1. C.S.M. Medical University, Lucknow
PRECONFERENCE COTE ON
DISASTER MANAGEMENT IN
OCCUPATIONAL THERAPY
Jan. 21, 2010, Ahmadabad
Dr. Anil K. Srivastava
President- AIOTA, Executive Chairman ACOT & Editor, IJOT
Head of OT Services, Department of Physical Medicine & Rehabilitation,
C.S.M. Medical University, Lucknow

2. PREAMBLE
It was all quiet on the waterfront on the Sunday morning after Christmas in 2004 at Kanyakumari, the famous Marina Beach in Chennai and elsewhere on the Kerala coast and Andaman Nicober Islands. There was the excitement of a holyday with an offbeat mood with swarms of people on the sea front: children playing cricket and man and women on their morning work at the Marina. Elsewhere, fishermen were putting out to sea for the day’s catch. Then all on a sudden, a curious thing happened.

3. The holidaymakers at Kanyakumari were awestruck when the sea receded from the shores. The horrifying Indian Ocean Tsunami waves of 26th Dec engulfed massive no. of lives and properties worth billions in coastal regions of Tamilnadu, Andhra Pradesh, Kerala, Pondicherry and Andaman & Nicobar Island in India. The damages in all respect were many times higher in Thailand, Indonesia and Sri Lanka. It led to cries, chaos, havoc, floating bodies, and screams for help.

4. It was the most severe disaster in recent history that has happened in Southeast Asia and affected many people. Similarly the killer Earthquake in Bhuj and Kucch in 2001 and again on Oct 8, 2005 in J & K region in India and Pakistan killed many thousands and grossly damaged properties and infrastructure in affected areas.

5. Haiti quake: Tens of thousands feared dead, millions homeless
The 7.0 magnitude earthquake that rocked the tiny & poor country of Haiti struck a week back at 4:53 pm on Tuesday, Jan. 12, 2010, devastating the capital city of Port-au-Prince, which is between the Caribbean Sea and the Atlantic Ocean.
“Parliament has collapsed. The tax office has collapsed. Schools have collapsed. Hospitals, main prison have collapsed,” Thousands of people may have died.
Officials feared thousands -- perhaps more than 100,000, but another official said that figure could climb to 500,000, but there was no firm count.

6. People running past rubble of a damaged building after a powerful earthquake struck Port-au-Prince, Haiti, on Tuesday, 12th Jan

7. LAST 5 KILLER EARTHQUAKES
Country
Year
Magnitude
Killed
China (Sichaun)
May 2008
7.9
90,000
Peru
Aug 2007
8.0
500
Indonesia
May 2006
6.4
5,750
Kashmir
Aug 2005
7.7
75,000
March 2005
8.6
1,500

8. Disaster Risks in India
The United Nations said in a report released on June , that People in China, India and Indonesia are among those at an "extreme" risk of dying in a natural disaster.

9. World Disasters Report 2006 informs: around 58% of the total numbers of people killed in natural disasters during were from countries of South East Region. In this decade, Asia had the highest no. of natural disasters (1273) and technological disasters (1387) - this comprises 44% of all disasters that occurred across the world during this time period.

10. Bangladesh is most threatened by cyclones
Bangladesh is most threatened by cyclones. People in China, Colombia, India, Indonesia and Myanmar were at the highest risk of dying from earthquakes. Indians are most in danger from floods also. India, on account of its geographical position, climate and geological setting, is the worst-affected theatre of disaster in the South Asian region. With climate change expected to increase the severity and frequency of natural calamities, India one of the 10 nations most affected by such catastrophes.

11. The Statistics Are Alarming:
22 States of the country are disaster-prone.
68 per cent of the cultivable area is vulnerable to drought.
58.6 per cent of India is prone to earthquakes of moderate to very high intensity. The fragile Himalayan mountain ranges are extremely vulnerable to earthquakes (and landslides and avalanches). Western and central India is equally unsafe.

