Occupational therapy role in disaster management

in Bangladesh

@ &.
Md. Monjurui Habib Md. Jamal Uddin Saleh Ur Rahman Nusrat Jahan Salma Akter
(Bangladesh) (Bangladesh) (Bangladesh) (Bangladesh) (Bangladesh)

AbStraCti Bangladeshisacountrypt"onetodisasters anditsroleinoccupationaltherapy(OT)isnotutellrecognized.

Therefore, the objectiue of this study u.)as to etplore the OT role in disaster monogement in Bangladesh.
A qualitatiue sttLdy inuoluing intet'uiews uith sLxpracticing O7's who had uorked in disaster manag ement was undertaken.
Theinteruiewswere transcribedctnddatastudiedfor emerging tlrcmes,using thematic analysis to code and analysethe data.
According to researchfindings, pre-disaster rolesfor OT include: risk and resource mapping, improuing accessibility for
shelters and homes, prouiding training for sensitiuity around disability issues, deueloping early euacuation plans, and
establishing early uarning signak;for people uith disabilities. Preparing the uolunteersfor rescuing people with disabilities
uas the main OT role during disaster. In the post disaster stoge, roles include: remediation, psychological rehabilitation,
uocational training and home modifications.
Ocorpational therapy in disaster managementin Bangladeshis practicedin a limitedway. The Gouernment shouldinclude
this seruice in its national policy for disaster monogement.

Key wOfdSl Disaster management, Bangladesh, occupational therapy.

lntroduction increased approximately six times from r97o to that of

Disasters, either natural or man-made, are a major issue
worldwide, and are increasing in frequency over time. They
have drastic negative short and long term effects on the
wellbeing of individuals, families and communities. Natural
disasters have increased all over the world since r99B (Vos
et al zoog). As most disasters are unpredicted, the negative
impacts of disasters are enormous. Most common impacts
include limited per{ormance in regular daily living activities
for persons affected, personal loss and environmental changes.
These have adverse effects on adaptive occupational per-
formance of individuals and communities. Individuals also
experience a wide range ofpsychological reactions, includ-
ing loss ofconfidence, fear, and helplessness (Scaffa zoo3).
From zooz-zott, Asia, Africa, the Americas and Europe were
affected by over 6754 natural and man-made disasters,
with a total of over r,z3z, 8oo killed (IFRC zorz). In terms
of financial losses, the average global economic cost is
increasing dramatically, for example the cost due to disasters
zooo (IFRC zorz).
Disasters not oniy kill a huge number of people, but
also create disability; for each individual killed in a dis-
aster, another three people are injured or left with per-
manent disability (CBM zorg). There are 3.5 million inter-
nally displaced people and refugees who live with a dis-
ability following various disasters around the world (United
Nations zooS).
Many major disasters have shown that the elderly and
disabled are often left behind (World Health Organization
zou). People with disabilities are disproportionately affected
when disasters strike due to accessibility issues with evac-
uation, response and recovery efforts (United Nations, n.d.).
Occupational therapists can offer much on in this regard
because they are qualified to establish the elements of an
emergency care plan, including how the individual with
disability will be transported, moved and positioned; deter-
mine the needs for personal equipment that may accompany

