Project Report

1. An Experience Based Report on
Occupational Therapy Roles in Disaster
Risk Management
Project Title: Make Community Based Disaster Risk Management Inclusive in South Asia
Duration: November, 2011 – June, 2012
Venue: Chittagong, Bangladesh
Reported by:
Md. Yeasir Arafat Alve
Trainer (Occupational Therapy)
Handicap International Bangladesh
Chittagong Branch
ORGANIZATION: HANDICAP INTERNATIONAL BANGLADESH
PARTNER ORGANIZATION: YOUNGER PEOPLE IN SOCIAL ACTION (YPSA)
SPONSOR: EUROPEAN COMMISSION

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POSSIBLE HAZARD:
Tropical Cyclone / Typhoon / Hurricane
Tornedo
Sea level raise
MAJOR RESPONSIBILITIES:
 Home based disability survey
 Need assessment.
 Provide home based therapeutic intervention, family training and awareness
about possible hazard, early warning system, and safe transition as part of house
hold preparedness for disaster.
 Basic orientation, assessment and measurements for adaptive equipment.
 Disable people organization to strengthen network.
 Advocacy with local government for disability rights and empowerment.
ORGANIZATION PROFILE:
Handicap International Bangladesh
Head office:
Plot # CES (D)4, Road # 125
Gulshan- 1, Dhaka- 1212, Bangladesh
Tel: 88-02-8859794
Fax: 88-02-8819128
Site office:
Handicap International Bangladesh
S.S. Villa, Ground floor (Right sight)
Holding No #688/1 East Amirabad,
7 no word Sitakunda Pouroshova, Sitakunda, Chittagong.

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BACKGROUND:
Bangladesh is number fifth world’s most vulnerable country after Philippines to natural
hazards and disasters. Its geographical location makes it subject to annual monsoon floods
and cyclones, but there are also a number of other risks the country has to cope with.
Widespread poverty and an extremely high population density add to the country’s
vulnerability to disasters. The project area is situated in Chittagong and the population are
vulnerable to tropical cyclone, water logging and flood.
Population: 164,795,675
Population density: 1266 per Km2 (3,279 people per mi2).
World population density Rank: Number 8.
Population Median age: 26 years.
Economy: Low-and-middle income country.

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DESCRIPTION OF ACTIVITIES:
1. Home based disability survey
Occupational therapists completed house to house survey to figure the persons with
disability (PWD) in community, where volunteers’ organization helped to find out the
houses and about 120 PWD houses monitored by three Physio and occupational therapists.
2. Needs assessment
Therapists used participatory methods to support and assess mobility, functional capacity,
activity tolerance, daily living independency, household resources and family capacities to
resist the hazards. Finally, the families were prioritized by their needs and intervention
applied from most vulnerable PWD family and dwelling livelihood with chronic poverty.
3. Providing home based therapeutic intervention
According to disability survey, persons with disability were diagnosed by CVA, spinal cord
injuries, cerebral palsy, poliomyelitis, nerve injuries, amputation, mental illness, intellectual
disabilities exacta. We, therapist used local materials and indigenous knowledge to provide
intervention in house. We showed interventions to the family members and also explain each
techniques with its advantages like activity modification, energy conservation and one
handed techniques. Our therapeutic goals were to ensure maximum independency in
community and could move themselves easily nearby to the cyclone during any crisis period.
Moreover, we conducted occupational counselling to PWDs to develop self-efficacy for
continuing daily function and engaging in outdoor activities. Finally, PWDs have understood
that the indoor living people are more vulnerable to disaster than outdoor and mobile people.
Figure 1: Home based Occupational Therapy Treatment

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Case 1
Mr. Arun was 50 years old and a person with right side hemiplegia. I found him in bed
lying position and has difficulty in hand function and mobility. We had taught one handed
techniques to perform daily living activities and he started to walk by stick. He was fear
to fall and stayed on bed. We leant the family members how to transfer and how to support
during mobility. This transferring and handing skills will keep advantage during
evacuation/emergency period/natural disaster. Then I encouraged him to spend few hours
in his business rather than stay in bed. I leant him to conserve energy and simplifying the
tasks with frequent short break during transferring and functional mobility for example
using unaffected side, using light weighted tools, using gross motor skills to support the
affected hand, completing the task in sitting position. Moreover, I suggested to visit
community gathering place at-least once a week to meet with other friends, leaders and
discussing about another PWD’s issues to maintaining networking with one another.
Social people come forward to modify his toilet and bedroom, even meet with him in shop.
Finally, we arranged a mag drill to evacuate themselves during disaster. Then, they
developed self-help group, Mr Arun contributed in search and rescue by utilizing
networking, knowledge and social power where 12 PWDs were involved too.
4. Family training and awareness
We suggested families to create positive environment for PWDs to continue homebased
cares and we also following up them. Our goal is to provide technical support and build
up capacities in family. We advised and created adapted environment to perform daily
living functions as much as independently. Our awareness program was about family
level preparation to disaster, encouraging to start vocational training, adapting with the
occupational migration (when crop land inundated by saline water, then need to start
another business), fast evacuating PWDs, transiting to the safe cyclone shelter and family
awareness about disability, priorities in work participation, rights to conduct life with
dignity. Moreover, we also involved with family preparedness program and responding
with inclusive early warning system as because of develop resilience in community to
occupy occupations spontaneously. I discussed with family member to keep up to date