12. over 40 million hectares (12 per cent of land) is prone to floods and river erosion;
of the 7,516 km long coastline, close to 5,700 km is prone to cyclones and tsunamis
Vulnerability to disasters/ emergencies of Chemical, Biological, Radiological and Nuclear (CBRN) origin also exists
expanding population, urbanization and industrialization, development within high-risk zones, environmental degradation and climate change heightened vulnerabilities to disaster risks

13. World Disaster Report 2006 also informs that Bahrain and a number of Gulf States face a very low risk of death from disasters. However Denmark, Estonia, Finland and Latvia were also among "the safest places on earth from sudden" disasters.
The 30 odd types of disasters, which have been experienced in the past in India, have been categorized as under:

14. WATER AND CLIMITE RELATED HAZARDS (Floods and Drainage Management / Droughts / Cyclones / Tsunami / Tornadoes / Hurricanes / Hailstorms / Cloudburst / Snow Avalanches / Heat & Cold Waves / Thunder and lightning)
GEOLOGICALLY RELATED HAZARDS (Earthquakes / Landslides / Mud glows / Sea Erosion / Dam Bursts & Dam Failures / Mine Fires)
CHEMICAL, INDUSTRIAL & NUCLEAR RELATED DISASTERS

15. ACCIDENT RELATED DISASTERS (Road, Rail and other Transportation Accidents including waterways-Boat Capsizing/ Mine Flooding/Major Building Collapse/Serial Bomb Blasts/Festival related Disasters/ Electrical Disasters & Fires/Forest Fires/ Urban Fires/Mine Flooding/ Oil Spill/ Village Fires)
BIOLOGICALLY RELATED DISASTERS (Biological Disasters/ Epidemics/Cattle and Bird Epidemics/Pest Attacks/Food Poisoning)

16. Earthquakes in India

19. Indian Ocean Tsunami 26 Dec., 2004

20. Marina Beach after Tsunami

21. Tsunami in Thailand

22. Sudden crashing of a giant wave against the Vivekananda Rock Memorial, situated at the southern tip of Kanyakumari.

23. 15TH May, The fire broke out in three coaches of the Golden Temple Express, which was travelling from Bombay (Mumbai) to the holy Sikh city of Amritsar. At least 38 people have died in a fire on an express train in India's northern Punjab state

24. Mumbai flooding after 2006 deluge

25. Disaster Management in Respect to Occupational Therapy: The Background
2004 Tsunami was a driving force for WFOT and OT’s in India, in advancing efforts to support and build capacity among occupational therapists - in Asia and beyond- to effectively engage in disaster work. WFOT undertook a situational analysis within the affected countries in this region in March 2005 to inform a strategic response, locally and internationally.

26. Based on the outcome of the situational analyses of Tsunami affected countries carried out by a WFOT Team , a 5 day Regional Action Planning and Capacities Building Workshop was organized by WFOT in close collaboration with WHO and other international NGOs , at Mount Lavinia, Colombo in Sri Lanka from Dec which was attended by 25 participants, including Tsunami affected countries – India, Sri Lanka, Indonesia and Thailand.

27. Post Tsunami Action Planning and Capacity Building Regional Workshop aimed to empower occupational therapists to alleviate the sufferings of disaster survivors. A strong need was felt for OTs to shift their knowledge and unique skills into a new context of OT in CBR and community development in disaster situations, and in coordination and liaison with NGOs and Government. It was also hoped that this initiative might contribute to a rejuvenation of the profession in India.

28. A holistic approach to disaster management is required in planning for prevention, reduction, mitigation, and preparedness and thereafter response planning, goes a long way to reduce the loss of life and property and minimizing the after-effects due to disasters.
It is estimated that the rehabilitation needs of 80% of people with disabilities, in India, could be satisfied at the community level. This calls for an urgent need to draft policy guidelines for inclusion of occupational therapy at grass root level. However appropriate training, counseling and employment of OT’s for working in community in disaster situations or in general, still remains a challenge.

