Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 29 th April 2015   1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. The meeting intent is an operationally focussed daily Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Introductions/attendees Partner name Rescue Net Norway Red Cross Canadian Red Cross Japan Red Cross Qatar Red Crescent Americares IOM UK Govt/Save the Children Italy Rubicon/Amercian Nepal foundation Ways for water JICA (Japanese Govt) Handicap International Capability Type 1 Type 2 Type 2 Type 1 Type 1 Type 1 (two teams) Nil Type 2 without facility Israel Defence Force Humedica (Germany) Type 3 Type 1 with light surgical capacity Type 1 mobile Type 1, but can become 2 if needed Ortho-plastics specialist team Type 1 Nil Lands AID (Germany) IMC MdM Spain NATAN (Israel) Nick Simmons Institute Comments 60 beds 40 beds +MCH component 15-20 beds 10-15 beds Camp management Type 2 Type 1 mobile Nil Type 2 Specialist rehab services Provides WASH Physiotherapists etc working in national hospitals To work in national hospital Curative services in Nepal hospitals programme WHO MOHP UNDAC-UNOCHA 3. Operational briefing Overview of impact on health system, numbers of casualties and current known FMTs deployed was shared. Up to 90% of primary health care structures in the 11 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 29 th April 2015     most affected districts have been damaged or destroyed. 3 district hospitals have been damaged and are not usable, requiring Field Hospital substitution. • • • Chautara, Sindulpalchock Bidur, Nuwakot Dhunche, Rasuwa The ministry decided to institute a “hub and spoke” approach to placement of large teams in strategic locations based on previously existing hospitals and health care facilities, and with extra placement according trauma load. From each “hub” mobile teams, or smaller type 1 facilities will be dispatched to the remoter areas, to allow remaining trauma cases to be either treated or referred to the next level of care, including back to tertiary level care at the Kathmandu hospitals. Large numbers (over 10) military field hospitals have been deployed from the armies of India, China, Israel, Pakistan, Bangladesh, Sri Lanka, Singapore and Bhutan. 4. Information for partners FMTs were asked to register using the following process; • • • Register with either the WHO prior to arrival in Nepal, or with the Reception and Departure Centre (RDC) at the airport. Proceed to the Ministry of Health headquarters for certification procedures and tasking, bringing a copy of the registration form. a. Present a letter from your organisation with a short summary of your organisation type, and intent while in Nepal. The letter must include a complete list of all health practioners on the team, and their licence to practice certificates. b. Teams should show proof of the licence to practice/registration, ideally in a photocopy form that can be left with the application c. Teams will then be certified as licenced to practice medicine for a time limited period, and as a functional team, for the purposes of the response and relief effort for the earthquake. d. Teams can expect a formal letter from the ministry attesting o their certification, as well as a tasking to proceed to a specified area to undertake tasks in support of a specific district under the district health director. Teams were informed of some key clinical and management issues to be aware of during their mission in Nepal. a. Documentation of all patient care. In particular, detailed patient records of those requiring difficult procedures such as amputations, and cases that require follow-up and rehabilitation. Notes must explain the reasons requiring the procedures carried out, and copies given to the patient, the Ministry of Health and retained by the FMT. b. c. d. e. f. Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 29 th April 2015     Reporting to the MoH must occur at least weekly. A form for surveillance for Public Health issues and critical diseases, as well as numbers of trauma cases was described to the teams, with the final copy to be available tomorrow. Teams asked about medical waste management and were directed to both the FMT minimum standards technical document to which they had all agreed to comply, and to the Nepal ministry protocols for waste management. Sharps and contaminated waste are to be disposed of to a standard expected in the FMTs country of origin, and pose no threat to the local population. Protocols for the management of patients that die in a health facility were discussed. Unidentified patients are to be seen by the police who will take forensic samples and proceed from there. Those who die with family in attendance should have death certificate and police identification carried out according to local district protocols and handed over to the family. Teams were asked to comply with the Nepalese trauma standard guidelines which will be sent to all teams by email. Drug donations are to be only if on the essential drug list for Nepal, and in English or Nepali, and in date. All other drugs must be destroyed properly or taken home by the teams. Coordination meetings will occur every day at 15.00 for at least the first week of the response and until all teams have a primary tasking. Meeting adjourned at 16.30 All enquiries to; FMT.coord.nepal@gmail.com Dr. Ian Norton WHO FMT Coordinator nortoni@who.int +41795965730 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Thursday 30th April 2015 1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) Lt. Col. Dr. Naiban Bhakta Shakya (medical team coordinator for military response) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. This meeting is an operationally focussed daily Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Updates from the ministry and military The military medical operational leader briefed FMTs on the current deployment of up to 12 military teams and large field hospitals. He stressed the collaboration of military and civilian teams with the same goal of relief of suffering and saving lives. Both Lt. Col. Dr. Naidan and Dr. Kharki agreed with the proposal for a hub and spoke model of larger teams at strategic and district focal points, and smaller teams both fixed and mobile fanning out from these points. Referral would then be to the district hospital if the case was manageable at that level or to the tertiary care facilities in Kathmandu. 3. Updates from partners A discussion on the capacities of Urban Search and Rescue (USAR) and rescue affiliated medical teams was held. The Search and Rescue phase has been declared over on day 5, with a concentration on body recovery by some teams. Medical details from these teams (3-6 members often) are now free to respond in other ways. A brief discussion was held, and while some USAR medical personnel must depart in a few days, others could be reconfigured and strengthened to form mobile teams for difficult access area response in distant areas, for 2 weeks or more. In particular UK ISAR, UMKE Turkey and Norway SAR offered to respond, and will be available for tasking to this role tomorrow. Action: Teams available have been placed on a tasking list at the end of the meeting, and will be tasked tomorrow morning to districts with critical needs. The need for water, food and shelter as well as health care was highlighted, when teams described mobile units being asked for these essentials while they attempted to care for injuries and illnesses in remote clinics yesterday. Action: this will be raised at the Health cluster 1st May. Transport into remote areas has been difficult, and helicopter access has been difficult. Please note, those teams requiring helicopter access to be dropped at their agreed location will go through the logistics cluster focal point for requests. Recon missions via helicopter should be done sparingly, as all sectors have already been assessed, and needs are known and helicopters are vitally needed to transport food and shelter to those cut off from roads. Those who are going are asked to be exact in their manifests and persons travelling and be early for any scheduled departure. Failure to comply has resulted in loss of flights as pressure on air time is very high. Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Thursday 30th April 2015 Surveillance and reporting were highlighted as a key requirement for all FMTs using the Ministry endorsed form. Action: this was made available to all partners after the meeting in hard copy and will be sent in digital copy within 24 hours Difficulty to discharge patients from the major hospitals of Kathmandu was highlighted, with over 500 patients who have no homes to go to, waiting in hospitals for discharge. Action: continue to explore options with ministry and the Camp cluster/IOM. Review of comments from yesterday’s meetings for those not present included affirming the need for patient records, and the patients right to have a copy, the need for referral of cases when a team do not have the capacity to manage, and their access to rehabilitation and repatriation when they have been transported far from home. Participants will receive meeting minutes daily. Teams requiring tasking were asked to stay behind and have their details captured for tasking early 1st May. All participants were given surveillance forms to fill. Next meeting 1st May 15.00 Ministry of Health Meeting adjourned 16.15 All enquiries to; FMT.coord.nepal@gmail.com Dr. Ian Norton WHO FMT Coordinator nortoni@who.int +41795965730 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Friday 1st May 2015 1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) Maj. Gen. Prof. Dr. Kishore Rana (medical commander for military response) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. This aims to be an operationally focussed daily Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Updates from the ministry and military The Military mentioned that the majority of patients in Kathmandu are accommodated and being looked after. It was reported that there are shortages of specific medical supplies within Kathmandu, and the lists are available from the ministry. The majority of Kathmandu hospitals are now almost fully functional. Uncertainties outside the valley exist due to lack of communication and access (road, weather, terrain, etc.). Helicopters are being used for majority of district operations, but there is a severe lack of access to these. Reports are that up to 95% of houses are destroyed in some communities and those who have been injured are hard to reach. Many of the areas have begun to be reached by army teams doing surveys and rendering first aid. It was stressed that responders need to be self-sufficient as the military cannot guarantee provision of food, communication or shelter. He also stressed the needs at the health posts will be 3-6 months while they are rebuilt or replaced. Discharge of patients evacuated from the districts who do not have accommodation in Kathmandu and cannot return to their homes will be a growing issue in the coming days. The Ministry opened by thanking the teams for their assistance. He mentioned the necessity of take-over plans between emergency responders and existing local facilities to ensure a sustainable approach. He reminded teams that the current response must be integrated into the existing system and be able to adapt to possible future outbreaks or public health issues in the coming weeks. Planning for rehabilitation needs of those discharged post-surgery and with Spinal Cord Injury was emphasized as a priority. 