WFOT Bulletin Volume 58 November 2013 33

 the individuals; and whether and where they should
exit
or to stay in the buildings (Asher and pollak zoog).
During
disasters, occupational therapists can provide
mental health
services for the victims and their families in order
to decrease
anxiety and stress as well as to first respondents
such as
firefighters who maybe ovenvhelmedbythe level of
tragedy
(Scaffa et al zorr). In post disaster management,
aside from
the physical management, occupational therapists provide
psychological intervention to reduce acute stress,
re_estabiish
routines and roies, and enhance the quality of the iife
of
affected people (Tierney et al zoor).
Bangladesh is one ofthe most disaster_prone countries
in the world due to its geographical position (Shahid
and
Behrawan zoo8). Major disasters in Bangladesh include
tropical cyclones, floods, tornadoes, tidal bores, riverbank
erosion and earthquakes. Repeated occurrences
of such
natural disasters cause deaths, disruption of livelihood,
degradation of the environment, and significant physical
and psychosocial disability (Choudhury et al zoo6).
The
recent man-made disaster, collapse of an eight_storybuilding
once situated in Savar, the outskirts ofDhaka, killed
over
t,roo people and injured 2,ooo more. Most of them are
predicted to have permanent disability in future (Lee
zor3).
Disaster management in Bangladesh is the joint
responsibility
of government, nationai non-governmental organizations,
and international non-governmental organizations.
A few
occupational therapists are working with the national
and
international organizations in different phases of disasters
management. Therefore, the aim ofthis studywas
to establish
the numbers of occupational therapists involved in
disaster
management and to explore in depth the role and
invoive_
ment of occupational therapists in disaster management
in Bangiadesh.
Method
The study was exploratory using qualitative research
design
to investigate the role of occupational therapists who
work
in disaster management in Bangladesh. The research
was
underpinned by thematic analysis to gain rich descriptions
about the role that Bangladeshi occupational therapists
play in different stages of disaster management.
Thematic
analysis offers a flexible and accessible approach and
it is used
to identify, analyze, and report patterns, or themes
within
qualitative data (Brauna and Clarkeb zoo6).
lnterviewees
All the contact details ofoccupational therapists currently
working in Bangladesh were acquired through personal
com_
munication with permission fiom the directory of Department
ofOccupational Therapy at Bangiadesh Health professions
Institute (BHPI), the only institute in Bangladesh offering
34 WFOT
both Bachelor and Diploma programs in occupational
therapy.
In total, ro occupational therapists were found who
had
worked in disaster management at any time in their
career
with a working experience in disaster management ranged
from z months to 2 years. For this study, 6 Bangladeshi
occupational therapists, 3 male and female, aged
3 between
25-35 years, were included. All the interviewees have
work_
ing experience in disaster management either in national
or international non-governmental organizations, namely
Handicap International (HI), Action Aid, or the Center
for
the Rehabilitation of the paralysed (CRp).
Data collection and analysis
Tire identified occupational therapists were interviewed
in their respective working places by one ofthe co_authors
of this study for 45-6o minutes. The interviews,
conducted
in to Bengali, were semi-structured, and consisted
of open_
ended questions with an opportunity for additionai
com_
ments. Questions included length of time working
in dis_
aster management, the kind of disasters, which stage
of
disaster, and details of the role performed as an
OT during
the disaster.
AII the interviews were recorded, transferred to a personal
computer of the first author in Mp3 format, transcribed
verbatim, and checked for accuracy. Next, each of
the Bengali
transcriptions was translated into English by three English
educators who also understand Bengali verywell.
One of the
co-authors accumulated all three transcriptions from
one
interview and checked with all of the three translators
for
accuracy.
Responses were analyzed. Coding was conducted
by one
of the co-authors and reviewed by two other co_authors.
Themes were generated through screening, clustering
and
comparing segments of the transcripts. Finally, a preliminary
report was sent requesting feedback from all the inter_
viewees as member checking.
Results
Results were clustered under the areas as identified
by the
interviewees of the role of occupational therapy prior
to
disaster; second, the role of occupational therapy
during
or immediately after the disaster, and third, the role
of
occupational therapy post-disaster.
Occupational therapy role in pre_disaster
activities
Three interviewees worked in pre-disasters and during
dis_
aster related activities. The work was mainly related
to natural
disasters such as floods, cyclones, and earthquakes.
As a
member of a disaster management team, the occupational
Bulletin Volume G8 November 2013
 therapist conducted community risk mapping through house-
to-house surwey in order to identify the areas most r"ulner-
able to natural disaster. The survey also identified persons