29. That was the reason that AIOTA accepted to become a part of the regional team and achieved success in generating cooperation from WHO in form of financial assistance for sending its 4 member team to participate in the Regional Workshop at Sri Lanka in Dec 2005 for supporting this unique development of the profession of Occupational Therapy in this subcontinent. Following were the participants:

30. Dr. Anil K. Srivastava President, AIOTA –Team Leader
Dr. M. Mathanraj David Chennai
Dr. P. Ramakrishnan Chennai
Dr R. K. Goel
Lucknow: from a National level N.G.O.

34. In response to the challenges faced by OTs in addressing the scale of need arising from disasters, coupled with the limited numbers of OTs and their access to appropriate resources, workshop participants adopted the motto: “Work Smart with Heart”. This captures the essence of how OT intends to move forward in progressing regional and national plans and proposals in Disaster Management.

35. The Indian presentation in the Regional Workshop stressed that:
“It is the uniqueness of each emergency that is crucially important to bear in mind for planning strategy for preparedness.”
“The planning and outcome of the workshop should be for disasters in general in place of Tsunami only to provide it a broader platform for intervention.”

36. “The after-effects of disasters including physical, social, psychological and economical and thereafter rehabilitation and relief services are identical to be addressed with.”
Until now globally O.T.’s have limited engagement in types of disasters. Although they have capabilities and potentialities to have a significant long term role to offer in helping the traumatized societies rebuild and return to meaningful occupations.

37. AIOTA emphatically emphasized on the lack of awareness of OT and thus limitations in OT involvement in disasters. It informed that OTs have been responding through their work within government services and in some cases, with local NGOs. Mostly it has been reactive and therapy oriented: Building OT understanding and capacity regarding all aspects of disaster management will help overcome many limitations, while language, cultural and contextual knowledge means a focus on equipping locally based OTs with disaster management skills

38. The WFOT project on DPR was designed in two phases:
The Regional Workshop followed with
Subsequent National Workshops in Disaster Preparedness and Response (D.P.& R.) in Tusanami affected countries : India, Sri Lanka, Thailand and Indonesia.

39. It also aimed to inform this cutting edge development to other parts of the world and build a foundation in disaster response to Occupational Therapy. Significantly no other international health care profession has achieved this outcome till date in care of disaster survivors.

40. National Occupational Therapy E-Group Workshop on
Disaster Preparedness and Response
Since due to the reasons beyond control the National OT Workshop on DPR scheduled from 3-7 July at New Delhi could not be held, the AIOTA and WFOT Presidents and officials in consultation with Regional DPR Team, decided to organize it as an E- Workshop by using the innovative mode of using the electronic media –the Internet: an entirely new approach for such an event of international significance.

41. The National OT E-Workshop on DPR commenced from 18th September, 2006 with voluntarily registered 16 participants, and concluded on 23rd Dec. 06.
As a first time experience for all concerned, and given the vagaries of electronic communication across continents, time zones and interspersed with national holidays, the E-Group proceeded surprisingly well.

42. Resource Facilitators for National OT E- Workshop on DPR
WFOT Consultant Kerry Thomas (Australia)
British Delegate and WFOT Executive, now V.P .Finance Samantha Shann (U.K.)
President AIOTA, Dr Anil K. Srivastava ( India )
WFOT President, Kit Sinclair
Hong Kong

43. Following were the 16 participants:
Dr Mrs Z.D.Ferzandi, Coordinator Participant
Dr. Indira R. Kenkre
Dr. Rajani Kelkar
Dr. Jyothika Bijlani
Dr. Anuradha Pai
Dr. Shailaja Jaywant
Dr. Shashi Oberai
Dr. Satish Maslekar
Dr. Veena Slaich
Dr. Anita Gupta
Dr. Krunal Desai
Dr. Poorva Shinde
Dr. Kalpana Kadu
Dr. Odette Gomes
Dr. Mahesh Kawle
Dr. Pankaj Bajpai

44. E-Workshop: The Purpose and Objectives:
The key purpose of this Action Learning – Action Planning E-Workshop on DP&R was: to build capacity of OTs to respond to emergency situations, now and in the future and in doing so to also advance the role of the profession in general community based and occupational approaches to work.

