The assistance from WRF to the hospitals in Tacloban have enabled them to operate responsive services to the needs of persons with disabilities of the area. However, a considerable amount of equipment, materials and supplies are still not available to the rehabilitation service providers at the three hospitals. Moreover, renovations for the optimal use of the buildings were not accomplished and are key in addressing the needs of the hospitals.
In this report, we would like to report on status of one of the three hosptial that WRF has assisted in the Philippines instead of covering developments in all three, to give an overview of how Rehabilitation Services in the Eastern Visayas Regional Medical Cetner developed, how they were affected by the disaster, how they recover, and what their future needs are.
EVRMC Rehabilitation Medicine Profile
After Typhoon Hayian the department was left in need of repairs, that have been and are continuously being done. It was just recently, April of 2014, when the Department of Rehabilitation Medicine was established. In earlier years, EVRMC Rehabilitation Medicine Department started as a Physical Therapy Unit established on July 13, 1981. Initially, the unit was under the supervision of the Chief of Clinics, and later on transferred under the Department of Orthopedics. Please see attached the layout of the department and the brief description of the needed renovations.
The EVRMC Department of Rehabilitation Medicine is a new department of EVRMC with a vision of providing Rehabilitation services and education to the people of the Eastern Visayas Region, and the mission of helping patients reach maximum potential and resume their place in society within the limits of their capacity with effective, efficient, and compassionate service. The Department is headed by a Physiatrist, and the workforce is composed of a Chief Physical Therapist, and two Physical Therapists (currently on job order positions). There is an applicant Occupational Therapist and Physical therapist, that are currently considered for positions as well.
Psychiatry and Social Services are provided for in the hospital as an integral part of rehabilitation. Patients referred to the department include pediatric, adult and geriatric population of varied musculoskeletal and neurological conditions that need rehabilitation. Currently, services include consultation, counselling, and rehabilitation through physical and electrical modalities, therapeutic exercises and patient education. Majority of patients are initially seen by Rehabilitation Medicine, or referred by the Departments of Orthopedics, Internal Medicine, Family Medicine, and Pediatrics.
EVRMC is a regional hospital; hence, referrals come from the northernmost part of the region in Samar, and down to Southern Leyte, including the island of Biliran. The monthly number of patients census from January to July 2014 ranges from 50 – 90 patients, with a weekly of 20 -30 patients, and a daily of 5-10 patients. The numbers were seen to increase this August with a daily of 10-15 patients a day, and gradually increased once the requested equipment arrived.
The Eastern Visayas Regional Medical Center started out as a 14 bed capacity and 8 personnel hospital in 1916. And has changed its name from the original Leyte Provincial Hospital to Speaker Daniel Z. Romualdez Memorial Hospital. It was then changed to Tacloban City Medical Center, and finally to EVRMC. Currently, EVRMC is a 350 bed capacity, Level III Government Hospital, and has been approved for expansion to 500 bed capacity.
Current location of the Department of Rehabilitation Medicine is at the second floor, Out-Patient Department. The Rehab Department has been transferred to the second floor to give way to expansion of the Laboratory Department. This has met minimal concern since the building is provided with a ramp, and wheelchairs can be used to transport patients to the second floor. Current area is approximately 40-50 square meters, but with renovation, an additional area annexed to the current space is given to the department, to a total floor area of 84 sq meters. Clinic space currently includes 3 separate rooms (2 treatment areas and consultation room), a storage area, a pantry/preparation area, an open space of ~ 10 sq meters divided into a gym/ambulation area and a receiving area.
Description of damage
Damage to the Rehabilitation Unit consisted of the whole Rehab area, previously located at the ground floor of the OPD Building, to be flooded with sea water and mud. Cabinets filled with equipment/supplies fell, and were soaked as well. Majority of equipment and supplies were considered damaged and were set aside or thrown out. Few were considered for re-use after clean up. The Rehab Unit after the typhoon was left with minimal supplies and equipment. Yet, the Unit still functioned despite the lack and has since requested for procurement of replacement and new Rehab facilities.
The top 10 causes seen in the Out Patient Department are:
- CP/Developmental Delay
- Bell’s Palsy
- Low Back Pain
- S/P Tendon Repair
- Adhesive Capsulitis
- De Quervain’s Tenosynovitis
The top 10 causes in the In-Patient are:
- CNS Infection/ Meningitis with Developmental Complications
- Fractures/ Post-surgical Implant Application
- New Born with seizure disorder
- Spinal Cord Injury
- Hypokalemic Periodic Paralysis
- Repair of the Rehabilitation Department:
5-6 curtained treatment bed areas, low bed/mats area, hydrotherapy room, pediatric/OT room, gym/ambulation area, consultation room, comfort room, pantry/preparation area, sitting treatment area, storage room
- For Pediatric use – walker, child stander, activity boards, toys, wedges/bolsters, ball pool, glider, sensory integration tools, table and chair set, art and music appreciation sets, mobility aids, theraputty
- For adults – tilt table, adult stander, mobility aids, ADL tools, activity boards
- For Strengthening – exercise mats, dumbbells and ankle weights, leg press/bench press/shoulder press, elliptical machine, stability system, quad board, dynamometer/grip strengthening tools
- For Assists – UE/LE orthosis, patient lifter, body harness for weight assist during ambulation training
- For Department Use – portable ultrasound machine, ES/TENS units, safety gears, Vital Stimulation Set, weighing scale with height scale, goniometer, 2-pt discrimination set, water heater, hot pack sleeves, paraffin mittens, cold packs/cryotherapy unit, Standard Examination/evaluation tools (for Physiotherapy and OTs), Rehabilitation books/journals
- Other Need: Additional training of staff
- Equipment requested and delivered:
Therapeutic ultrasound (1); hydrocollator machine( with 24 HMP); paraffin wax bath; multi-exerciser with shoulder wheel, finger ladder, wrist rolls, knee extensor/flexor exerciser, shoulder pulley; bicycle ergometry (1); exercise bikes: recumbent (1) and upright (1); stainless parallel bars, IRR Lamp (1), whirlpool, treadmill, and cervical and lumbar traction machine (1).
ES/TENS unit (3), IRR lamp (1), balance board (1), therapeutic ball (2), elastic band (1), ankle weights (8: 4 – 1.5 lbs, 4- 1 lb), dumbbells (3: 2 – 1 lb, 1 – 2 lbs), parallel bars (Wood), overhead pulley (non-functional), peg board ( 1 set), staircase (1), hot moist pack (5: 3 cervical, 1 lumbar, 1 standard), gait belt (2), crutches ( 2 pairs BAC), quad canes (2 pcs), treatment bed (3), mat (1).
The overview and the description of the ongoing work and needs are compiled by Liezel P. Calina, MD, Rehabilitation Medicine, Eastern Visayas Regional Medical Center.