Rehabilitation support to Storm Injured People in Bara
and Parsa Date of Response: 7th to 19th April 2019
Physiotherapists of Naryani Hospital Conducting the Post Hospital Rehabilitation in Community
Snapshot of the Rehabilitation Response
125 in the need received rehabilitation services. Out of 125, 71(57%
received rehabilitation services from community. More than 50% of those
receiving the rehabilitation in community were initially discharged from the
hospital without ensuring any rehabilitation services.
130 assistive devices were delivered (Crutches, Braces, Walker, Walking
stick and Wheelchair). 90 devices directly delivered to injured people and
40 handed over to the Naryani hospital for follow up cases.
86 follow up physiotherapy sessions have been conducted for severe cases
Completed the line listing of cases receiving rehabilitation and handed over
to Naryani Hospital physiotherapy department
68 people need physiotherapy for more than 3 months with atleast one
follow up in a week.
Rehabilitation service was delivered in government hospital, private
hospital and all the affected community
Rehabilitation service was delivered in coordination of local health
emergency operating centre, local physiotherapists and health coordinator
of municipality & rural municipality
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Introduction
Two districts of southern Nepal, Bara and Parsa were hit by a deadly storm on the 31st March 2019. According to the statement from Health Emergency Operation Centre (HEOC) released on the 11th April, storm killed 28 people and injured more than 1110. The powerful storm destroyed local houses and trees causing injuries very similar to those caused by an earthquake. Of the two districts, Bara is the most affected where the largest health facility is only a government district hospital with no surgical and rehabilitation facilities. Storm affected all group of population from children to people with disability, pregnant mother and elderly people. The Birgunj city of Parsa district has a tertiary government hospital plus some private hospitals with provision of surgical as well as rehabilitation facilities. As a consequence, the most severely injured (both Parsa and Bara districts) were brought to Birgunj city for medical treatment. Nepal Physiotherapy Association (NEPTA) requested one of its members for an initial need assessment which showed that fracture and soft tissue injury as the most common injuries. These types of the injury needs rehabilitation service right from the first day in order to ensure wound healing, to prevent disabling complication and to enhance functional activities as early as possible.
Map of storm affected districts (Source: National Emergency Operation Center), Source WHO Nepal
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Ministry of Health & Population (MoHP) and Leprosy Control & Disability Management
Section (LCDMS) of Epidemiology & Diseases Control Division (EDCD) identified the
unmet need for rehabilitation services for storm injured people in Bara and Parsa
Physiotherapist of Naryani hospital, Birgunj expressed the high need of physiotherapy in
storm affected district that was also recorded in a health emergency meeting minute
held in Naryani Hospital
MoHP assigned Humanity & Inclusion (HI), National Disabled Fund (NDF) and Nepal
Physiotherapy Association (NEPTA). Coalition (annex 1 &2) of these organizations has
delivered rehabilitation services both at hospital and storm affected communities.
Functioning of this coalition was guided by local Health Emergency Operation Centre
(HEOC) Birgunj, Central HEOC and EDCD that means rehabilitation service is being
delivered through one door system of MoHP and its local entities.
Services offered: Physiotherapy and Assistive devices (Mobility aids and braces): fitting
and user training.
Framing rehabilitation service delivery to the local need: Guided by need assessment
that was jointly done with multidisciplinary local health team on the 9th April 2019.
Coordination for the patient appointment was done through local health coordinator of
rural/municipality who is requested to show person in limb cast, implant or with soft
tissue injury to be benefited by rehabilitation services. In addition, door to door case
hunting was jointly done with health coordinator or person assigned by him/her on the
most affected areas
Areas covered: Hospital based rehabilitation on Naryani hospital, National medical
college, Birgunj health care, LS neuro hospital and Gandak hospital. Community visit to
identify and manage the injured people on Bara district- Pheta, Gadhimahai ,
Subarnapur, Parsauni, Parwanipur, Kalaiya municipality and Pachrauta and Devtal
In Naryani and private hospital rehabilitation was done in leadership of their own
physiotherapist while response team was providing the back up support and assistive
devices for the early ambulation/mobilization of patients.