45. The Outcomes of the E-Workshop:
Group members have increased understanding of DP&R and the potential roles that OT can have in DP&R, and increased knowledge, skills and confidence to progress planning and engagement of Occupational Therapy in DP&R.
A first Draft National Occupational Therapy DP&R Plan Document is prepared from which future capacity building and assistance can progress.

46. Draft Terms of Reference for a National OT DP&R Task Force, a body authorized by AIOTA to take forward further development, national endorsement and implementation of the National Plan, and to identify potential members for the Task Force.

47. THE NATIONAL OT PLAN ON DPR: The Highlights:
KEY OBJECTIVES AND IMPLICATIONS FOR OTs:
The establishment of a National OT Disaster Management Task Force
Education and capacity building for OTs in all aspects of disaster management.
Coordination with different disaster preparedness and response agencies.
Mobilization of systems and resources (materials, funds, volunteers, association structures and events etc) to progress plan objectives and actions.

48. PURPOSE
To enable OTs to contribute to national DP&R efforts in an effective and professional way… to assist in the recovery of survivors of disasters and to reduce the risks for those who are especially vulnerable in disaster situations such as people with disability

49. COMPONENTS OF PLAN AND ACTIONS INITIATED
Awareness Rising
To create awareness among OTs of the role of OT in DP&R and especially to promote OT engagement at the primary and grassroots levels by:
Including DPR as a subject in the OT curriculum (direction has been issued to all OT Educational Centers in India for implementation)

50. Arranging camps and making compulsory postings for students for relief and rehabilitation work in community before and after disaster (AIOTA Branches and few of the OT Educational Centres are rendering services to disaster survivors within the community and also in institutions after referral).
Publishing related articles in the journals, periodicals read routinely by OTs. (Articles. News, Letters and information are appearing in AIOTA official publication Indian Journal of OT and AIOTA website as and when received)

51. Policy, Procedures and Standards
As a new area of practice for OTs in India, there is a need to develop policies and procedures to guide OT’s in preparing for and responding to disaster situations. (COTE arranged today on Disaster Management in OT is specifically planned to guide and prepare OT’s to respond to render their expertise for disaster survivors whenever is desired)

52. Coordination, Networking and Partnerships
After the policy planning there will be a need for publicity, co-ordination with other disaster team members.
Evidence-Based Interventions
Liaison to be established with key research and educational institutes to ensure that OT education in the field of DP&R is based on evidence-based policy.
It would be achieved by critically evaluating what is already done and to blend it with new knowledge so that it can be implemented in a given situation.

53. It means placing more emphasis on integration and transfer of research knowledge into practice to be used along with judgment, training, needs of PWD and community members.
Capacity Building
Facilitating development of DP&R in OT undergraduate and Post graduate programs.
Facilitating professional development in DP&R for OTs who want to or may otherwise become engaged in DP&R.
Sharing national and international expertise, experience and exchange programs with Key International Organizations.

54. NATIONAL O.T. D.P. & R. TASK FORCE
1. PURPOSE OF THE DP& R TASK FORCE
To take overall responsibility for the development, endorsement and implementation and evaluation of DP&R involving OT’s in India, including preparedness, emergency response and recovery programs. This will include ensuring OTs work as a team in providing immediate OT services for disaster stricken people and people with disability, and maintaining proper follow-ups.

55. KEY TASKS
The main functions and responsibilities of the Interim Task Force that has been constituted by AIOTA and that further needs to be strengthened, are aimed to:
Coordinate OT National DP&R Plan development and endorsement.
Coordinate development and endorsement of OT Guidelines and Standards for engagement in DP&R.
Coordinate OT awareness raising and marketing regarding OT and DP&R.

56. Develop plans for preparedness and response in conjunction with Branch members and other key stakeholders.
Coordinate OT education and professional development regarding DP&R, including for existing OT professionals and for Undergraduate and Postgraduate students.
Develop partnerships between OT’s and other key stakeholders (government, donors, local and international NGOs, WFOT, etc).

