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Mareschal G.1, Pokhrel S.2,3, Retis C.4
1Handicap International Nepal, Kathmandu, Nepal, 2Handicap International, Technical Resources Division, Lyon, France, 3Nepal Physiotherapy Association, Kathmandu, Nepal, 4Handicap International, Technical Resources Division, Phnom Penh, Cambodia
Background: Following the earthquakes that hit Nepal in April and May 2015, over 22,302 people were injured and 8959 people lost their lives. Life-saving and surgery interventions were provided by local health facilities and international aid. However, post-surgery interventions were limited by the exceptional number of patients, the limited skills on nursing and rehabilitation on trauma care and poor discharge procedures and referral mechanisms for follow up. Availability of rehabilitation services in districts where the majority of injured resided was very limited , increasing the risk of complications and poor functional recovery for people in need of medium to long term rehabilitation.
Purpose: With the overall goal of ensuring long-term access to rehabilitation to earthquake survivors and people with functional limitations, a programme was implemented to support the Ministry of Health to set up rehabilitation services in both urban and rural areas.
Methods: Seven rehabilitation units were set up in government health facilities with the technical and logistical support of Handicap International. In each unit one physiotherapist provided therapy sessions, assistive devices, patient and care-givers education, referral to other health and specialized rehabilitation services. Social workers were mobilized to support need assessment, referrals and facilitate access to social protection and community services for disability. Medical staff was trained on impairment identification skills and rehabilitation options through an inter-disciplinary approach. Outreach activities in surrounding areas ensured the identification of cases in isolated communities.
Results: In 12 months, among the 4,617 people who received rehabilitation, 24% had earthquake-related injuries. Overall, impairments were mainly musculoskeletal conditions (56%) and fractures (25%). The age group 24-60 years represented the highest proportion (60%), followed by age group ≥60 ( 21%), age group 0-15 (11%), out of which only 2% for age group ≥5 , and age group 16-24 (8%).Among earthquake-related beneficiaries, 68% received rehabilitation through outreach. Data disaggregated by gender show a higher prevalence of women among beneficiaries.
Conclusion(s): Rehabilitation services at the district level are able to respond to the high needs in the community, not only for trauma-related injuries but also for impairments related to non-communicable diseases and developmental disabilities. The low proportion of beneficiaries under 5 years shows poor links with mother and child health programmes. Gender disparities in access might be due to population characteristics in rural areas, with high rates of male migration, but also to isolation of women due to gender barriers. Further research is needed to better define rehabilitation needs in rural communities, considering population features and gender issues, and to look at sustainable models of rehabilitation services for continuous care to all segments of the population.
Implications: The government of Nepal should identify strategies to integrate rehabilitation units into the health system, in coordination with existing rehabilitation programmes. Access to timely care could be improved by strengthening early detection mechanisms among health staff and referral procedures to existing community-based and specialized rehabilitation services.
Funding acknowledgements: The authors would like to thank DIFD for funding the project in Nepal : “Rehabilitation Services Support´
Topic: Disaster management
Ethics approval: Ethics approval was not required for this project
All authors, affiliations and abstracts have been published as submitted.