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Aligning to the local health system
Participated & reported on all meeting facilitated by health emergency management
centre
Provided Humanity & Inclusion vehicle and rehabilitation human resource for health
related need assessment (rehabilitation embedded) of affected community conducted
by local Health Emergency Operation Centre
Collaborated with the physiotherapist of existing hospitals to ensure rehabilitation in
his/her ownership
Conducted the joint rehabilitation and psychosocial (TPO) field visit in community using
HI vehicle
Worked in synergy with physiotherapists (Annex 3) of Naryani hospital for the handover
of rehabilitation service
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Preparation adopted for the handover of rehabilitation services
o A request letter (Annex 4) was forwarded to medical superintendent of Naryani hospital
for mobilizing its 4 physiotherapists both in hospital and in community for the
rehabilitation of storm injured who were already discharged.
o Medical superintendent has written the formal instructive letter (Annex 5) to
physiotherapy department in charge of Naryani hospital to ensure the follow up
rehabilitation of injured living in community
o On the 17th of April, the health partner meeting of DPHO Bara has also decided to
request one physiotherapist to Provincial government and Epidemiology & Diseases
Control Division.
Handover to the physiotherapist of Naryani Hospital (18 & 19 of April)
Meeting with the team of Naryani hospital physiotherapist was facilitated to debrief
the need of rehabilitation of injured survivor discharged to community
All line listing of cases who received first level of rehabilitation was explained and
handed over (individual client assessment sheet, trauma summary sheet of
municipality/rural municipality and client database) to Naryani hospital physiotherapy
department
Jointly two community field visits were conducted with two physiotherapists of Naryani
hospital in order to orient the scenario in community and how to work in coordination
with health coordinators of rural /municipality
Essential assistive devices that might be required in coming days for the injured
survivors was also formally handed over to store of Naryani hospital (annex 6 and
annex 7)
It has been explained to Mr. Uday Mishra (Naryani hospital, physiotherapy team lead)
that any extra support need for rehabilitation in coming days should be immediately
formalized to medical superintendent then to concern provincial and MoHP entities
Based on the number of injured needing rehabilitation services, Naryani hospital
physiotherapy team plans a field visit to 3 clusters in Bara: Pheta, Subarana + Pachrauta
+Devtal, Parsauni+Parwanipur.
A team of two physiotherapists will have a community visit in a vehicle arranged by the
Naryani Hospital.
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Rehabilitation service pathway for community jointly agreed with PT team of
Naryani hospital
Pertinent issues and recommendations
Disaster help desk is required in Naryani Hospital to guide follow up cases. Clear linkage
of this desk needs to be created with social service unit which has mandate to
coordinate the care for disaster injured
A clear consensus needs to be made regarding where the disaster injured case should
be sent for the follow up from the community. Especially for those who have received
the first level of intervention from private hospital.
Dressing should be arranged near to the location of most affected areas. All the injured
survivor might not be able to reach the health facility for follow up
The need of rehabilitation in terms of intervention time might increase after the
removal of cast and implants because it needs more time to mobilize the stiff joints. This
might call the back up support to physiotherapy team of Naryani hospital.
Bara district hospital is closer by the affected communities where injured people will go
for follow up. However, there is no physiotherapy department on this hospital at
present. It is also important to depute one physiotherapist in Bara hospital who should
work in close coordination with the physiotherapist of Naryani hospital (hub) and also
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can provide the back up support to rehabilitation team of Naryani hospital. A partner
and government health staff meeting held in Kaliya hospital has identified this
need.(Annex 8)
The backup support needs of Naryani hospital physiotherapy team should be time and
again reviewed at the Naryani hospital, provincial and EDCD level.
A government focal person with rehabilitation profile needs to be deputed at provincial
level and MoHP/DoHs level for the surveillance of rehabilitation work going at storm
affected areas. The surveillance information should atleast cover; Rural/ Municipality,
Name of Patient, intervention delivered and any complications indicating to the long
term disability. This information should be compared to the already line listed data of
injured patients.
