hotline at present. 4-Ws Members of the injury rehabilitation sub-cluster are kindly asked to complete the attached 4-Ws form pertaining to their rehabilitation activities, and return to This information will then be fed in to the wider 4Ws format. NEXT SUB CLUSTER MEETING FRIDAY 12 TH June, 9am, MOHP (NHRC building) Following this will be: SCI working group at 10am and P and O working group at 10am

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