3. Overview of previous updates for those not present at previous meetings Teams were reminded of;  The hub and spoke approach to building of response from central to more peripheral areas in each district  The shift in emphasis, particularly in Kathmandu from trauma to public health issues Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Friday 1st May 2015      The need for surveillance for outbreaks of illness as per the reporting guidance from the ministry. The importance of medical record keeping, with the record copy being kept by the patient, and in cases of amputation or other serious intervention, being copied to the Ministry for rehabilitation follow-up. Self-sufficiency and compliance with standards was emphasized. Linkage to health systems and referral between teams and to the higher level care system of the Nepal ministry was repeated. Discharge of patients with a treatment plan and follow up is required. 4. Tasking of teams Tasking’s were delivered to the following teams Team Task Location UK-Med/Save UK-ISAR/UK-Med MDM (+ Solidarite International for WASH) AmeriCare (LOGS) / NYC/medics( medical) HUMEDICA Canadian Military DART Surgical specialist cell Mobile clinics Nepal Medical College Hospital Sector south of Dhunche, (Rasuwa) Mobile for Charikot (Dolakha) Fixed and mobile type1 Mobile type 1(s) Jalbire (Sindhupalchok) Syaphru and north of Dhunche (Rasuwa) MDM Spain Surgical specialist cell and logistics support to damaged hospital Manthali (Ramechhap) Barpak (Gorkha) Czech AMP Japanese Military Heart to Heart Thai Military South Africa USA-Human Outreach Program Chanauta (Sindhupalchok) Balajor (Sindhuli) Thapalkot Bagmati Kurtipur (Kathmandu) Chilime (Rasuwa) Singapore Military Gorkha Camp (NW of city) A total of 83 FMTs have registered to date, with over 70 having been given tasks and locations. 5. Rehabilitation Handicap International (HI) discussed the importance of rehabilitation. Of a snapshot of the almost 300 earthquake injured patients visited by HI in Kathmandu hospitals over 60% had suffered fractures to limbs, sometimes multiple; head and spinal injuries were prominent. Patients from almost 10 districts were among those surveyed, meaning discharge home will be difficult. There are currently more injured females than males, (though timing and duties, such as meal preparation rather than outside activities may have possibly been a factor with the earthquake striking at 11.56am). There is an expectation that approximately 600 patients will require extensive post-surgery rehabilitation and all national facilities are currently full, particularly for spinal care. Human resources, in particular physiotherapists will be Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Friday 1st May 2015 required. A large number of assistive devices have already been distributed but more are still needed (crutches, wheelchairs, walkers, braces and slings). There is also a need to look at the provision of health care to those discharged, including rehabilitation, for the time it takes to get them back to their communities. The strengthening of capacity of existing health facilities and FMT run facilities in the area of rehabilitation was stressed. A hotline was suggested as an option for referral of patients requiring rehabilitation. Action: A small working group was formed directly after the meeting to progress urgently an options paper for presentation to the ministry and then partners. IOM reported that 2 out of 16 camps in Kathmandu Valley are now closed, with 24,000 persons still displaced, and unknown numbers outside of the Kathmandu valley. 6. Any other business The Ministry reported that there are have no instances of security issues when visiting communities and that armed police or military have been providing support where needed. If issues arise, whether security or through demands for basic needs, it was recommended to contact a nearby barracks or police outpost for assistance, and to remember health is one of several priorities for families affected by the earthquake, with food and shelter vital. This point has been brought up at the Health cluster and will be escalated at the inter-cluster level. A question was raised about salary guidelines when engaging local staff. This information is available on the MoF website and it was recommended not to deviate from the values by any significant amount. Action: To distribute recommended salaries for locally engaged staff in the form of web-link. http://mof.gov.np/en/document/index.php?page_no=2 Participants will receive meeting minutes daily. Meetings to be conducted daily for at least the immediate future. Next meeting 2nd May 15.00 Ministry of Health Meeting adjourned 16.30 All enquiries to; FMT.coord.nepal@gmail.com Dr. Ian Norton WHO FMT Coordinator nortoni@who.int +41795965730 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Saturday 2nd May 2015 1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) Maj. Gen. Prof. Dr. Kishore Rana (medical commander for military response) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. This aims to be an operationally focussed daily Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Updates from the ministry and military The Military commander described being comfortable with hospital status within the valley and majority of hospitals are full, but resuming normal functions gradually. There are still uncertainties with the status of damage in the remote villages but they expect to have reached all within a day or two. Kavre and Sindhalpalchok have more patients than expected. There was a description of the extensive recces and work by Army medical and rescue teams, and multiple sorties for delivery of vital food and shelter with very limited air assets. At this stage no possibility of transportation of medical teams as the Nepalese army have other life-saving and food delivery missions ongoing. He reiterated about self-sufficiency as no resources available for resupply or management of teams unable to care for themselves. Shelter, food, shelter, water, communication are vital. The Ministry welcomed new teams and thanked them for being here. Most medical teams have been deployed, with few requiring further tasking. Road to Dhunche is about to be cleared and connecting district roads also nearly cleared. Rasuwa will then be accessible, with plans for UK roving teams, Canadian Red Cross Field Hospital and Italian Level 1-2 team further north in Rasuwa. Continuous landslides north of Bahrabise and toward the Chinese border, with the Chinese helping clear the road from the north heading south. Many requests of food and shelter from vehicles moving into newly accessed area. Caution was urged about checking water sources before use by roving mobile teams due to animals decomposing in waterways. There are needs for psycho-social support as well as medical care and this should be bourne in mind by medical teams. WHO reiterated that dead bodies do not cause epidemics or disease, except in specific infectious disease cases, and referred to the WHO dead body management guidelines for reference for any teams that require guidance. FMTs need to work within district system and report on arrival to the DHO. Central ministry will provide a letter of dispatch. Respect the knowledge of district managers and potential for redistribution within district, please remain flexible to the needs of the MoHP. Reiterated hub and spoke approach of referral back to the nearest level 2 facility if beyond your capacity to treat. If capacity of your FMT is overwhelmed, Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Saturday 2nd May 2015 please referral back to WHO/MoHP FMT team for further assistance of other teams, both national and international. For logistics support for air-transport civilian teams are required to register using the form available at humanitarianresponse.info>>Nepal>>civ-mil. Please be sure to use these air assets with utmost respect, as every hour of flight time is precious, as is every kilogram of carrying capacity. Please advise FMT team 2-3 days before demobilisation so can ensure continuity. Surveillance is important, please report weekly using provided format. In that document you can report on exit. Provide details on diarrhoea, and a new form will breakdown causes to bloody, acute watery and “other” diarrhoea. Question re outbreak in the past was handled by the ministry: Diarrhoea outbreaks have occurred in western part of country, also in several other southern regions. Priority districts have historically had bloody diarrhoea outbreaks but not cholera. There will be an increasing focus on to public health phase from Monday onwards. 3. Tasking of teams Tasking’s were delivered to the following teams Team Task Location Rubicon NORSAR (if available) Italian Civil protection Canadian Military MSF Spain Helambu Basharka Syabru and surrounding villages North of Charikot Bidur? Indonesian BNBP Cuban Medical Brigade Mobile medical clinic Mobile medical clinics Mobile and light surgical unit Mobile medical teams Type 2 field Hospital with at least 20 beds Type 2 Field Facility Type 2 Field Facility Kathmandu Kiritipur A total of 86 FMTs have registered to date, with all having been given tasks and locations, and most now in process of deployment or fully deployed. 