Most of the affected areas are inhabited by the Dalit and Muslim community. There
should be a mechanism to cross check the impartiality and localization on aid.
Psychosocial interventions specially targeting the injured people needs to be started.
There might be the need of one experienced person who can coordinate and depute the
existing psychosocial workers of different organizations through properly framed plan
Emergency trauma management training (NHTC endorsed training) which was already
done in province number 3,5 and 7 is must to ensure the multidisciplinary trauma care
at hospital level in mass causality. But this is not urgent as patients are already
discharged from hospital. However, this should be considered as preparedness initiative
of mass causality in province 2.
A short hands on training (3 days) to health workers (Health post and PHC) on basic
integrated rehabilitation follow up care of injured patients is required in order to ensure
the continuum of rehabilitation at the community level. This training should be
integrated that means covering all types of injury occurred due the storm. After 2-3
weeks, removal of limb cast will start after which need for rehabilitation will further
increased as it needs more dedicated time to mobilize joints and strengthen muscles.
Therefore, the right time to start this training is not later than 2 weeks from today (29-4-
2019).
15 people with disability who were not injured but affected by the storm were
consulted during the community visit. Most of them do not have assistive device and of
those who are using it are not in good condition. A rehabilitation camp with the
provision of assistive device is required in order to ensure personal mobility of these
people.
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Acknowledgement
We would like to express our sincere gratitude to the following person whose contribution was
vital to form and guide this team
Name Hospital/Organization Support
Dr. Kedar Prasad Century Director, Bir Hospital Deputing Mr. Sujeet Singh in request of Nepal Physiotherapy Association
Dr. Pramod Kumar Yadav Chief Medical Superintendent, National Trauma Center
Deputing Mr. Pravin Kumar Yadav in request of Nepal Physiotherapy Association
Dr. Basudev Pandey Medical Superintendent, Sukraraj Tropical and Infectious Diseases Hospital
Deputing Mr. Nabin Jaiswal in request of Nepal Physiotherapy Association
Dr. Anamul Hauq Medical Superintendent, Naryani Hospital
Creating enabling environment to establish rehabilitation care and handover the post-hospital care to Naryani physiotherapy department
Mr. Yam Nath Mainali Secretary , National Disabled Fund
Deputing one Prothetist& orthotist and Wheelchair technician. Releasing the stockpiled assistive device. Commitment to provide prosthesis for two amputee
Mr. Willy Bergogne Country Director , Humanity & Inclusion
Deputing HI staff to HEOC , MoHP for each health cluster meeting and sending 4 HI staff for rehabilitation response. Releasing HI stock piled assistive devices for emergency. Approving the travel and accommodation cost of entire team members of rehabilitation coalition
Mr. Laxman Adhikari President, Nepal Physiotherapy Association
Mobilizing 3 physiotherapists experienced on trauma management through Bir hospital, National Trauma Center and Sukraraj Tropical and Infectious Diseases Hospital. Participating on
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health cluster meeting at HEOC to convey the need of rehabilitation service.
