Rehabilitation Disaster Response Focusing Cyclone SIDR and Savar

Rehabilitation Disaster Response: Focusing Cyclone SIDR and Savar Building collapse Taslim Uddin Physiatrist and Professor of PMR BSM Medical University, Dhaka. Bangladesh Member , ISPRM Disaster Rehab committee Email: taslimpmr@gmail. com

Introduction Amputations, TBI, SCI, bone fractures are the major problems requiring attention to Medical Rehab professionals Disasters commonly leading to huge onslaught of injuries giving these injuries can be better managed by Rehab team Disaster Rehab Response is a rather newly introduced subject we Need to know more about it Ref: Glob Health Actionv. 4; 2011: PMC 3160807, Published online 2011 Aug 16. doi: 10. 3402/gha. v 4 i 0. 7191

Concern for Disasters : Bangladesh • Thickly populated country • Poverty • Political instability, Poor health sector infrastructure and less health budget • Few PRM Disaster movements / Rehab Doctors

• Total land area of 147, 570 sq km, It is a low-lying country • Population: 150. 6 million, with 1, 021 people living per square km • No. of registered physicians: 64, 434 • No of Physiatrists : 95, Physiotherapists: ? ? • No. of physicians per 10, 000 population: 3. 0 GOV Bangladesh , BMDC, DGHS: 2013

Cyclone SIDR: 2007 Nov, coastal Dist: Bangladesh…………………

Cyclone SIDR: pattern of injuries: N: 14649 Nature of injury Percentage Minor Chest injury Limb injury Abdominal injury Spinal injury Head injury 58% 15% 13% 10% 1. 1% 0. 9 132 1 st conf of AOSPRM proceedings Nanjing, China 2008, J Rehabil Med 2008, suppl 46; 124

Rehab Response - post disaster : Medical Teams Primary focus on Medical rehab Services Teams: (volunteer) – Physiatrist – PT – Social worker

Savar (Rana Plaza) Building collapse: 2013 the worst workplace disaster

Savar (Rana Plaza) Building Collapse Death : 1129 (in the spot and in Hospital) Injury: 2224 (WHO, 2013) number of workers at the time of collapse: 4000 -5000 time of collapse: 8. 30 - 8. 45 am Analysis of 61 cases admitted to NITOR Age : 15 to 50 : mean 26. 5 yrs : Sex: 15 male : 45 female ---------------------------------------------- Injury: limb fracture, soft tissue injury, spinal injury (4), Amputee(3) --------------------------------------------- Outcome: SCI (paraplegia) discharged home, Amputee : provided prosthesis Courtesy : Dept of PMR, NITOR

Amputee : UL and LL

Hospital/clinics offered injury patients • Enam medical college hospital; 1000 • NITOR 61 -------------------- • New deep clinic 33, Rose clinic-63 • Prime diagnostic and consultation center 30, Shima general hospital 30 ----------------------- • Savar upazila health complex 30 • Deep clinic and hospital 20, Lab john unit 1, unit 11; 26; 21 • Rezia, sheba, mukti: 31 • Others : CRP, CMH SAVAR, DMCH, NHF, BSMMU askbd. org; uploads 2013/11

Out come • Distribution of relief items and medications • Specialist rehab consultation/referral • Physiotherapy • Training to the general people • Training to Religious leaders as the early responders • Reporting

Type of Rehab Response/Funds • Response: Intermediate/subacute (~3 days – 12 weeks) • Funds – Medical supplies: donations from friends/families/pharmaceutical companies – Personal expenses : self funding – Had proposals from IRF, ISPRM and Indv Members: we could not take it because of cumbersome procedure of money transfer

Lesson's learned • Physiatrist can better manage the disabilities resulting from disaster trauma: as team leader in the field and thereafter • Timely rehabilitation interventions for SCI, TBI, MSK trauma and Amputee can effectively reduce the disability intensity • We need to work in a better team and organized way

Recommendations • Form a disaster medical rehab response Team: leader, PT, OT, Plaster technician/orthotics/ Nurse/ Social worker • Fund: PMR Society liaison with national Budget , Donations • Development of education/training course for PRM disaster responders

References/acknowledgements • ISPRM Committee on Rehabilitation Disaster Relief (CRDR) • • NITOR (Prof Habib), WHO 2013 askbd. org; uploads 2013/11 Gov of Bangladesh, DGHS, BMDC, ISPRM news and Views 1 st. AOCPRM conference Nanzing IRF Jim Gosney, Farooq Rathothore, Tom Haig