4. Reproductive Health The reproductive health team from WHO presented details of referral plans to key district hospitals with the capacity to manage obstetric complications/C-sections etc at the level of Complex emergency obstetric care. These are;  Paropakar Maternity and Womens Hospital, Kathmandu  Dhulikhel Hospital  Sheer Memorial Hospital, Banepa  Gandaki Zonal Hospital, Pokhara  Bharatpur Hospital, Chitwan  Lumbini zonal Hospital Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Saturday 2nd May 2015 FMTs with complex obstetric emergency capacity include;  Norwegian Red Cross Chatuara  Canadian Red Cross, Dhunche  MSF France Aragaat  Israel Field Hospital Kathmandu (till May 6th) 6. Any other business The ministry described the system of free medication for TB and HIV, and for teams interested in background to read the National Centre for AIDS and STD control (NCASC) for details. Treatment is free in Nepal, but break in medications for some time can increase the risk of multi-drug resistant TB and other issues. Action: FMTs to work with local counterparts to restart normal medication supply. Participants will receive meeting minutes daily. Meetings to be conducted daily except for tomorrow Sunday. Next meeting 4th May 15.00 Ministry of Health Meeting adjourned 16.00 All enquiries to; FMT.coord.nepal@gmail.com Dr. Ian Norton WHO FMT Coordinator nortoni@who.int +41795965730 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 6th May 2015 1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. This aims to be an operationally focussed daily Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Updates from the ministry and military Dr. Karki expressed thanks for the ongoing work and collaboration of all teams. He noted over 100 Nepali Medical Teams are working across the country, both mobile and as Type 1 fixed location teams, and called on the over 100 FMTs to work closely together, or if in the same location, consider working as a combined team. Communication at the district level was a key priority, and FMTs are reminded that their district Health office is their key contact point while working in Nepal, and secondarily the FMT coordination team in Kathmandu. He reminded everyone of the need to follow MoHP requests in terms of location to work. These had been carefully selected by the ministry/WHO FMT coordination team, based on need, District Health Officer request, and taking into account local sensitivities that may not be obvious to newly arrived teams. Dr. Karki mentioned that one or two teams have now been asked to return to Kathmandu because they had not been able to follow this request. 32 teams have sent in their surveillance forms, and teams are asked to send these in as soon as possible for the week just gone. A report of a cluster of diarrhea in a village in Sindulpalchowk was investigated by the MoHP rapid response team within 24 hours. Teams are encouraged to report any such cluster or issue and the MoHP have teams on standby to respond from the district and if needed the central level. The District office will provide a brief letter confirming work conducted on departure of an FMT and when returned to MoHP, along with the prescribed exit form (attached) a letter of appreciation will be provided. Blood and oxygen can be requisitioned through provided points of contact. Grandee Hospital in Kathmandu can provide medical waste disposal services. There is a WFP log cluster contact point for helicopter travel. All of this information is available in the new FMT coordination room (the meeting room at the MoHP). RH cluster have supplied RH kit to logistic management; please request for those who require it. Please support the young females in maintaining their dignity and recovery. Dr. Norton updated that 112 teams are now registered and deployed in country, with most now tasked. Note this number includes 13 military teams, who have been Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 6th May 2015 coordinated through the Military rather than MoHP. There are also several teams that have registered, but are here to begin long term projects with the MoHP rather than acute care as an FMT, or are awaiting tasking. Psychosocial support forum is available through a protection sub-cluster which meets after each protection cluster meeting. A support model has been developed and tested for Nepal and Dr. Kharki recommended that all teams use this national approach. Links on guidance is found at: http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-subsidi-tf_mhps-default 3. Coordination A 3 times weekly meeting, on Monday, Wednesday and Friday at the MOHP at 15.00 will continue this week. FMTs assigned to districts are reminded to check in and have regular contact with the District Health Office (DHO). These offices will now be supported with a WHO person, who can also be a contact point for FMTs if they require access to WHO. The list of key focal points at each district level has been sent to all FMTs. The DHO is in charge of decisions to re-task FMTs (mobile and Type 1) within their district on a day to day basis, if the FMT have finished their mission in a particular VDC. If the district has no further work for the FMT they should report to the FMT coordination team. If no further work exists and no retasking is available then they will be tasked to end their mission with thanks for their work. 4. Rehabilitation working group There was a brief update from the rehabilitation and discharge planning working group. A concept note has been prepared and will be distributed today with the minutes of this meeting. A presentation will be given a the next meeting. Multiple partners have expressed interest, both before and during the meeting, including Handicap International, UK-EMT, BRAC, Cuban Brigade, Thai-Medical rehabilitation team, Royal Melbourne (Australia) Hospital Rehabilitation team, Project Hope, CBM, Nepal Red Cross, Israel medical team, Mercy Malaysia. 4. Standing items Gender issues: Gender based violence and child protection issues are to be reported to a Hotline numbers 104 and 1098 respectively. Security updates: Nil to report from MoHP, no teams described any incidents Environmental issues: Recent Chinese team report of 83% of random water samples take from drinking water sources showed high coliform load. Dr. Kakri confirmed this is consistent with pre-Earthquake reports of 82% such contamination. Teams are Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 6th May 2015 asked to bear this in mind when using water within their facilities and for patient and team drinking water and appropriately treat all water to remove contamination. Coordination and reporting: Reminder to coordinate at district level with DHO, and to send reports of cases treated etc to ministry. Access: Road to Tatopani, Sindulpalchowk is still blocked and will require another few days. IFRC will continue to work with DHO to plan access and type 1 team deployment when access is available. Chinese medical teams have rendered emergency assistance already, and IFRC will support for a longer period in coordination with the DHO. Road access to Dhunche is now open to small vehicles, but not heavy trucks. Road is still blocked north toward Syabru and beyond but UK-EMT/Save the Children have accessed by helicopter and will continue with plans for type 1 support and longer term Health Post rehabilitation project for the area. They report a small number of diarrhea cases in the village and problems with WASH, food and shelter access. Damaged District Hospital updates; 4 hospitals are being supported by FMTs: 1. Ramechapp (MdM Spain). First 72 Metre tent has arrived after donation by WHO. WHO worked to arrange Nepal army assistance to clear site for tent construction. MDM expect at least another 5 or 6 tents to arrive in the next day or two to construct laboratory, outpatient, inpatient and other service areas. They have supported power and water supply and are working with the DHO to allow the district hospital staff to recommence full services within the tented structures. 2. Chautara, Sindulpalchowk (IFRC) 60 bed facility is functional, and is located 100 M from damaged Hospital. Surgery, emergency C-Section, x-ray and inpatient care is now open. 3. Dhunche, Rasuwa (IFRC) 20-40 bed facility is still under construction (road is now partially open but truck access difficult). Care has commenced at Type 1 level, but surgical and emergency C-section access should be available in the coming days 4. Bidur, Nuwakot (Bhutanese army) district hospital supported by field facility, but army will withdraw in 1-2 weeks and partners such as MSF Spain are considering ongoing support options. If other partners are interested in a longer term support programme in a tented facility then please contact the FMT coordination team at MoHP. Other large Type 2 facilities: MSF France have now a fully functioning Type 2 facility in Arughat, Gorkha offering emergency surgery and C-section, inpatinet care for over 20 patients and OPD services. JICA report their facility in Bharabise in Sindulpolchawk is open and able to perform emergency surgery but not C-section. Israel Defence Force Type 3 facility in Kathmandu will close by Monday 11 th May. Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting Minutes Wednesday 6th May 2015 AOB/Questions; IMC mentioned the importance of timely feed-back between partners at the district and national level, and between military and civilian teams, so that VDCs are not assessed as needing assistance by one organisation are not subsequently covered twice, by another team also assessing and responding. Participants will receive meeting minutes after each meeting. Meetings to be conducted Mondays, Wednesdays and Fridays. Next meeting 8th May 15.00 Ministry of Health Meeting adjourned 16.05 All enquiries to; FMT.coord.nepal@gmail.com Dr. Ian Norton WHO FMT Coordinator nortoni@who.int +41795965730   Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting th Minutes Friday 8 May 2015   1. Welcome, opening comments Dr. Kem Kharki (MOHP focal point for International Teams) and Dr. Ian Norton (WHO coordinator for Foreign Medical Teams, FMT) opened meeting. This aims to be an operationally focussed Coordination meeting for teams providing medical and health related care to the population affected by the Earthquake. 