with disabilities and potential barriers during disaster
response. Simultaneously, a resource mapping was carried
out to identify opportunities available for people with dis-
abilities in their community, useful information for post-
disaster planning. For example, if there are any accessible
shelters, healthcare or rehabilitation centers and also volun-
teers to provide support for the people lvith disabilities,
these factors might actually hetp in risk reduction action
plan (RRAP). As interviewee-r said:
] We did both risk and resource mapping to identifu the people
I with disabilities, their potential problems during disasters and
I
also the possible ;facilities auailable ;t'or them in their comrnunity.
We actualtg didit throughhouse-to-house suruey in aparticular
community. The risk and resource mappirlg contribute a lot in
deueloping risk reduction action plan.
As part of preparedness, intelYiewees reported various
awareness raising activities and trainings, for example: sensi-
tizing staff, rescue volunteers and other community members
towards disability, so that everybodyhas a clear idea about
the difficulties faced by the people with different kind of
disabilities. Training about early evacuation procedure for
the people with disabilities was also conducted among the
people with disabilities, volunteers and the caregivers.
Particular focus for this included ways oftransferring people
with disabitities and also providing first aid. Interviewees also
gave importance to mainstreaming people with disabilities
in various steps of disaster management, in particular engag-
ing them in various plan-related steps, so that their voice
could be heard for an effective risk reduction plan. They noted
that occupational therapists also facilitated early warning
strategies for people with disabilities. For example, people
with visual impairment require early warning announce-
ments and auditory signal system, and posters must have
large characters and appropriate colour contrast. Hearing
impaired people benefited from a warning system con-
sisting ofvisuai signal system (red flag, symbols), pictures
and flashing lights. For people with intellectual impair-
ment, the warning system should be special signals (red
flag, sl.rnbols) and clear announcement' Announcement and
the auditory signal system are also appropriate for people
with physical impairment.
The interwiewees indicated that they are involved in
assessing and providing necessary assistive devices for
people with disabilities in their regular jobs. This includes
intervention regarding the appropriate use of assistive
devices, and heiping the people with disabilities to per{orm
their activities of daily living as independently as possible.
An important pre-disaster task for occupational therapists
is making the shelter and home of the individual physically
accessible. Participant-3, noted that:
WFOT Bulletin Volume 68 November 2013
We try to make accessible both the shelter and the house of the
person with disobllities by following uniuersal accessibility
guidelines. We desigrt ramps' toilets, water sources areas and
also uarious aspects of the liuing hotLse of personwith disabilities.
We emphasize the use of local materials such as bamboo, uood
and other low-cost materials for anl7 reconstruction it order to
ensure accessibilitg.
Occupationa! therapy role during or
immediately after disasters
According to the interwiewees, they were rarely directly
involved in this stage. Instead they worked as an adviser
by providing training and education at pre-disaster stage
to rescue volunteers and caregivers regarding how people
with disabiiities or any other injured person should be
evacuated. In particular, occupational therapists provided
education and training to volunteers and caregivers about
different tlpes of transfer techniques for people with
different kinds of disabilities and in situations in order to
have better evacuation. Interwiewee-2, said in this regard:
We prouide training for the uolunteers who work during or just
immediote after of any natural disosters and also ue prouide
trctining the caregiuers. We actually giue training and edumtion
about hou to euacuate the people with dffirent disabilities
inclurling people with physical disabilities, people uith uisual
impaired, people with dfficulty hearing and also people with
intellecttLal problems. There are dffirent kinds of physically
challenqedpeoplefor example, somebody may use assistiue deuices
... we teach the uolunteers and caregixers on how to euacuate
themwith the ossistiue deuices. Somebody may need extensiue
xtpporl for that, we teach the uolunteers and caregiuers about
ttuo or three person osslsted fransfer techniques.We also teach
u eru simple but importont techniques for the euacuation of people
uith uisuallg impaired, such as giuing uerbal guidance when any
obstacles are ahead during euacucttion . i;f there are many people
. .
with disctbilities in a same place then theg should hold the hand
each other andfollow the leader. Similarly, using Jlash cards,
demonstration, gestures and pictures would be more effectiue
to communicate with the person who has problem in hearing
during the euacuation of any natural disasters'
Interwiewees also mentioned that they focused on the
evacuation plan for the severely injured person, especially
positioning during evacuation, so that further damage can
be prevented.