57. Support the coordination and implementation of Pilot Projects and other programmes and services in relation to DP&R
In a Disaster/Emergency, to coordinate implementation of appropriate Action Plans.
Develop and maintain an operational function regarding administration, systems, capacity development, and coordination at all levels.
Coordinate monitoring and evaluation, and reporting.

58. Facilitate sharing of information and learning, and resource dissemination.
Members of the Task Force may require orientation and training in order to success in a Disaster/Emergency, to coordinate implementation of appropriate Action Plans.
Task Force membership and determination of roles will be endorsed by AIOTA in consultation with its local branches.

59. The Interim National OT Task Force:
To respond to emergency situation an Interim National OT Task force is being constituted in AIOTA. The need is for its strengthening for the effective functioning for involvement of OT’s therein.
President AIOTA – Coordinator
Group Leader: any one of the senior AIOTA member in the affected area, may be designated as Group Leader to take up the responsibility.
Branch Convenor of the affected area.

60. NTF Members –Active participants of E-Workshop
Associate Human resources – qualified OT’s in the affected region ,
Undergraduate interns and Postgraduate OT students from the particular/ nearby regions.

61. Potential Benefits of Involvement in DPR
“Occupational therapists are passionate and committed professionals, and potentially have much to contribute in facilitating the recovery of traumatized people and communities. Generally however, occupational therapists are not connected into formal disaster response mechanisms. This is mainly because OT’s have limited familiarity or connection with disaster response coordination systems. Their role is not widely recognized.”

62. The primary goal of occupational therapy is to enable people to participate successfully in the activities of everyday life. They achieve this outcome by enabling people to do things that will enhance their ability to live meaningful lives or by modifying the environment to better support participation. It enhances longer term national capacity and self-reliance in disaster affected countries, and beyond.

63. The significant benefits of involvement of OT’s in DPR also include:
better equipped with local health professionals in their ongoing efforts to rebuild their lives and livelihoods, contributing to outcomes that can be sustained by local service providers and systems

64. local Health Professional including OT’s, engaging with disasters and reconstruction policy, planning and coordination mechanism, contributing pertinent expertise to the current response effort while laying the foundation for more cohesive involvement and response efforts in the event of future disasters

65. local occupational therapists and others become more effectively able to participate in and progress wider community, government and international objectives for enabling ‘access for all’ to community based rehabilitation and health care services, contributing to the achievement of national, regional and UN goals (eg. WHO, UNICEF, Human Rights and Millennium Development Goals)

66. role in stronger networking and coordination between local health professionals, government services and projects, and national and international NGO programs, providing for a more integrated, holistic and yet rationalized and self-reliant service framework

67. at a more practical level benefit include better quality ongoing care and support for disaster affected individuals and their families, particularly those with psycho-social trauma and physical injuries, stronger referral and follow-up systems between community care, hospital and rehab centre programs; and more disability and age friendly accessibility in private and public buildings/spaces

68. Relationships between donors and occupational therapy organizations (including WFOT and national associations) established that lay the foundation for ongoing partnerships for mutual benefit and the benefit of communities into the future.
Practitioners become equally responsive to psychological and psychiatric conditions as they are to physical disorders. A special focus is built on the early detection of stress, psychological distress and psychiatric phenomena
Intra professional support that is essential is also achieved.

69. Specific OT Roles: Post Disaster
Inclusion of OT’s in CBR-Post Disaster at grass root level is not possible unless there is knowledge and understanding of the local culture, the socio economic background and the religious practices within the community. The culture, the religion and family in India, impel people to support and look after the weak and disabled. Families provide an identity and sense of security to its members irrespective of their ailments and/or disability.

70. Caring and sharing is still a part of Indian culture
Caring and sharing is still a part of Indian culture. An effective community therapy program is very much dependent upon its acceptance by the community. Realization of need and involvement of community both are key factors for acceptance.

