Sample Disagreggation of Injuries by Age 80 and over 3%

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1 Sit Rep from Injury Rehab Sub Cluster: 25/05/2015 Attached: Referral form for patients with rehabilitation needs 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 Injury Data: At present, as part of the government response to the earthquake, a new position within the Ministry of Health and Population (Curative Division) has been formed, and under the leadership of Dr Basu Dev Pandey, Dr Daya Pant will lead as the disability focal point. Along with the HEOC, they are gathering immediate data on injury numbers and disaggregation as to type, gender, age, needs and home of the patient. Dr Santa Tamang, from Save the Children, also highlighted the need for any data to be disaggregated as to the age of patients to identify the specific rehabilitation needs for children. Further data with more disaggregation is expected to be available to the sub-cluster over the coming week. Based on the initial Hhandicap Iinternational sample of 678: Sample Disagreggation of Injuries by Age 80 and over 3% 0 to 5 2% 60 to 79 15% 6 to 17 16% 18 to 59 64%

2 Injuries by Gender 54% 46% Female Male Initial sample puts 18% of those injured as being under 18, with 18% being over 60. As this data is from a small number of hospitals it may not be representative. Step Down / Rehab Beds inside Kathmandu There is no shortage of step down beds available. Currently within Kathmandu there are over 100 beds available for patients requiring ongoing rehabilitation or nursing care. The sub-cluster is working on a simple flow chart to help tertiary hospitals identify which the best facility is for each patient, as reports are currently that discharges are not being planned effectively and patients are not receiving appropriate follow-up. 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: Cuban FMT now based at Aryuvedic Hosptial, Kirtipur. Currently have 7 rehab patients. This is a well-staffed facility for rehabilitation, with onsite medical services and x-ray facilities and are keen to accept step down referrals for patients with ongoing nursing and rehabilitation needs. Currently 26 beds available. For referral please liaise with Zener Gonzalez zenercaro@gmail.com , or via the IOM hotline. Anandaban TLM Hospital, Laltipur offers nursing and rehabilitation step down, currently has 23 free beds for patient needing step down care. Please contact: Spinal Injury Rehabilitation Centre (Sanga) Expanding to 140 capacity, 9 free beds at present. Please contact Nepal Youth Foundation: Operating a stepdown facility for people with injuries. Has nursing Currently 29 beds free. Not appropriate for complex patients. Contact Lalit Gahatraj: or lalit@nepalyouthfoundation.org.np

3 Patan Jaly Yogpeeth: Mandikhatar. Max 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: Nepal Orthopaedic Hospital: Is operating a 50 bed step down open in collaboration with MSF France. Currently 15 beds available, but just for patients from the orthopaedic hospital at present. Future Capability: The army rehabilitation has identified 20 civilian earthquake related patients who will need long term continuity of rehabilitation; it requires 1 or 2 large tents to host these patients for step down. District level rehabilitation The sub-cluster meeting reviewed the MOHP injury numbers reported at a district level via HEOC. From the top 10 districts in terms of injury data - Rasuwa, Dhading and Dolakha remain the only districts without confirmed rehabilitation input - whether from rehabilitation institutions, a step-down perspective, or mobile teams. MSF-Belgium are now assessing needs from this perspective in Dolakha. Further information is required from Rasuwa and Dhading. Data from MoHP indicates that the overwhelming majority of patients with complex trauma remain in the Kathmandu Valley and surrounding Tertiary Hospitals at present. Green Pastures/INF (Pokhara) currently have 20 free beds with capacity to 50 if required. They accept Spinal Cord Injury patients. Any SCI patients from the Pokhara area should be referred here. Please contact: Dhaka Magar, clinical director on Chitwan Spinal Injury Centre, Bharatpur Hospital - has the ability to increase to 15 SCI patients if needed IMC are currently finalising arrangements for a rehabilitation and 20 bed step down facility alongside Ghorka District Hospital (where ICRC noted at least 86 patients were transferred to Kathmandu, and where a specific need for long term rehabilitation for 150 patients has been identified). Dhulikhel Hospital are providing outreach care including physiotherapy in Kavre district, reports are that an FMT from UAE are providing stepdown care here now FMT coordination group notified. Handicap International are providing a fixed point centre in Nuakott (Trishuli), and have a physiotherapist working with Norwegian Red Cross in Sindupolchowk.

4 Patient transport IOM continue to operate patient transport services, which now extends to Lalitpur, Dhulikhel and Bhaktapur from Kathmandu. Please call the HOTLINE for further information. IOM are also awaiting a shelterbox donation which should arrive in 1 week. For those patients who would be suitable to be transferred for rehabilitation nearer their homes in Pokhara, Green Pastures say they can arrange transport. Plastic and Reconstructive Surgery Kirtipur Hospital in partnership with Resurge International currently have 39 free beds for plastic surgery and microsurgery. They have already completed 177 procedures, and are currently doing 7-8 plastic and reconstructive procedures daily. They are also closely working with the Cuban Step Down facility to link appropriate patients. Please contact Dr Shanka Rai: Sushma Koirala Memorial H, in Sakhu also has the capacity for reconstructive plastic surgery, and is already receiving patients from SIRC. Amputee and P&O Update Estimates vary, but the total number of amputees is estimated at present to be in the region of The P and O working group met today, and are mapping the capability, capacity and needs of the sector - both in terms of prosthetic and orthotic provision. Equipment Requests for assistive devices crutches/wheelchairs etc. can currently be made to Handicap International: through Hotline number above. An immediate need has been highlighted for cock-up/future wrist splints. Currently due to the high demand, orthotic suppliers prefer to issue pre-fabricated splints, although capacity exists in country to make these. SIRC has requested support to fix or replace their x-ray machine. At present, patients are having to be transferred for all x-rays. Engineers from the Cuban Medical Team will review the possibility of fixing the existing machine. SIRC has also requested support to improve lab facilities at the centre. The Army Rehabilitation Centre has an immediate requirement for two tents which could house 10 in-patients each. This is for a proposed step down facility. Government Plan for Rehabilitation Response MOHP are now co-ordinating closely with Ministry of Women Children and Social Welfare and the Ministry of Local Development, as well as local and international partners to develop the short,

5 medium and long term rehabilitation strategy. This cross ministry work is vital to strengthen the rehabilitation sector, but also the ability of existing community workers. Details are currently being finalised for a three stage plan focusing on the short, medium and long term rehabilitation response and capacity building required. The plan focused on services in 3 levels Kathmandu, district level and community based services. It aims to anticipate the staffing and funding requirements to meet the current increased needs and create a more integrated, sustainable, multi-level rehabilitation sector for the future. Several of the organisations represented todaythat are operating rehabilitation facilities made open requests to the for operational financial support, as most patients who require stepdown will need adequate nutrition, WASH facilities, consumables for both themselves and their carers, on top of the medical and rehabilitation HR and overall care costs. NEXT SUB CLUSTER MEETING FRIDAY 29 TH MAY, 9am, MOHP (NHRC building) MEETINGS WILL BE ONLY TAKE PLACE ON MONDAY and FRIDAY