Sit Rep from Injury Rehab Sub Cluster: 01/06/2015 HOTLINES

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1 Sit Rep from Injury Rehab Sub Cluster: 01/06/2015 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 Government Plan for Rehabilitation Response The Ministry of Women, Children and Social work (MWCSW) and the Ministry of Federal Affairs and Local Development (MoFALD), led by MoHP, along with WHO and the rehabilitation sub cluster, have developed a strategic plan covering the emergency response and extending throughout the recovery phase. The 2 year medium and long term strategy feeds directly into the health sector reconstruction plan, and includes scale up of rehabilitation activities following the emergency, and long term strengthening of rehabilitation services and linkages on a tertiary, district and VDC level. Its overall objective is to decrease mortality, morbidity and disability among injured and other vulnerable people affected by the earthquake The specific objectives of the plan are: 1) to strengthen the capacity of health facilities at the tertiary, secondary and primary level in the management of impairments, especially for traumas 2) to strengthen the capacity of, and improve the access to existing specialized rehabilitation services in the country 3) to establish collaborations among the ministry of health and other relevant ministries, service providers and communities to ensure comprehensive and quality care A final version of the plan has now been produced, alongside an annex document which lays out recommendations to the government for rehabilitation structures, human resources and essential equipment. In the last meeting it was highlighted that the establishment of a disability technical unit within MOHP is vital, but also cross ministry efforts are extremely key in terms of working at a community level on inclusion issues as well as specific injury rehabilitation. Injury Data: There are currently several sources of data, which have been triangulated to propose an overall number of people with injuries likely to require long term care or rehabilitation. Total number of injuries reported currently stands at 21,433 (HEOC, 29/5/15) At least 817 patients in Kathmandu Valley hospitals who will require long term care and rehabilitation: MOHP surveyed 36 facilities in Kathmandu, Bhaktapur and Lalitpur. These numbers

2 exclude data from several large hospitals such as Dulikhel and Bir Trauma, as well as excluding those who are already discharged and not accessing rehab services. At least 200 people with injuries are currently receiving step-down or in-patient rehabilitation at the highlighted facilities. Handicap International s database of over 1,000 patients with injuries provides a sample of the breakdown of injuries, Based on this current information, and the awareness of the gaps, initial estimates have been confirmed: people with injuries will have ongoing rehabilitation and/or nursing needs patients with spinal injury amputees Update from tertiary hospitals The sub-cluster felt that there continues to be weak rehabilitation referral mechanisms from the tertiary level, as well low visibility of the available rehabilitation services. Consideration should be given to awareness raising activities such as radio broadcasts. The MOHP are meeting with main hospital directors and will promote referral both to rehabilitation services, but also to other facilities - such as those with strong reconstructive surgical capacity, or specialist centre. The strategic group recommends the appointment of specific discharge coordinators within the main hub hospitals. Physiotherapist and OT clinicians noted that they have seen up to 40 patients so far who have been admitted to government hospitals over the last few days with the need for treatment of infection or complications arising in other private facilities or due to conditions of living. Health and rehabilitation providers should be aware that at the 4 week mark post-earthquake, there may well be further complications and even amputations arising. IOM representatives confirmed rumours that some patients are being charged on follow up appointments, and these facilities are being logged and information will be formally fed back to the MOHP. On this note, the MOHP has subsequently confirmed that free follow up services will be provided in public hospitals in Kathmandu and the district hospitals in the 14 affected districts for one year. Hospitals in Kathmandu include TUTH, Bir, Patan, Army Hospital, Civil Hospital, Police Hospital, Dulikhel and Nepal Orthopedic Hospital. At present, centres offering free rehabilitation, and for what time frame have yet to be announced. Step Down / Rehab Beds inside Kathmandu The following centres have been identified as step down facilities with capacity now. Where possible, patients should be referred to centres close to their homes:

3 Cuban FMT now based at Aryuvedic Hosptial, Kirtipur. Have a well staffed facility with up to 50 bed capacity and are keen to accept step down referrals for patients with ongoing nursing and rehabilitation needs. Have capacity to expand as required. For referral please liaise with Zener Gonzalez , or via the IOM hotline. Anandaban TLM Hospital, Laltipur offers nursing and rehabilitation step down. The 50 bed facility currently has 23 free beds for patient needing step down care. Please contact: Spinal Injury Rehabilitation Centre (Sanga) Current capacity 110 today, 9 free beds at present. Continuing to increase capacity but require increased operational funding. Please contact Nepal Youth Foundation: Operating a stepdown facility for people with injuries. Has nursing They have 75 beds in total, currently 25 beds free. Not appropriate for complex patients (eg pelvic fracture, complex polytrauma) Contact Lalit Gahatraj: or Patanjali Yogpeeth: Mandikhatar. Maz 30 capacity for simple orthopaedic patients requiring step down. Must be independently mobile or with carer. Nursing and medical review, with outreach rehabilitation from HI. Currently around 5 spaces. Telephone Yog Diksha Sharma: District level rehabilitation There remains the need to move as many people as possible closer to their home, and to a district level prior to the monsoon season and in order to free beds in the tertiary hospitals. There will also be ongoing rehabilitation needs for a number of these patients once they return home. The MOHP has confirmed it will, with support from INGOs, set up three stepdown/rehabilitation facilities in three of the worst affected districts. These are Gorkha, Sidhupalchowk and Nuwakot. IMC will be supporting in Gorkha, with HI supporting the other two districts (where they currently have fixed point rehabilitation outpatient services). MSF Belgium are investigating the possibility of setting up a rehab/stepdown unit in Charikot, Dolakha. In order to ensure consistency in approach and set bench marks for set up of further district level rehabilitation centres, the operating agencies will meet with MOHP to agree on standardised support, referral pathways and data collection. Concerns were raised over the operational costs of these facilities, and other informal stepdown facilities in Kathmandu, particularly feeding patients and their relatives. Suggestions were made to request support from WFP for provision of food. Transport

4 IOM have extended their patient transport plans to include those outside of Kathmandu Valley. At present they are mapping the main areas people wish to go back to, and ascertaining if they need rehabilitation whether those people will have access to the stepdown services mentioned above. Handicap International Hotline Is open 8am-8pm. There are currently two main reasons why patients are calling the hotline. Firstly for specific rehabilitation services - such as assistive devices or advice. Secondly, many are calling with shelter needs and cash request. Whilst these are issues beyond the remit of the sub-cluster, IOM and HI will both feed in to the shelter cluster and inclusion working group to ensure that the needs of this specific group of injured people are met. The Red Cross have a number of tents which they are waiting to distribute to the most vulnerable groups of people; those with injuries requesting shelter needs therefore need to be directed to IOM (hotline above) so they can be highlighted to the appropriate channels. Community Based Rehabilitation/Identification of those injured in the community CBM was able to provide an update on the mapping of CBR activities in the 14 most affected districts. There is now a CBR focal point in each of these districts. There are at least 65 members within the CBR network, which met 29/5/15. CBR organisations identified are both NGO and Governmental based. Generally, NGO CBR organisations current activities relate more to primary rehabilitation care and follow-up, they receive between 1-3 month training, and this is mainly disability focused. The CBR organisations under MWCSW receive 3 months training, which appears to be inclusion focused. These particular organisations acknowledge their capacity is very low, but links with female community health workers can be made, and training in injury identification and after care are essential. The priority of the CBR network is now to conduct comprehensive training, and ensure an appropriate referral network through to the district and tertiary level is available. Amputee and P&O Update Over the past week, a mapping of P and O services capability, capacity and needs has been conducted with the P and O Society of Nepal. This survey of prosthetic and orthotics facilities indicates that they have the capacity to support the predicted number of amputees (40-60) but are likely to require financial support and some specific additional equipment to be able to do so. The P and O working group are working on 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.

5 Human Resources NEPTA continue to be able to disseminate job adverts through their social media for those organisations recruiting physiotherapists. Concerns have been raised about the inconsistency in salaries offered to rehabilitation staff, particularly by international agencies who are offering high salaries, which is affecting recruitment and retention at other established centres. There remains an urgent need to establish normalised and sustainable payscales, and the strategic group will meet to discuss this as a matter of urgency. UK-EMT currently have clinical specialists available for training on spinal cord injury amputation, preprosthetic rehabilitation in particular. If there are staff from wider facilities interested in attending this training, please contact the rehab cluster. CBM have identified three Occupational Therapists from India who are able to support in projects or facilities where needed. Further information will be available soon. The Nepal Youth Foundation, who currently host 50 people with injuries made a request in the meeting for medical doctor to support with a 1-2 weekly ward round. This need was immediately met in the last meeting by IOM staff. SIRC are looking for local or regional staff to support them in the following areas at present: psychologist, OT and SCI nurse trainer. NEXT SUB CLUSTER MEETING FRIDAY 5 TH June, 9am, MOHP (NHRC building) MEETINGS WILL BE ONLY TAKE PLACE ON FRIDAYS FROM NOW ON

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