2. Updates from the Ministry of Health and Population Dr Karki reminded participants that it is now 2 weeks into the worst disaster in our lifetime in Nepal and thanked everyone for their moral support at this critical time. Dr Ian Norton visited some of the worst hit districts and FMTs over the last two days and the scale of destruction is evident. The ministry is planning for handover and takeover process so FMTs are requested to provide an exact date of exit and coordinate with the FMT coordination team. Dr Karki added that there is intention to create an earthquake book surrounding the disaster and would like to capture everyone’s contributions and thoughts about their time here. (Provide information to fmt.coord.nepal@gmail.com labelled clearly). Dr Norton informed that the humanitarian hubs are established in Gorkha (ocha.gorkha@gmail.com, Tel: 9824125560, OCHA office at the Hotel Gorkha Inn) and Chautara (hub.palchok@gmail.com , Sat Phone: +881 641436757). There are 7759 confirmed deaths and 16 434 are injured. More than 121 FMTs have been deployed, and two teams have departed. 3. Rehabilitation working group (Presentation by Brian) A rehabilitation network headed by Dr Bachchu KC (MOHP) has been formed. He is supported by Dr Guna Raj Lohani (MOHP) and Dr Khem Karki (NHRC). Alice Harvey and Peter Skelton from UK EMT is supporting is coordination. It is collaboration of WHO, IOM, Government and non-Government health facilities, NGOs and FMTs There are more than 1000 patients requiring ongoing care and 700-800 will need accommodated care mostly orthopaedic. Also there are more than 200 patients with spinal injury many with neurological deficit. Patients need to be accommodated in step down hospitals. Some existing facilities can be utilized and some needs to be built. Up to four facilities are required in Kathmandu valley. Collation of Information on which patients need step-down care and rehabilitation is handled by co-ordination team – MoHP and UK-EMT. A hotline   Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting th Minutes Friday 8 May 2015   will be established by HI for information, and for referral, as well as an email, that is already active (see below). Physical rehabilitation needs, assistance devices needs, psychosocial needs, shelter / ongoing accommodation needs and transport needs are to be identified. FMTs are requested to notify suitable cases to co-ordination team and advise capacity to receive suitable patients into district facilities. Contact: rehabclusternepal@gmail.com 4. Logistics support for medical teams Reminder that all registered teams need to be self-sufficient for first 2 weeks; if requiring additional stocks contact: Mr.Purushottam (Puru) DHAKAL Ministry of health Tel. 9843493101 Email : puru_dhakal@yahoo.com Do not proceed with vaccination programmes without consultation as MoHP have existing programs. 5. Medical Evacuation In case of emergency for team members, medical evacuation by private helicopters is available but be aware it needs to be self-funded or by the insurance company of your team. Contact details are below: SHREE AIRLINES shreeair@shreeair.com, Tel: 9851020639, 9851026197 6. Update from an FMT – Israel IDF medical corps (Presentation by COL. Tarif Bader –Commander) A Type 3 FMT, IDF has 129 Medical personnel with 45 medical officers. It has treated 1299 patients in the period of 4/29/2015 to 5/8/2015. Out of 104 procedures, two thirds are orthopaedic surgeries. EQ related patients are decreasing to less than 10%. It is being demobilised from 9th May at 1200 and will refer patients to nearby facilities in Kathmandu. However there are issues with 4 patients still intubated, with the receiving ICU unable to provide the required hardware so if any teams have   Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting th Minutes Friday 8 May 2015   spare ventilators, please advise, and they will be returned directly after the patients have been weaned (4-7 days). The team also demonstrated an electronic medical record system where all patient information is captured digitally and available for display at once, or printed out for patient discharge. There may be application for future responses where FMTs can share such information between each other and report to the Ministry in almost real time. 7. Updates on hospitals Ramechapp (MdM Spain) is returning to normal capacity and can take referrals but no C-section or major surgery, as this did not exist prior. Chautara, Sindulpalchowk (IFRC) can take referrals (including C-section and emergency surgery). Dhunche, Rasuwa (IFRC) can take referrals (including C-section and emergency surgery). Bidur, Nuwakot (Bhutanese army) will be demobilising but currently can take referrals (including C-section and emergency surgery). Dr. Karki and Dr. Norton will report on their field visit to the site and meeting with partners at the next FMT coordination meeting. MSF France in Aarughat FMT is up and can take referrals. Canadian RC in Tatopani are providing basic health care from yesterday for three weeks. JICA (Japan Govt) Type 2 is open in Bharabise (Sinduhpolchowk), as is the Type 2 of the Italian Govt in Betrawati (Nuwakot) Langtang has suffered massive destruction due to avalanche and will not require an FMT because any survivors are no longer in the village. 8. Standing items Gender issues: NTR Security updates: Communities are reported to be very appreciative of the FMT services. FMT coordination team will provide an aftershock map. Please be cautious when using damaged buildings for sleeping or other activities.   Environmental issues: NTR Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting th Minutes Friday 8 May 2015   Coordination and reporting: Reporting from about half the teams is still missing. Please be mindful it is a requirement for recognition, surveillance and capturing patient records. Be in email group of the FMT coordination cell (fmt.coord.nepal@gmail.com) and you will be provided a cover note, reporting form and exit form. FMTs should provide daily surveillance reports to the FMT email account by 1600hrs using provided form. Medical team exit process: FMTs need to coordinate with the District Health Office (DHO) and WHO field coordinator for the exit process. Advance notice of withdrawal is required and much appreciated. FMTs need to submit service related data to the DHO first. In case of inpatients and operated cases, detail case profiles need to be submitted. The medical team then receives a brief acknowledgement letter from the DHO. Along with this letter an exit report needs to be submitted to the FMT coordination cell (FMT CC) at Ministry of Health and Population. The FMT CC verifies the information and HEOC will issue letter of appreciation to the medical team. The procedures at the MOHP will be rapid, but please leave at least an hour and a half for the processing of this appreciation letter. In case of donation, the teams should submit a list of equipment and tents to be handed over to the DHO or Logistics Management Division (LMD) and get a receipt so this can also be reflected in the letter of appreciation. (See attached detail process of exit and FMT exit report form for use) Access: Road to Tatopani is open. Potential for landslides with monsoon rains but already considered by GoN. Dr. Norton provided detail on an aerial recon flight over the road north of Dhunche to the border, there are two blockages being worked on within 1km of the town, byt then the road is relatively clear to Syaphru. The road north to the border from there has been completely lost, or covered in deep avalanche in at least 15 places and is very unlikely to be cleared soon. The final avalanche at the border itself is estimated over 50M high and several hundred metres wide AOB/Questions; Some hospitals are reported to ask money with the patients. Dr. Khem said this is against the directive issued and the government will take action. Participants will receive meeting minutes after each meeting. Meetings to be conducted Mondays, Wednesdays and Fridays.   Next meeting 11th May 15.00 Ministry of Health Meeting adjourned 16.05 All enquiries to; FMT Coordination Team WHO / UNDAC / MOHP Operations Cell at MOHP Conference room, 1st floor fmt.coord.nepal@gmail.com + 977 9801083421 Nepal Earthquake 2015 Foreign Medical Team Coordination Meeting th Minutes Friday 8 May 2015   FMT Meeting Minutes from the 14th May 2015 lead by Dr. Khem Karki (MoHP), Major General Prof. Dr. Kishore Rana (Nepalese Military),  Dr. Ian Norton (WHO). Time: 3:00 PM ­ 4:00 PM 1. Updates 1.1. Update from the WHO Dr. Ian Norton introduced Flavio Salio as his replacement for WHO Coordinator for Foreign  Medical  Teams.  He  provided  updates  on  the  second  earthquake  on  12th  May,  2015  with  epicenter  in  Dolakha  which  has  resulted  in  reported  80  deaths  and  1961  injuries.  Level  2  civilian and military Indian and Nepali teams have been attending the victims in Charikot at a  field hospital and have seen at least 114 casualties. There has been conflicting numbers on  the number of casualties. At present there are no gaps to be addressed by FMT deployment.  However, gaps still exist in hospital tents and maternity tents in the affected areas.  He informed that 72 FMTs currently deployed. Although the total numbers are fluctuating, we  know of at least 49 FMTs which have left or are leaving in the next day or so. 1.2. Update from the MoHP Dr.  Karki  informed  that  the  second  earthquake  which  caused  major  destruction  in  Dolakha  was quite manageable.  NHRC  is  conducting  a  three­day  training  course    to  the  local  health  workers  working  in  surveillance  with  the  help  of  the  Chinese  Medical  team.  It  also  includes  management  of  reproductive health in crisis. There are around 30 local participants, who, on completion of  the  training  will  be  competent  in  field  investigation,  post­disaster  surveillance  and  management of reproductive health in crisis.  Cuban team has almost established hospital at Kirtipur  and will have rehabilitation facilities.  They will work with Ayurveda hospital and Phect hospital and will have a total of 150 beds. Furthermore, he emphasized that reconstructing health facilities is a prime issue. MoHP has  started formal discussions with external development partners and will be continued.  