Occupational therapy role in the post disaster
phase
Most interviewees said that after receiving post disaster
victims, they provided formal occupational therapy assess-
ment considering the variety of conditions presented' Based
on the preiiminary assessment, they set the treatment plan
and carry out the intervention activities accordingly. As
interuiewee-4, said:
I am working uith the suruiuors of recent building collapse ...
Rana Plaza building collapse ... and ue receiued patients with
fractures, amputees, spinal cord injury, nerue injury and soft
tissue injuries.
35
 Interwiewee-5 said:
I worked withthe burn patients after a massiue fire disaster in
Mmtoli. We receiued patients with dffirent degrees of burn and
also patients with burns associated with ner-ue injtrry and amputee.
For the post disaster victims, inter-viewees used a wide
range of biomechanical activities in order to restore the
functions such as passive range of motion, strengthening
exercise and also different kind of purposeful activities.
Training on activities of daily living was another important task
with post-disaster victims mentioned by the interuiewees.
All of the interviewees said that psychological problem
such as anxiety; depression and fear are most common for
post-disaster victims. For this, occupational therapists
conduct individual counseling sessions, structural group
activities and also group leisure performance.
All the interviewees stessed that they consult with the client
about their future productive job. Interwiewee-6 said:
As, cwrently,I amutorking withthe recentbuilding mllapse uictims
... most of them do not want to returnbackto their preuious job
due to;fear and negatiue impresston tourords tt. Almost 9o% of
them want uocational training for a new job. We are suggesting
appropriate uocational training for them based on their ouerall
situation.
The interwiewees said that they always discuss accessi-
bility issues with clients; in particular, those who wiil be
discharged with assistive devices. They also noted that they
do a follow-up home visit in order to modift the environment
and make it accessible for the individual.
Discussion
There are very few occupational therapists working in disaster
management process in Bangladesh, and most of them are
working in the non-governmental sectors. In fact, globally,
occupational therapists have limited involvement in disaster
management, despite their great potential. This is because
occupational therapy has not yet been well recognized in the
disaster response coordination system (Srivastava 2010).
However, occupational therapists can play their role in
disaster preparedness, disaster response and disaster recovery
(Scaffa et al zorr). The interviewees of this study have
demonstrated working experience in all three stages. In
disaster preparedness (referred to as pre-disaster stage in
this study), occupational therapists in Bangladesh do com-
munity risk and resource mapping, design shelters and homes
using universal accessibility guidelines, train sensitivity to
disability issues, early evacuation strategies and early warn-
ing signal for people with disabilities. Similar roles for occu-
pational therapists are also discussed in other literature
(Tierney et al zoor). Asher and Pollak (zoo9), state that
occupational therapists are uniquely qualified to identify
the elements of an emergency care plan for people with
35 WFOT
disabilities. Occupational therapists can work with disabled
groups to develop their own emergency preparedness plan
(Diamond and Precin zoo3). Occupational therapists also
modify and make accessible shelters as part of disaster
preparedness to ensure safety and increased independence
(Scaffa et al zorr).
The interviewees have not much direct engagement during
the disaster phase. They provide training to rescue volunteers
and career on appropriate ways to evacuate different tlpes
of people with disabilities and other injured people' In this
phase, besides the rescue training, occupational therapists
can work with people in shelters during disasters engaging
them in various physical activity, leisure activities and play
in order to reduce worry, acute stress, recurring thoughts and
concerns about the future (Scaffa et al zorr). Participating in
such activities, can help clients to cope with traumatic stress
(Hobfoll et al 2oo7), to suppoft one's role identity, to restore
confidence in ability to function (Gerardi 1999), and restore
adaptive habits and routines (McColl zooz). Occupational
therapists may also work to reduce the distress offirefighters,
rescue volunteers and medical personnel at this stage.
The inteiviewees played a significant role in post-disaster
management by providing intervention for possible restora-
tion, activities of daily living (ADLs) training, accessibility
consultations and modifications, psychological intervention,
and also vocational rehabilitation. The interventions made
by the interviewees are well supported by the literature.
Tierney et al (zoot) discussed that post-disaster recovery
includes reducing acute stress, re-establishing roles and
routines, and promoting psychological well-being and quality
of life. Hobfoll et al (zoo7) also place emphasis on helping
clients to problem solve issues which promote a sense of
self-effrcacy. The interwiewees of this studyfocused primarily
on being involved in the occupation perspective ofthe post