71. Specific OT Roles: Post Disaster may include but are not limited to-
Ensuring accessible environments post disaster at all stages of recovery ( eg. In displaced persons camps) and reconstruction ( in rebuilding homes and community facilities)
Organization of daily activities in displaced persons camps and surviving communities to include persons with disabilities, women, elderly and children
Liaison with/ and encouragement of community leaders and others to reorganize community supports and routines

72. Use of every day occupations including play and sports to facilitate recovery
Assessment of mental health status of survivors for depression and suicidal tendencies, with subsequent counseling and occupation based activities
Training of volunteers to carry out mental health assessment and counseling, thus providing more immediate services for greater numbers.

73. Disability and Disasters: Some Facts
60% of PWD are overlooked during disaster situations; PWD and their relatives are even more excluded in emergency situations than in ‘normal’ times
Women and children are 14 times more at risk than men; the elderly are also at high risk; PWD are more at risk
PWD suffer particularly high rates of mortality and morbidity in disasters, while many more become disabled as a result of disasters.

74. The Issues to be considered in Disaster Management
A typical Disaster Management continuum comprises of six elements i.e., Prevention, Mitigation and Preparedness in pre-disaster phase, and Response, Rehabilitation and Reconstruction in post-disaster phase.

76. The OT’s engaged in management of Disaster affected should consider following issues in planning strategy:
Large and overwhelming numbers of displaced persons who may be highly mobile (including within camp accommodation) and/or with whom it may be difficult to register their needs.
Issues of immediate requirements for shelter, food, water, and disease prevention/sanitation; and their long term provision and sustainability.

77. Loss of income and sustainable means of living for survivors -- affecting immediate and long term survival, and responses to post-traumatic stress.
Psychosocial effects to survivors which include loss of family and other supports – particularly affecting vulnerable groups (e.g. the elderly, children, people with disabilities).

78. Significant needs for psychological and mental health care – including identification and referral, and support for health-workers and systems and organizations who may struggle to cope with the demands in the early stages post-event.
Loss of, or effects to, local community services and local health workers.

79. Difficulties in service delivery due to effects to infrastructure and supplies – emergency medical, food and water supplies, sanitation issues, destruction of roads and access routes, transport and fuel availability, health care buildings and facilities.
Common physical traumas caused by the event itself – e.g. fractures, amputations, brain injury as well as the needs of people with disabilities prior to the disaster.

80. Necessity to offer a coordinated approach between all groups and organizations involved.
Building on existing local community coping strategies.
Offering culturally and contextually appropriate responses.

81. Mental Health Issues:
Persons affected by a disasters …are exposed to extreme stress, immediately and over a period of years, and are vulnerable to the development of serious mental health problems and mental disorders. The early intervention should include making effort in actively engaging people in decision making, including about how emergency care is to be provided, has shown to markedly reduce the impact of trauma and promote recovery (e.g. reduce psychosocial trauma and longer term stress reactions).

82. It is important to consider the culture and socio-political context - having people themselves be actively involved in sorting out these things will improve the appropriateness of the responses.

83. The National Vision on Disaster Management
On 23 December, 2005, the Government of India took a defining step by enacting the Disaster Management Act, 2005, which envisaged the creation of the National Disaster Management Authority (NDMA), headed by the Prime Minister, State Disaster Management Authorities (SDMAs) headed by the Chief Ministers, and District Disaster Management Authorities (DDMAs) headed by the Collector or District Magistrate or Deputy Commissioner as the case may be, to spearhead and adopt a holistic and integrated approach to DM.

84. The focus is: from the erstwhile relief-centric response to a proactive prevention, mitigation and preparedness-driven approach for conserving developmental gains and also to minimize losses of life, livelihoods and property.
The Union Cabinet also approved the National Policy on Disaster Management (NPDM) very recently on Oct. 22nd, 2009.