Psychosocial cluster is also working together and we will need updates from them too. He inquired about difficulties in the field, especially in Tatopani and Barabise. Also asked the  FMTs to use  new account info@fmtcoord.org for sending their  reports and any other  communication as required. 1.2. Update from the Military Director  General of Medical services of Nepal Army Dr.Rana provided the following  updates:  Death  toll  has  reached  8219  as  of  today.  Nepal  Army  is  involved  mainly  in  Search  And  Rescue,  the  operation  resumed  after  the  second  quake  especially  in  Charikot  area  where  most  houses  have  collapsed,  and  also  in  the  valley.  Almost  80  people  have  died  from  the  second  quake;  most  of  these  deaths  are  in  Dolakha    i.e.  37.  There  were    1299  injuries.  27000 houses in Kathmandu has been destroyed beyond repair. Nepal army  rescued 175  and US army rescued 42 from Langtang after  the second quake. However, the rescue has  been stopped due to difficult geographic conditions. The  Nepalese  Army  had  15  foreign  medical  teams  in  the  country.  To  this  date  there  are  5  teams still continuing their service in the deployed area. A combined Indian Nepali Level 2  team  has  been  deployed  at  Charikot  to  deal  with  surge.  It  has  provided  triage/  primary  trauma  care  to  114  patients.  Canadan  Military,  Pakistan  Military  and  Indian  Military  teams  have been deployed in Sukute, Bhaktapur and Sinamangal respectively. These teams were  asked to hold their departure due the second quake but are likely to  leave soon due to low  severity of new quake. Indonesian military team has left (and been replaced by civilain team),  Half of the Bhutan  team has left and the second half leaves by Sunday.  Estimated 600 medical facilities have been destroyed and concern is rebuilding them. In  Kathmandu  valley  most  hospitals  are  fully  functionning.  Army  hospital  has  been  destroyed,  however  it  is  providing  services  from  the  tents  outside  the  building.  Other  hospitals like Bir Hospital and Om Hospital are paritially damaged  but are doing the same.   Most of the roads are open and functioning now. 3. Other 3.1. Safety and Security Issues The major issue is the safety of own teams and patients after the major aftershock.  Everyone is advised not to use buildings to sleep in, especially if they appear damaged.  Thankfully on the check with all FMTs, no casualties has been reported. Lanslide risk will increase with the coming rainy season. 3.2. Gender Issues NTR 3.2. Environmental Issues One Landslide blocked a road in the Tatopani region ­ now unblocked again ­ there is a  serious risk for landslides. Sunkoshi dam is the name FYI. Dr.  Karki  reminded  the  FMTs  to  seek  help  of  Grande  Hospital  for  hospital  waste  Management if required. The Chinese Medical team in coordination with Epidemiology and Disease Control Division  (EDCD)  and  National  Public  Health  Laboratory  (NPHL)    has  collected  232  samples  ­  180  water, 40 stool and 56 stool swap, and will submit the report formally tomorrow on 15th May  .  2  stool  samples  are  found  positive  for  V.  cholera  and  1  positive  for  Shigella  from  Kathmandu valley. The positive news is there is no indication of outbreak from anywhere. 3.2. Coordination and reporting Many teams are exiting but only a handful have submitted an exit report. FMTs are requested to provide the exit report as this is crucially important for the Ministry for further  use. Surveillance forms are not coming in very often; we implore you to report back on a daily  basis using info@fmtcoord.org  gmail account.  We lost 12­24 hours of surveillance because  of failing gmail account. Please re­send any forms you think may have been lost in this time. All  reporting forms can be accessed through:  www.humanitarianresponse.info  (http://www.humanitarianresponse.info/en/operations/nepal/foreign­medical­team­wg ) 3.2. Remote Area Access http://logcluster.org/ops/nepa  provides updates to road access. Tatopani - Canadian Red Cross working there had to be evacuated due to the destruction caused by the second earthquake. According to the team, there are lot of damage and it is very unsafe. Their equipment are still there, taken care by a local security guard. Redeployment is under discussion. According to the Japanese team  working in Barhabise, road is blocked around field hosptial.  There are no casualties in the region. JICA team has been evacuated because of landslides  and are now working in Dhulikhel Hospital Emergency department until May 18, 2015. MSF working in Dolakha rediverted medical teams to region and evacuated 6 people to  KTM. 5 causalties in the field.  3.2. District Hospital Status and updates from the teams Ramechhap:  MDM    Spain  is  supporting  district  hospital  in  Ramechhap.    7  patients  were  injured; no reports of deaths. They will start psychosocial support program soon.  Chautara (IFRC):  There were 80 disaster related  casualties  after the second earthquake.  Psycological  first  aid  also  being  provided.    The  hospital  is  functioning  well.  National  Red  Cross Society has been set up near the hospital to provide some first aid. Nuwakot: Post exit plan in Bidur exists.  District hospital has prepared ground. Italian team  has donated a tent. Unicef and Save the Children also donated tents.  By next week district  hospital  will  be  functional.Tents  will  be  used  for  indoor  patients.  Govt  doctors,  Italian  team  and  Red  Cross  led  by  Nepali  doctors  will  work  there.  On  12th  116  paitents  visited  Italian  team. Ambulatory part has been donated to Trishuli hospital as well as old equipments has  been transferred. Dhunche: No issue after the major aftershock. Gorkha : 3 minor injuries  Arughat: Patients are low­ 9 patients, half are injury cases. Small outreach teams are  working as well. No new injuries from the new quake. Samaritans  Purse­  3  small  teams  are  deployed  in  Dolakha  for    initial  assessment  and  WASH. Health facilities at Simigaon has been  completely destroyed. No casualties due to  the earthquake. Only 30 tents have arrived from Government and they are asking for tents  for health post and medicines/matress. Medical team in Pangtang: French team doing 60­70 consultations a day. The team is  coming back tomorrow on 15 May Team Rubicon: 16 patietns in Barwa area after earthquake. No evacuation was needed. Japanese team  in Melamchi are fine continuing to work from tents. Few casualties, one  death, one head injury and some small injuries. Czech­ Receving 23 casualties per day Thailand team working in Sipaghat: Have splitted into 3 groups to respond at health post.  It  is  handling  minor  surgical  cases  as  well  and  mobile  teams  went  up  and  saw  40  cases­ regular disease. Disease prevention team is  teaching how to care for themselves and health  promotion. Next team  is coming tomorrow. Departure date is not sure yet. Chautara (South korean): Mobile teams in different areas of Chautara. Humedica, Jalbire­ One seriously injured flown to Kathmandu. Road is blocked. Received 6  minor cases from Ghatlang after the second quake. Left Jalbire due to bad wheater.  Cuban team: Arrived yesterday and are in Kirtipur. The hospital will be inside the Ayurvdea  Center and camping out as residence. OPD starts from 15 May and embedded some Nepali  team  to  increase  capacity.  Right  now  there  are  20  beds,  basic  surgery  will  start    from  day  after tomorrow. Ready to deploy mobiles from 15 May and ready for rehabilitation work in 2­ 3 days. Rehabilitation:  There  are  60  beds  for  spinal  injury  patients  in  Anandaban  Hospital  and  Green Pastures and the hospitals are running out of capacity. Spinal center is increasing its  capacity to take more patients. Handicap International is setting up a focal point outside Bir  hospital  to  address  the  demand  for  rehab  prosthesis  and  assistance.  If  anyone  requires  equipment, please contact them.  Rehab cluster group is working for the same and is assessing Dolakha facility to see if there  is  any  need  there.  Next  meeting  of  Rehab  cluster  is  at  9  am  tomorrow  morning  at  NHRC  Hall. The medical rehab team from Royal Melbourne University Australia treated over 300 spinal  injuries  in  the  past  5  days.  They  worked  with  Handicap  International  on  community  based  rehab and referrals. There has been 30% increase in pressure sores in spinal injury patients.  The hosptital currently has 88 paraplegics, and 50 more are coming in tonight. Army hospital­ Dr Rana provided update on status of Army hospital. It is  paritally destoyed  after the first quake. ICU patients were inside the hospital but everything was shifted outside  after the second quake. It may take 6 months for the entire hospital to be reconstructed. It is  490 bedded tertiary level hospital , now catering to 125 casualty patients.At present it is only  taking  emergency  and  trauma  cases,  OPD  cases  will  open  in  a  few  days.  Army  to  be  contacted for any evacuations. Bir hospital is also functioning outside. Almost all of IPD department is damaged.  Patan hospital is partially damaged. Civil hospital is okay. Orthopedic hospital only OPD is  fine.  B  and  B    is  alright.  Most  part  of  Grande  Hospital,  Om  Hospital  and  Medicare  are  unusable.  All  together,  700  bed  have  been  decreased  within    the  valley  and  with  reduced  capacity should any new crisis arise. 4. Any other business:  Contact  Rajib  Pokharel  at  Airport  Custom    9841272138  in  case  of  any  inconveniece  regarding to custom clearence. Tents: Americares has 5 tents ­ 45 by 45 feet coming from India and 5 more from USA and  Amersterdam  each  (25  beds)  .  Global  medics  from  canada  16  by  16  sized  ­9  tents,  and  eureka 32 by 20­ 2 tents. 5. Meeting practicabilities Participants will receive meeting minutes after each meeting. Meeting closed  at 16:00 hrs. Next meeting on Monday, 18th May, 2015 15:00 hrs at Ministry of Health and Population  Conference Room, 1st Floor. All enquiries to; FMT Coordination Team WHO / UNDAC / MOHP  Operation Cell at Research Section, 1st floor Nepal Health Research Council (NHRC) info@fmtcoord.org  + 977 9801083421 FMT Meeting Minutes from the 18th May 2015 Chaired by Dr. Khem Karki (MoHP), Col. Dr. Arun Neupane (Nepalese Military), Dr. Flavio  Salio (WHO)    Time: 3:00 PM ­ 4:00 PM  Flavio  welcomed  all  FMTs  to  the  meeting and  introduced  Col.  