Mr. Uday Mishra PT, Naryani Hospital For providing the real information on the surged need of rehabilitation services and collaboration
Mr. Om Prakash Sah PT, Naryani Hospital
Mr. Satya Naryan kumar PT, Naryani Hospital
Mr. Dhan sundar prasad yadav
PT, Naryani Hospital
Mr. Baiju Jaiswal PT, National Medical Collage
Mr. Mitlesh Yadav PT, National Medical Collage
Mrs. Reycha PT, LS Neuro Hospital
Miss. Nirpendra Karn PT, Ex-general secretary of Nepal Physiotherapy Association
Dr. Erana Joshi WHO Providing the contextual information and helping to connect with health coordinators and other local health actors
Dr. Soniya Bhagat WHO
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Some Glimpse
Physiotherapist facilitating the
ambulation of an elderly in Kaliya
hospital
Size of crutches being adapted
to the height of injured person A physiotherapist supervising the
ambulation of injured
Women with injury learning to
walk with crutches at her
community
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Annex 1: Letter from Ministry of Health and Population to the coalition of Humanity &
Inclusion, National Disabled Fund and Nepal Physiotherapy Association
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Annex 2: Composition of Rehabilitation Team deputed by MoHP
Name Organization Profession
Sunil Pokhrel Humanity & Inclusion Physiotherapist(Team Lead)
Pravin Yadav National trauma centre, supported by Nepal Physiotherapy Association( deputed from 7th -12th April)
Physiotherapist
Nabin Kumar Jaiswal
Sukraraj Tropical and Infectious Diseases hospital, supported by Nepal Physiotherapy association
Physiotherapist
Sujit Singh Bir hospital, supported by Nepal Physiotherapy Association(deputed from 14th April to 19th April)
Physiotherapist
Rati Gurung Chautara district hospital, Sindupalchok (Humanity & Inclusion staff)
Physiotherapist
Ram Bdr Thapa National Disabled Fund, Social welfare council, Ministry of Women Children & Senior Citizen
Prothetist & Orthotist
Ramhari Lamsal National Disabled Fund, Social welfare council, Ministry of Women Children & Senior Citizen
WHO certified wheelchair service personal
Mohan Bhatta Humanity & Inclusion (( deputed from 7th -9th April)
Logistic coordinator
Krishna Duwal Humanity & Inclusion(( deputed from 7th -12th April)
Driver
Lal bahadur chaudhary
Humanity & Inclusion(( deputed from 12th – 19th April )
Drive
Team: 1 Female , 10 Male and 1 person with disability
Annex 3: Physiotherapy Team of Naryani Hospital
Name Email
Mr. Uday Mishra [email protected]
Mr. Om Prakash Sah [email protected]
Mr. Satya Naryan Kumar [email protected]
Mr. Dhan sundar Prasad Yadav
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Annex 4: Emergency rehabilitation coalition requesting the medical superintendent of Naryani
hospital to mobilize the physiotherapist for rehabilitation of storm injured people
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Annex 5: Instruction given by medical superintendent to head of physiotherapy department of
Narayani hospital to lead the rehabilitation in response to the request letter of rehabilitation
coalition
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Annex 6: Assistive devices donated speculating the further needs during the community follow
up by the rehabilitation team- Humanity & Inclusion (5 pairs of auxiliary crutches, 2 Anti-
bedsore mattress and 4 walkers).
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Annex 7: Assistive devices donated speculating the further needs during the community follow
up by rehabilitation team- National Disabled Fund (2 pairs of Axillary crutches, 2 wheelchairs, 5
knee immobilizers, 5 wrist splint, 10 arm slings and 5 ankle braces).
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Annex 8: Minute of DPHO meeting in Kaliya Bara held on 17th April 2019 identified need for
having one physiotherapist at Kaliya district hospital
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Forms & Format used and handed over to Naryani Hospital Physiotherapy Team
Emergency Rehabilitation Assessment Form
Name: Age: Gender: M/F
Address ( ward, municipality/rural municipality & District) :
Hospital/Health facility Name: Type: IPD/OPD/Outreach
Disability card Yes/No: Red/ Blue/ Yellow/ White/Not app Contact number of client:
Diagnosis: Left/Right/not app…………………………………………………………………………………………………………………
Treatment: conservative/surgery……………………………………………………………………………………………………………
Causes: Strom/specify others………………………………………………………………………………………………………………….
Assessment Findings:
Muscle power: ROM: Balance:
ADLs: Complications:
Others:
Rehabilitation Intervention Details
Session Specify the Rehabilitation Intervention Specify Assistive Device (If Delivered)
Signature of Rehabilitation Professional
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2
3
4
Smart Goal Setting Goal: Goal set Date: Status: under review/Achieved/Not achieved
Referral: required/not required Place where referred :
Any comments(Future follow up needs, any risk for long term disability and constraints that can impact the prognosis ):
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Follow up form
Rehabilitation of Bara Parsa Storm Victims:
Name of hospital/community health facility (village, ward):
Date:
Name of patients Age/Sex Diagnosis Treatment/ Surgery Rehabilitation sessions/ follow up
Date Date Date Date