disaster victims, which actually enhance skills required in
daily life roles. ADLs also promote the independence of living,
coping skills deal with anxiety, stress and psychological
arousal; and social skills increase socialization and decrease
emotional and social withdrawal (Davis and I(utter r99B)'
Limitations of the study
As the studyis qualitative in nature, the results are not general-
isable. Even those intetwiewees having working experience
of onlytwo months were included. Therefore, a detailed role
explanation might not have been provided by some interviewees.
Conclusion
Occupational therapists have a great role in all three stages
of disaster management, including pre-disaster, during or
immediately following a disaster, and also in post-disaster
Bulletin Volume 58 November 2013
stages.In Bangladesh, a few occupational therapists are
working in different stages of disaster management with
national and international non-governmental organizations.
Geographically, Bangladesh is a disaster prone country and
the rate of disability is also a matter of concern. Therefore,
in addition to including people with disabilities in national
level disaster management plan, the role of occupational
therapy in disaster management should be incorporated
and recognized.
Acknowledgements
We greatly appreciate the participation of occupational therapists with
working experience in disaster management in Bangladesh.
References
Asher, A, (zoo9) Planning Emergency Evacuations for Students
Po11ak, J.R.
With Unique Needs: Role of Occupational Therapy. OT PrcLctice, t4,
CE1-CE7.
Brauna, V., Clarkeb, V. (2006) Using thematic analysis in psychology.
Qualit atiu e Resear ch in P sy cholct g y, 3 @ ), 7 7 - to r.
CBM (zor3) lnclusiue Emergency Response. Retrieved 5 May zor3, from
http : / / ru tttu. cbm. or g / i/ inclusiu e - emer g encA -r esp ons e- z 15 47 z. php
Choudhury, W.A., Quraishi, F.A., Haqte,Z. (zoo6) Nlental health and pq'
chosocial aspects of disaster preparedness in Bangladesh. lnternohonal
Reuietu of Psy chiatru, tB(6), 529-535.
Davis, J., Kutter, C.J. (1998) Independent living skills and posttraumatic
stress disorder in women who are homeless: implications for future
practice. Anierican Journal of Occupational Therapy, 5z(t), 39-44.
Diamond, H., Precin, P. (zoo3) Disabled and Experiencing Disaster:
Personal and Professional Accounts. OccupationalTlterapg in Mental
Health, t9$/1, z7-42.
Gerardi, S.M. (rqqq) Part I. Worl< hardening for warriors: Occupational
therapy for combat stress casualties. Work, tSG),185-195.
Hobfoil, S.E., Watson, P., Bell, C.C., Bryan! RA., Brytrer, M.J., Friedman, M.J.,
et al (zooz) Five essential elements of immediate and mid-term mass
trauma intervention: empirical evidence. PsychiotrU, Zo(+), zB3-3r5;
discussion 3r6-269.
IFRC (2o12) World Disasters Report. Geneva: International Federation
of Red Cross and Red Crescent Societies.
Lee, S.J. (zo4) Bangladesh building collapse underscores httportance
of btLilding codes in preuenting disosfers [ElectronicVersion]. Retrieved
zog, from : / wu.:u.ifrc.org / en/uhat-we-do /idrl/latest-news/
9 July http /
anrr ent - dis aster -law -new s / b ang lade sh-building - collap s e -under s cor e s -
imp or tance - of-bLLilding - co de s -in - pr eu enting - dis ast er s - 6 z 57 4/
WFOT Bulletin Volume 58 November 2013
McCol1, M.A. (zooz) Occupation in stressful times. Arnerican JoLLrnal of
Occupational TherapU, 56(9, 35o-3S3.
Scaffa, M.E. (zoo3) Competence, Mastery and Independence: Our Cultural
Heritage. TheAm eican Occupational Therapy FotLndation Connectton,
to(t),6-2.
Scaffa, M.E., Reitz, S.M., Smith, T.M., Delany, J.V. (zorr) The role of
occupational therapy in disaster preparedness, response, and recovery.
American Journal o;f Occupational Therapg, 6S(Suppl), S11-S25.
Schneid, T.D., Collins, L.R (zoor) ,Dis aster Management and Preparedness.
Boca Raton: Lewis
Shahid, S., Behrawan, H. (zoo8) Drought risk assessment in the western
parl of Bangladesh. Natural Hazards, 16Q), 397-413.
Srivastava, A.K. (zoro) Preconference Cote on DiscLster Management
in O ccup ational Ther cLpg.
Tierney, KJ., Lindell, M.K, Perry, R.W. (Eds.) (zoor) Facing theUnexpected:
Disaster Preparedness and Response in the UnitedSfates. Washington,
D.C.: Joseph Henry Press & National Academy of Sciences.
United Nation (n .d.) Disability , natural disasters and emergency situcrtions .
Geneva: United Nations. UNISDR. Economic losses from disasters
set nerv record in zorz. (zor3). Geneva: United Nations Office for
Disaster fusk Reduction (UNISDR).
Vos, F., Rodriguez, J., Below, R., Guha-Sapir, D. (zoog) AnnualDistzster
Statistical Reuiew 2oog -The numbers and trends. Brussels: Centre
for Research on the Epidemiology of Dlsaster (CRED).
\4rHO (zou) Worldreport on disabrt4T. Geneva: World Health Organization
(wHo).
Womens Refugee Commission (zoo8) Disrzbllihes among Refugees and
Conflict-Affe cted P opulations : Resour ce kiqfor fi elduorker s. WomerL's
Comnission for Refugee Women and Children.
Address for correspondence
Md. Monjurul Habib
Lecturer in Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
P.O. : CRP-Chapain, Savar, Dhaka-r343, Bangladesh
Tel: +88o17167092S3
Email: monjurulshagar@yahoo.com / monjurulshagar@gmail.com /
HabibM @aplp.eastwestcenter.org
Linkedln: b d.linkedin.com/pub /rnd-monjurul-habib-shaq ar / 3o / z 9 z / z 66/
Webslte: http: / /tutuw.crp-bangladesh.org /
37