85. It is prepared in tune with and in pursuance of the Disaster Management Act, 2005 with a vision to build a safe and disaster resilient India by developing a holistic, proactive, multi-disaster oriented and technology driven strategy through collective efforts of all Government Agencies and Non-Governmental Organizations.
This will be achieved through a culture of prevention, mitigation and preparedness to generate a prompt and efficient response at the time of disasters. It will provide the framework/roadmap for handling disasters in a holistic manner.

86. The National Policy on Disaster Management
The Policy covers all aspects of disaster management covering institutional, legal and financial arrangements; disaster prevention, mitigation and preparedness, techno- legal regime; response, relief and rehabilitation; reconstruction and recovery; capacity development; knowledge management and research and development.

87. The NPDM addresses the concerns of all the sections of the society including differently able persons, women, children and other disadvantaged groups. In terms of grant of relief and formulating measures for rehabilitation of the affected persons due to disasters, the issue of equity/inclusiveness has been accorded due consideration.

88. The NPDM aims to bring in transparency and accountability in all aspects of disaster management through involvement of community, community based organizations, local bodies and civil society.
The Policy represents merely the first step in the new journey. It is an instrument that hopes to build the overarching framework within which specific actions need to be taken by various stakeholders including OT and health professional at all levels.

89. India needs to make its Hospitals Disaster Resistant
According to WHO “Global Warming is increasing every day, raising the chances of typhoons and floods. In such a situation, the need is to have safer hospitals with sufficient human resources to tackle the surge of patients that would be impacted by disaster.
In pursuance of it, WHO is spearheading the campaign in disaster prone regions of S.E. Asia to promote the concept of disaster- resilient health facilities in its 11 member countries, including India.

90. The U.S. Agency for International Development (USAID) is also committed to including people who have physical and mental disabilities and those who advocate and offer services on behalf of people with disabilities. The commitment extends from the design and implementation of USAID programming to advocacy for and outreach to people with disabilities.

91. Future Plans in Respect to OT: AIOTA plans to expend OT services if required in collaboration with WFOT and other national and international agencies, for expansion of OT services in DPR by:
Facilitating development of DP&R in OT undergraduate and post graduate programs
Facilitating professional development in DP&R for OTs who want to or may otherwise become engaged in DP&R

92. Contributing to processes, to increase the number of OTs available to work in DP&R and related community based work roles
Mobilize access to learning-teaching materials and resources in support of OT capacity building
Sharing national and international expertise, experience and exchange programs

93. Sensitizing the key authorities in government, on contribution of OT’s in DPR and involve them in the planning/Implementing of the educative and communicative program. Recommending to Government for employment opportunities for OT’s for community based roles
Propagating through media (Print, T.V., and Radio) regarding achievements made by OT individuals and groups from the field in DP&R related activities.

94. Natural disasters are often frightening and difficult for us to understand, because we have no control over, when and where they happen. What we can control is how prepared we are as professionals, communities and governments to deal with the dangers that natural disasters bring. The effects of disasters are made worse by underdeveloped infrastructure and widespread poverty in our country.

95. Tsunamis, earthquakes, hurricanes or any other natural disaster can't be avoided, but with good preparation and well-organized help after the fact, it is possible to survive and go back to normal life afterwards, with experience, expertise and dedicated efforts of all concerned, including we OT’s.

96. Acknowledgement
Inclusion of OT’s in Disaster Management is a brain child of Kit Sinclair the immediate past President of WFOT. It was her vision and the hard work and dedication that the new area of OT practice has emerged. In support with Kerry Thomas an OT and WFOT Consultant, she not only organized Regional Workshop but the both also had been the key persons in successful organization of national workshops in Tsunami affected countries.

97. WFOT’s Disaster Preparedness & Response: Information & Resource Package is document carrying useful information, based on the report on Post Tsunami situational analysis, outcomes of Regional and National Workshops and useful linkage for further development of this specific area. The encouragement and guidance from Kit and Kerry to me in preparation for the COTE on Disaster Management in OT is gratefully acknowledged.
My gratitude to AIOTA and ACOT EC for showing confidence and faith on me for conducting the COTE on an entirely new area of OT practice.

98. THANK YOU