Dr. Arun Neupane from the  Nepalese Army in the absence of Maj. General Prof. Kishore Rana.    1. Updates 1.1. Update from the WHO   Flavio  highlighted  the  issue  of  retasking,  and  raised  daily  surveillance  reports  as  an  issue​ .  He discussed medical needs. Medical needs in affected areas still include maternity  and  hospital  tents.  There  is  the  need  for  psychological  support,  which  has  been  further  exacerbated  by  the  12th  May  aftershock.  There  seems   to  be  no  requirement  of  further  medical  teams   from   outside  Nepal,  though  redistribution  in  Sindhupalchowk  may  be  required.  Flexibility  of  teams  is  needed  in  regards  to  tasking.  E.g.   level  2  team  may  be  tasked as a level 1 based on the needs communicated by district and MoHP.    Flavio  presented  maps  of  districts  severely affected  by  the aftershocks of 12th of May. He  also  presented a map depicting health care facility  damages in Dolakha as of 10th May, as  well  as  a  graph  of  FMTs  deployed  in  Dolakha  as  of  17th  May.  He  mentioned  that  discussions   are  ongoing  regarding  deployment   in  Dolakha,  and  that  he  will  ask  some  FMTs  to  provide  information  on  their  movements,  in  particular  International  Federation  of  the Red Cross and MSF.    On  the  topic  of  reporting,  Flavio  stressed  the  fact  that  the  number  of  FMT  daily  reports   received  is  still low​ . 56 FMTs are deployed at present, and the highest number of reports  received  so  far has been less than 20 a day. He asked FMTs why they are not sending the  reports.  This  information  will  be  used  to  retask  the  teams.  Only  45  teams  have submitted  at   least  one  daily  report,  and  only  17  have  submitted  exit  reports.  From  a  project  management  side,  Oliver  ​ asked  the  teams  to  fill  in  date,  district,  FMT  name,  location  and  date,  while  they  send  their   daily  surveillance  forms.  Without  this  information,  surveillance  is  not  possible.  He  also requested that  teams update their contact information  and  departure  dates  in  order  to  facilitate  planning  structured  handovers.  A  letter  of  recommendation  from  the District  Health Officer is required to get the letter of appreciation  from  MoHP,  along  with  exit form. He said that the FMT coordination team will send  out the  daily  surveillance  form  in  an  Excel sheet format as of tomorrow for teams  to fill out instead  of   word  document  of  the  form,  ​ which  will  make  life  much  easier  for  FMT  coord  team  moving forward.    A  snapshot  was  shown  of  total  cases  treated  by   FMTs:  28,372  OPD  cases,  1499  IPD  cases,  440  major  surgeries,  158  cases  referred  from  FMTs  to  hospitals,  6073  trauma  cases,  2,793 ARI cases and 308 deaths reported.     1.2. Update from the MoHP   Dr.  Khem  B  Karki  provided  an  update  from  the  MoHP.  He  thanked  all  FMTs  for   their  support and tireless efforts in the field, as well as for attending this meeting.    He  apologized  for  not  being  able  to  use  the  MoHP  meeting  hall:  following  damage  sustained  on  the  May  12th  earthquake,   engineers  have  assessed  the  building  and  deemed  it  unsafe.  As  the  UNICEF  tent  is  too  noisy,  the  meeting  is  being  held  in  NHRC  meeting  hall.  He  added  that  Italy  Civil  Protection  and  JICA  will  be  leaving  by tomorrow  ­  two huge groups that we are farewelling fondly.    This  morning   the  Bidur  office  was  contacted  by  Dr.  Karki.  Operations  have  already  been  handed  over  to  the  district  hospital  there,  which  is  now  supplied with  Italian  commodities  and  a  tent. Other  teams  including  MSF  and  an  Israeli  group are working there. Qatar Red  Crescent  was  not.  Bidur  has  need  of  medical  doctors  and  nurses,  but  the government  of  Nepal  has  plans  to  recruit  Nepalese  doctors and nurses in the very near future to fill these  gaps.    Dr.  Karki  described  his  and  Flavio’s  visit  to Melamchi.  They  went  there  yesterday to meet  with  medical  teams  on  the  ground:  the  Czech  Medical  Team  and  Japanese  Red Cross,  and  spoke  with  the  private  health  care  workers.  There   is  very  good  work  going  on  and  cooperation  between  teams.  The  Czech  team  have  a good generator, while the Japanese   team  have  an  X­ray,  which  are being  shared  synergistically.  A  young doctor  recruited as  medical  officer  is  in  command  and  is  doing  a  surprisingly  good  job.  In  a  very  short period  of   time,  an  exit  plan  was  developed,  meaning  primary  health  care  services  in  Melamchi  can  take   over.  The  Czech  team  is  leaving  within  2  weeks,  while   the  Japanese  team  is  staying for 3 months to conduct activities including WASH, nutrition etc.    He  also  shared  a  tale  of  improper  practice  in  the  field  which  should  be  avoided.  In  Dubachor,  near  Melamchi,  unknown  medical  team(s)  treated  wounds   without  cleaning/sterilisation,  approximately  48  hours  after  the  earthquake.  These  patients’  wounds  are  now  all  infected.  The  team(s)  went  there  directly  and  started  work  without  being deployed. This case must be followed up to identify the medical team(s) responsible.  The  avoidance  of  situations  such  as  this  is  the  reason   coordination  and  regular  communication is critical.    Dr.  Karki  added  that  it  is  important  to  maintain  a  global  list  of  FMTs,  detailing  with  their  strengths  and  performance  history.  This can  be  referred  to  times  of  disaster  anywhere  in  the  world,  and  the  best  teams  can  be  dispatched.  Not  all  teams  are  necessarily desirable  or  able  to  be  useful. For example, a team of 19 people recently approached him asking for  deployment   instructions.  However,  the  team  was  not  self­sustainable.  They  were  without  medical  supplies,  appropriate  staff,  water  and  related  necessities  for  effective  operation.  This  is  another  reason  for  requirement  of  FMT  registration  and  surveillance.  There  is  a  greater need to have effective information systems.    Flavio  added  that  the  WHO  is  preparing  such  a  recording  system   for  global  disaster  responses. It is likely the process will be active as of the second half of 2016.    Dr.  Karki  reiterated  the numbers of FMTs and their various statuses. There have been 140  teams  from  38  countries. Of  these,  56  FMTs are still deployed, 70 have left, 9 teams have  unknown  status  and  the  rest  either  left  after  assessment   or  were  not  applicable.  These  unknown  teams  came and registered,  then  deployed  by  themselves  rather  than  returning  the  next  day  for  instructions,  so  they’re  now lost. Generally we do not have contact details  for   them.  It’s  possible  that  they’ve  done  good   work,  but  it  is   not  recorded  anywhere  or  known.    1.2. Update from the Military   Dr.  Neupane  gave  an  update  from  the  military.  He  said  as  far   as  military  support  is  concerned,  from  day  zero till  now  there  have  been  a  good service. Military teams have all  departed  bar  one,  which will depart next week. All gaps  will be filled by MoHP and national  military  teams,  which  are  getting organised  quite  well.  He  has  seen that the health cluster  is  doing   a  great  job.  Activities  are  much  more  organised,  which  should  be  commended.  One  issue  is  the  small  amount  of  medical  support  that’s  been   able  to  reach  remote  locations,  so  the  Nepalese  Army  Medical  Corps  is  going  to  these  thus  far  unreached  locations  to  fill  in  the  gaps.  There  are  two  more  mobile  field  hospitals  being  set  up,  and  vehicle­mounted  field  hospitals  which  were  meant  to  arrive  a  long  time  ago  and  have  finally arrived in Kathmandu and will be deployed shortly.    There are two epidemic prevention teams from the Chinese government (civil and military),  specialising   in  assessing  water  sources  and  toilets,  and   monitoring  sanitation.  The  civil  team  tested  water  sources  and  the  military  team  had  subsequently sanitised any problem  areas,  and  they’ve  played a very significant role in  preventing the spread of communicable  diseases.    Nepalese  military  air  assets  can  be used when required and requested through the proper  channels.  They  evacuated  a  newborn  baby  with  respiratory  distress  from  Dhunchhe  ­  IFRC  Hospital,  which  made  the  front  page  news  in  The  Kathmandu Post a couple of days  ago.    Villages  are very  scattered so health access is a challenge. VDCs are broken into 9 wards,  potentially   spread  across  4  mountains.  As  such,  it  may  appear  a  small  area on  the  map,  but in  fact be very large on the ground and difficult for  people to move around. Large FMTs  are  therefore  requested  to  send  satellite  teams  to  service  the  wider  area.  This  is  more  effective than staying in one location.      3. Other 3.1. Safety and Security Issues   The  Nepalese  Army  is  distributed  in  567  places  in  earthquake  affected  areas,  as  well  as  permanent  camps  in  villages.  If  you  have  any  safety  or  security  issues,  please  report  to  them.    Bob  from  Team  Rubicon  raised  a security issue faced by his team. A female burn victim in  the  Surmitan  area  came  to  their  camp  and  was  treated.   The  local  army   was  called  to  provide  evacuation,  and  advised  that  this  couldn’t  happen  until  the  morning,  when  they  would  send  transport.  However,  Nepali  police  forces  showed  up  in  the  morning.  It turned  out  that  the  patient  was  a  domestic  abuse  victim,  and  locals   accused  Team  Rubicon  of  calling   them.  Luckily  the  situation  was  defused,  but  there  is  much  grief  and  stress  in  affected  populations,  and  sensitivity  is  paramount.  Counseling  and  training  of  locals  is  important, and it is critical to have a local translator working with all FMTs.    Sam  Taylor  from  MSF  shared  another  security issue.  While  assessing  small communities  in  Dolakha  yesterday  by helicopter, landing was not possible in several instances because  of   the  danger  of  the  helicopter  being  swarmed.  