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with mass media, Cyclone signals, flags hanging with PWDs as like two flag hanging
means 4-6 no. signal running on and the PWDs should move nearest any safe cyclone
shelter. At the signal period, how they could keep their valuable wealth in safe place,
safe the cattle and other animals, re-constructing the house etc.
Figure 2: Family awareness program
5. Basic orientation, assessment and measurements for adaptive equipment
We have assessed functional limitation, decided about assistive devices/mobility equipment
and adaptive home environment and distributed according to their priority. Moreover, we
visited frequently to their homes to adjust with new devices and environments.
Figure 3: Functional mobility practice to
move in safe place
Figure 4: Education session to use white
care in-case of emergency move out
(visual impairment)

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Case 2
‘Sadia’ is a case with Cerebral palsy live near to the sea belt and had an adjustable special
chair. When I arrived to house, noticed that the seat is in another room but the child lying
on the floor. I placed the child on the chair with belt, kept the foot appropriately in foot
plate, also kept the hands on the arm rest and described the advantage of that positioning.
I described to the child’s grandmother, the seat enhanced the child’s functional
performance, eye contact and head and neck control during functional performance. I also
said to communicate with the child and playing game with colorful toys on the arm plate
of special chair. I described how assistive devices enhance the PWDs function. We visited
to the nearby school to enroll this child and neighbor helped to propel the special chair.
Initially, the school authorities were not agreed to admit the child, however, we contacted
with local government and create awareness about inclusive education. Finally, she
involved in school activities and in playing with other children. Moreover, she was safe
in school because her parents return back from job at evening.
6. Education about modifying the environment
I provided education and modified the home
environment, including who got wheelchairs and
special chairs. I described that the accessibility will
enhance functional performance. Moreover,
occupations interacted with social people and coming
out from room is important to be occupied in society.
PWDs can move themselves easily by accessible
door, toilet and entrance. We have prepared ramp,
special stairs with rail, slop, different grab rail, long
handle household equipment and grab bars. When the
PWD is independent to engage in community. Then,
we can expect that the person could be able to rescue
own self during emergency period.
Figure 5: Adapted environment

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7. Advice and planning for appropriate cyclone shelters design including universal
design
The cyclone shelter should be assessable for all otherwise the wheelchair persons don’t get
opportunity like others at the disaster period. So, we have prepared ramp (1:8) in shelter with
rails for unstable person the height of the rails was 900mm. We rearranged the electric board
at adjustable height and also modified the bathroom and toilets of cyclone shelters. We set
up commode chair, increased height, wide bathroom and other reconstruction for wheelchair
users. We arranged meeting with cycle shelter committee and develop policy like in
committee at least one PWD must have to accommodate. To access this safe shelter PWD
with get first priority in special toilet facilities, food and in water supply before children and
women. Our meeting with local government to accommodating the PWDs in emergency
period, reoccupying in occupations and develop disaster resilience.
Figure 6: Accessible cyclone shelter
8. Disable people organization to strength network:
We had developed disabled people organization in vulnerable community where around 40
– 50 number of persons with disability meet together once a month to share knowledge.
Even they build their capacities, advocate for themselves, advocate for accessibility and
rights to access basic need during emergency period. They made structural plan to evacuate
themselves with their family members. Similarly, we demonstrated inclusive early warning
system to evacuate effectively.

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Conclusion
At the end of my report, I want to say that occupational therapists have significant role in
disaster risk management phase to develop resilience in community, to occupying in daily
activities, to engage in social activities, to adapted with undesirable environment, to maintain
self-help group, social network for supporting one another, to aware family member about
vulnerability and to advocate with local government and leader for accommodation PWDs
in society.