Some  villages  have  not  been  seen  for  more  than  3  weeks,  so  there  is  anger,  stress  and  impatience.   MSF  is  flying  with  experienced Nepali pilots who are making judgements about when it’s safe to land.  3.2. Gender Issues   NTR    3.2. Environmental Issues   Flavio  stressed  that  ​ it  is  the  responsibility  of  FMTs  to  handle  medical  waste  management​ .  It  is  advised  FMTs  ensure  they  have  the  capacity  to  treat  waste  onsite.  If  not,  they  should  coordinate  with  Nepali  military  forces  near  the  service area.  The MoHP  has  requested  the  military  support  anybody  who  approaches  with hospital  waste. Medical  teams  who  can’t  manage  medical  waste can also contact the Grandee Hospital, who have  an extensive waste management system and can accommodate FMT waste as well.    A  meeting  participant suggested  that  FMTs with mobile clinics in  camps should go beyond  providing clinical assistance, to also stressing hygiene and health education to locals.    3.2. Coordination and reporting   IOM  is  facilitating  step­down  and  relocation  of  patients.  They  requested  that  departing  FMTs  provide  them  at  least  2­3  days  notice  for  any  patients  that  require  transportation  or  step­down. Calling on the morning of their departure is not acceptable.  Flavio  reminded  all FMTs with  departure dates to work on their exit plans. Also take stocks  of   all   assets  being  left  behind  so  that  distribution  can  be  coordinated  according  to  the  needs communicated to WHO/HEOC.    Dr.  Karki  showed  a  graph of  FMT  departure dates. This information  is important for MoHP  to have in order to plan takeover of health services that were being provided.    3.2. Remote Area Access   Dr.  Karki  said  that  there  was  a  request  for  support  from  Dolakha   District  Health  Office.  Following  that,   MSF  has  committed  to  providing  logistics  and  health  materials  for  3  months,  so  that  even  in  the  face  of  monsoon  season  and  potential  landslides  they  will  have stocks to continue their services there. He thanked MSF for taking on that challenge.    Sam  Taylor  from  MSF  said  that  they  will  work in  13 VDCs listed as affected by the DHOs.  MSF  will  be  stocking  most  damaged  health  posts  with  3­4  months   of  drugs,  and  taking  shelter  materials  to  the  worst  damaged  areas.  They  have  access  to  a  number  of  small  helicopters   and 300 tonnes  of  material  that  they’d  like  to distribute. They  have  conducted  assessments  and know where  it  needs  to  go,  but  are  having  difficulty  getting heavy lifting  helicopters,  and  instead  are  flying  up  to  20  rotations  per  day  with  small  lifting  helicopters  which  is  suboptimal. He added that UN civil military has not given any clear  answers about  what  assets  may  be  available  to  them.  It  is  now a race against time and has already been  2­3 weeks.  Dr.  Neupane  suggested  MSF  would  need  heavy  lifting  helicopters  to  Charikot,  and  they  could  take  smaller  helicopters  from  there.  He  informed  that  Army  HQ  has  a  brief  every  morning  with  OCHA  and  that  there  is  a system  in  place  for  actioning  requests  that  come,  including  medical  relief.  MSF  should  come  through  Dr.  Karki  or   OCHA.  Sam  said  he’d  already  tried  those  channels  and  action  was  not  being  taken  fast  enough.  Sam  was  requested  to  give  Dr.  Karki  a  load  table  which  representatives  from  the  Nepalese  Army  could assess.    Dr.  Khem  suggested  sending  materials  by  truck  to  Charikot   and   using  helicopters  from  there,  but  Dr.  Neupane  updated  that  road  access  is  not  possible.  Dr.  Khem  added  that  most  requests  are  covered  by  MSF in Dolakha. Singati is the hardest hit village, which the  Canadian  Red  Cross  and  some  other  group  have  been  asked  to  support.  Dr.  Mausam  from  Nepal  Red  Cross  confirmed  that  needs  look  fair  as  most  health  posts  are  not  functional.  The  Canadian  Red  Cross  is  planning  to  establish  a  base  there  in  the  next  few  days.     3.2. District Hospital Status and updates from the teams   Ramechhap (MDM Spain):​  No representative from  MDM spain present.    Dr.  Karki  mentioned  an  issue  recently  took  place.  Some  members  of  a  mobile team  went  into  the  community and talked about  religious  issues,  which  angered  the  locals. It is not a  time to discuss anything publicly except medical needs.    Sindhupalchok/Chautara  (IFRC):  ​ The   ​ Red  Cross  there  is  offering  surgical  care  and  mobile clinics, as well as taking referrals from another team.     Nuwakot   (Civil  Protection  Team):   ​ The  Italian  Civil  Protection  Team  is  departing  tomorrow.  The  meeting  representative  would  like  to thank everyone, especially the central  government.  There was  very good  coordination  between  central  and  local government he  said,  which  facilitated  the  Italian  FMT’s  actions.  He  met  the  MoHP  representative  who  visited  their  camp  and  the  local  DHO. The  MoHP  visit  was  very  important  psychologically  for the local people and the team.    He  added  that  they  were  supported  by  WHO  to  fill  the  famous  exit form. It  is an important  form  for   exit  customs  as   it  provides  proof  of  work  done  here.  The   Italian   team  added  another  appendix  to  the  two  existing  ones  ­  “material  on  arrival  minus  material  donated”,  i.e.  material  returning  to  Italy.  He  also  made  a  note  on  self­sufficiency.  Their  team  was  self­sufficient,  but they  made  a  waste  management  agreement  with  the  local hospital and  an  agreement  with  the  municipality  for  providing  water.  He  stressed  that it is important for  FMTs  to  be   self­sufficient,  and  for  the  government  to  support  them  in  whatever  activities  needed.  Another  important  factor  was  the  population  in  Nuwakot,  who  he  described  as  fantastic.  They  assisted  the  FMT  in  everything, offered dinner  to the Italian staff, and cried  on  the   last  day,  saying  “Don’t  forget  Nepal”.  The  Italian  FMT  members   cried  too.  He  concluded  that  it  was a  good mission for the Italian  FMT because the state was with them.  He thanked his colleagues, especially his officer who coordinated operations.    Arughat  (MSF):  The  hospital  is  up  and  running  but  receiving  quite  low  patient  numbers ­  not  sure  why,  though  possibly  patients  are  unaware  of its existence and are instead going  to   Gorkha.  Sam  said  that  the  team  is  going  to  do  community  radio  to  announce  the  presence  of  the  hospital.  Dr.  Khem  informed  everyone  that  he  would  be  visiting Arughat  tomorrow.  A lady from IOM updated that IOM has been requested to provide psychosocial support in  Gorkha.    Barhabise   (JICA):  ​ JICA  had  been  working  in  Barhabise.  They  saw  5­6  patients  in May  11th  and  12th,  and  after  that  went  to  Dhulikhel   to  help  coordinate.  They  spent  5  days  there, and are returning Japan tomorrow.  Flavio  thanked  the  JICA  team greatly for their flexibility and  for supporting the FMT Coord  Cell here at NHRC with staff.    Dr.  Khem  added  that  Barabise  was  a  very  difficult  situation  as  no   land  space  exists  to  establish  even  a  tent,  let  alone  a  larger  health  clinic.  He  informed  that  he  has  started  talking  with  political  leaders  to  seek  means  to  resume  primary  health  service.  They  have  doctors, nurses and supplies there.    A  local  woman  named  Sam  (owner  of  the  the  Last  Resort),  in  Listikot  VDC  above  Barhabise,  says  that  the  health  posts  in  Marming,  Chankhu  and  lower  villages  have  all  collapsed.   The  local  appointed  doctor  has  left  for  Kathmandu,  and  Hindi  health  post  has  collapsed.   Her  groups  is  working  with  a  local  health  worker  in   Thengthali  (a  village  in  Marming  VDC).  Many  local  villages  have  been evacuated and people have arrived in their  clinic,   but  they  don’t  have  necessary  health  facilities.  The  nearest  facility  is  Dhulikhel,  but  road conditions to get there are very bad.    Flavio said that he and his team discussed this with MoHP yesterday. Dr. Khem asked to  discuss this with them further after the meeting.    Cuban  team:  ​ Hospital  has  been  operational  since  yesterday,  and  they  have  performed  first  4   surgeries.  He   provided  lots  of  details  about  operations  carried  out  in  Lalitpur  and  Bhaktapur.  They  are ready  to tackle  more  complicated surgery patients and are in contact  with  the  Nepalese  Military. All  their  facilities are ready, although there are some shortages  with  chemicals,   though  these  can  be  discussed  bilaterally.  Dr.  Khem  said  that  some  requested  supplies have already arrived, but the representative from the team insisted that  oxygen and medical gasses have not arrived.     International  Medical  Corps:  ​ They  are  ​ providing  medical  teams in Gorkha and Dhading  ­  two  teams  in  both  locations.  Additionally  they are also providing WASH facilities, shelter,  protection  and  running  assessments  on  gender  issues.   Also  they  are  discussing  establishing rehab facilities in both locations to help with step­down.    MSF:  ​ It  is  ​ going  to sign a MOU with the Nepalese Orthopaedic  hospital, which is hoping to  increase their capacity with various activities    UK  International  rehab   sub­cluster​ :   There  is  quite  a  lot  of  support  within  Kathmandu.  The  Nepal  rehab  cluster  is  able  to  direct  to  services  such  as  physio  etc  when  contacted.  The  cluster  visited   Gorkha  district  hospital  yesterday  and  is  going  into   partnership  with  IMC.  Dr.  Khem  asked  to  make  sure  to  get  rehab  information  as  well  from  DHO  to  determine where priority areas are and also coordinate with MoHP.    IOM  have  a  patient  transport  number,  so  they  can  be   called  if  you  have  trouble  discharging or relocating patients.    Flavio  said   that   daily  surveillance  reports  are  being  read  too,  so  FMTs  can  report  any  assistance or materials required in there.    Thailand  team​ :  They  are  a  3rd  rotation  team  which  started  on  May   11th.  Their  treated  cases  numbered  1200  up  until  yesterday.  They’re   sending  out  mobile  teams  and  door­to­door  searching.  During  the  last  week  they  were  able to find one earthquake victim  who  was  unable  to  walk  to  the  hospital.  They  assisted  in  his  infected  open  foot  injury. He  was referred  to Dhulikhel local hospital where he was operated on.    4. Any other business   Handicap International can be contacted for assistance with Rehab operations:  +977 1437 2794    Further  discussions  to  be  held  now  with  JICA,  the  Cuban  team  and  anyone  else  with  issues requiring urgent actioning    5. Meeting practicalities   Participants will receive meeting minutes after each meeting.    Meeting closed  at 16:00 hrs.    Next meeting is on ​ Thursday, 21st May, 2015 15:00 hrs  at Nepal Health Research Council (Behind MoHP Building) Meeting Room , Top Floor.    All enquiries to;  FMT Coordination Team  WHO / UNDAC / MoHP   Operation Cell at Research Section, 1st floor  Nepal Health Research Council (NHRC)  info@fmtcoord.org   + 977 9801083421    Welcome! FMT Meeting 18 May 2015 - Clevernmel?n of Nepal . World Health of Health and Population Organization Welcome to FMT Coordination meeting Chairman Dr. Kem Kharki MOHP FP for Foreign Medical Teams Maj. Gen. Prof. Dr. Kishore Rana Medical commander for military response Flavio Salio WHO coordinator for Foreign Medical Teams Welcome to FMT Coordination meeting 1. Situation overview 2. Updates from MoHP, Military & WHO 3. Other - Safety and Security situation - Gender issues - Environmental issues - Coordination and reporting - Remote area Access - District Hospital status updates 4. Any other business 5. Meeting practicalities 0 m?xl Lalitpur .- Kabhrepalanchok a Maka?wanpurad-na-n?m . Parse 33'? Q- Bautahat . if?; . Sa?ahi Government of Nepal Ministry of Health and Population ?x Ramechhap Sindhulikmi 6/ @S'ndhdinadi ?\Dhanusha a Okhaldhunga Q) World .Heqlth Organization Map of Dolakha • 12 may Aftershock – Requeest for support – Retasking of some FMT • Number of Requests from Dolakha • Number of FMTs in Dolakha Healthcare Facility Damage of Dolakha as of 10th May ET -- newbnxun?nm . . m; MRBU FMT Deploymant in Dolakha as of 17th May SN FMT name Country Team FMT type FMT Class District location VDC 150 MSF Belgium-3 Belgium 1-mobile NGD Dolakha Chhapchet. Sunkhani Bhimeswar 43 India India 2 Dolakha Charlkot Municipality 133. Easiest?! 1 [4.6.9 Pele the $1133}! Easier Bhimeswar 158 Medical Service Center/All Nepal Progressive Public Health India 1 N60 Dolakha Municipality A District headquarter Type 2 (nubile) I Typo 1 River Trail - Read :l we Deployed District Situation Overview • 12 may Aftershock – Requeest for support – Retasking of some FMT • Number of Requests from Dolakha • Number of FMTs in Dolakha Surveillance Data • Majority of teams reporting – Special thanks to • XXX • XXX • XXX • XXX • XXX • XXX Teams Reporting • Majority of teams reporting – Special thanks to • XXX • XXX • XXX • XXX • XXX • XXX Medical needs in affected area • Need for hospital tents and maternity tents for health facilities in all areas remains (need of coordination). • Need for psychosocial support remains, exacerbated by after shock. • No need for further FMTs from outside Nepal. • Redistribution may be required in Sindulpalchowk (Tauthali) due to evacuations. • Flexible team in matter of tasking needed. Figures • Numbers from SitRep as of today / yesterday • Teams deployed / returned • Total number of patients treated – OPD = – IPD = – Trauma Cases THE HAP IS IN TENDEE TD TI-E HEM. UF IHE ON THE BERT INFORMATION AVAILABLE THE THE OF IT DOES NOT ADDRESS ACEESSIBSUEB RELATED TCI THIIH THE PHYSICAL CONDITION OF THE ROAD ITSELF. Fl HDTREFLECT THE DR ISSUES. run I lIu'IIgunu Byrd-mnmu-Chanm ll-Iahwalr man Mung Muir Hunmur Lamru ng .- Io theme. headquarteus of arsIqur Has been minded a: harm-I FDIC. .Unhr srnal IehIcIes H- 4- Ieeps} are allowed LITHIUM Gar-E1 I3me :5 adult-ed duE'mush Inf new Irmdiides. _n Mll?ar'r Suume RMD .- I '5 a - gun?.- mu:- m: Debris [lam lindalde alal?erenl I . A Rand Do Banal: an'n will 91 helm; 4.11! ml: Inlal?udlilldl'? 13-:qu in! and ham-:3 can access Emma RMMCI :Ind Hr?pulL WERE: I: I I .- Beam: Opalqu Bear I ?lm-El man. 011'? sg'nall vehIdEE 4 alum-d 5mm EMU .A-Ictmn; - a 5 a - .Svarvn - . - fr g, T?r?hum?h hunch: I - my am rum-- In trans-pm 1' I. all-Jun . ?11. I I. Hawaiian mtu more: 1 Chum-Int? 3' . ?91Harm] ammupaIchaII Ku-Ila? I Idlng .Im-'muml Rom? CummingMalmcm ??33223? vm . Run hr f?qgmm. 5m, "mm; 1' ?If .11.. ?x um [1:13th- at Iriiuhs 4? hath. A Smr-ze Chautarn ., .. - faratPLI-lr ?(If {4199-92} a a If I. MIMI an Kllumuters Ghan?'m "wt .a r" Jlri Naljunar capital Pn'manr Road Inlema?nnai Boundary Mam-ram Eewndary Mad - - Region bmundary - . - . . a b- a I ll Int-enTIEdIale Tawn Terl'ran'r Road mummy . A Ema" Tum Ralhltay - - DI: Incl mun-clan.r I I ?Ems mm . Wang R?ad Passable van HIM: mm access COHEEWB CONDITIONE- TD Damaged bul passable Wa Iar Body Intel." atlanal A".an PLEA HE W??tf ?Cl ?Raad NM assahte mmnon OFFICER ll I- Domestic Aim?? I ?ush I HEMIHH a a TI-E TI-DETEORIJLDGI-CALI THAT PHYSICIHII. I: I . I M. Magnum?antenna? on THE mmnan - I hurl mauve: EMADEEPTI ND FUR RELIANCE ON THE dhuli PLEJME TO VERIFY DEFINE DIE. .. . I - Source: WFP Logcluster as of 16th May Updates from the Ministry of Health and Population and the Military 3 wernment )if"! Wor d_Health Ministry of Health and Population orgamzatlon Deployment Status • A total of 56 foreign medical teams (FMTs) are currently deployed. • 69 FMTs have left or are in the process of leaving Nepal (of 136) Other • • • • • • • Safety and Security situation Gender issues Environmental issues Coordination and reporting Remote area Access District Hospital status updates Any Other Business Status of Foreign Medical Teams Unhold, 2 Untaske d, 1 Unknown, 15 Deployed , 52 Returned, 70 -140 teams from 38 countries -Half of them have returned -15 teams have unknown status 1 Russia 1 Deployed Saudi Arabia 1 South Africa 1 Srilanka 1 Returned Switzerland 1 Unknown Holland Hungary Indonesia Malaysia Norway 2 1 2 1 1 1 Taiwan 1 Singapore 2 On hold Israel 1 Australia 2 Turkey 1 2 Bangladesh 1 3 1 Untasked Thailand 1 5 3 3 6 2 1 4 13 3 2 11 8 USA 4 2 Nepal 3 2 Germany India 1 4 Spain UK 1 2 2 Japan South Korea 1 1 3 France 5 Canada China Status of Foreign Medical Teams-Country wise 1 Qatar 25 1 Poland 20 1 Philippines 15 1 Pakistan 1 1 1 Netherlands 1 1 1 Italy 1 1 1 Czech Republic 1 1 1 Cuba 2 1 Bhutan 10 5 0 Belgium Number of FMT Daily Reports Received daily 20 18 16 14 12 10 NUMBER OF DAILY REPORTS 8 6 4 2 0 25.4 26.5 27.5 28.4 29.4 30.4 1.5 2.5 3.5 4.5 5.5 6.5 7.5 8.5 9.5 10.5 11.5 12.5 13.5 14.5 15.5 16.5 17.5 SANPSHOT OF NUMBER OF CASES PERFORMED BY FMTS (Based on daily surveillance report submitted) Total OPD Cases 28,372 Total IPD Cases 1,499 Total Major Surgery 440 Total Trauma Case in OPD 6,073 Total ARI cases in OPD 2,793 Total referred cases 158 Total hospital deaths reported 308 • 45 teams have submitted at least one Daily Surveillance Report • 17 teams have submitted Exit forms Issues to consider in Reporting • Use the MoHP forms to fill in Daily Surveillance Report and Exit Report • Mention team name, country and date of reporting in the Daily Surveillance Report • BOTH Daily Surveillance Report and Exit Report must be submitted • District health facility/DHO recommendation is also required with Exit report Medcinsdu Monde orwalf Red Cross Korean Red Cross Japanese Red Cross Society MSF Holland?1 Czech Medicalteam Depa rtu re Dates Team Rubicon MEF France MSF Belgium-2 by Can adian Medical Assistance Teams Good Neighbors International SDC Swiss International Medical Corps?2 MSF Belgium-1 Red CrossSocietyr of China NYC Medics Clarion Cuban Medical Brigade Global Medics Indonesia?Civilian Elndonesia?BNEIP] ISindhupalchowk lGorkha thading lKathmandu Project Hope Me rcI.r ala1.rsia EMTE Dhaka Com unitI.r Hospital Medical Eme rgenclf Response Team EM China2 China3 Doctors for 1I"ou Edel mundo medicos] Gw angji?Metrocitl.r Medical Relief Team Canadian Red Cross] Clatar Red Crescent Al?Ithair Foundation MSF Holland-2 MEF Spain?1 MSF Belgium?3 Trekmedic Buddhist Tzu Chi Foundation Diabetic and Endocrine Association Nepal (DEAN China1 Kavre palan ow Dther {9190 31?; 46?; 4's a 3e f??ggiflk?ggi ?ak @4935 094935 *6?ng 421936 94% a Of 18th ay 2015 33!, Jeff!) 3&0 Indian Air Force Indian Armyl Ba ngladesh ed ical Team Sri Lanka Army Pakistan MedialTeam SDC Swiss Alliance of International Doctors Bhutan Army Team EMTI Emergency Team Poland EMT3 Ma lteser lnte rnatio nal ThaiAlmy Singapore Army Tlekmedic HumediE: 5a ma n'tans Pu rse International Relief Japanese Military Israel ed ical team Team for chilayu Corps Mondial de secours Italy Civil Protection EMT4 Crises Relief Singapore Ma harast ra Team Actsof Mercy ActsWorld Disaster Medial Fellowship Heart to Heart International 'lu'icente Sotto Memorial Medical Center-2 Humanity First ational Med ical Organ izat ion Vicente Sotto Memorial Medical Center-1 Korea Disaster Relief Team Dhaka Community Hospital Taiwan Root Medial Peace Corps MEdilE MM DA Bhalatiya Jain Sanghathan Rotary Club of East Calcutta Good People International Royal Melbourne Hospital as of 18 May, 2015 a a a fag, ?3'?Pre-Dpe rational Operational Post-Operational ASE rheiter?Eamariter?Elund Physiciana Ac r055 Cam paasianate handa for Nepal a1:an Medical Teams ln1:e rnatian aI KPIM Pam pier5 Hum ani :aine5 Francais Human Outreach Taiwan lnternaticrn aI Hea ith Acticrn lnclia Ameb lnclia Am'wEa Team for TUTH The Jahanniter lnternatian al Aasistan ce Team Flubican China? Me rcI.r ala1.r5ia Hcrpe Chinal Medical Eme rJg;encI..r Reapanse Team I as of 18 May, 2015 WE NEED YOUR HELP ! Provide your contact information Provide your departure date Send daily surveillance reports (DOC > XLS) Exit process 1. Get Recommendation (DHO) 2. Fill Exit Form 3. Get Letter of Appreciation (MoHP) Meeting practicalities • Meeting Minutes – Will be E-mailed tomorrow • Next meeting: – Date/Time: – Venue: Thursday 21st May 2015 15:00 hrs Ministry of Health and Population UNICEF Tent on carpark • Contact – E-Mail: – Phone: info@fmtcoord.org +977 9801083421 Thank You - For your assistance and cooperation! Government of Nepal Ministry of Icalth and Population Egg