European Journal for Person Centered Healthcare 2015 Vol 3 Issue 2 pp 249-252
ARTICLE
A multidisciplinary approach to disability rehabilitation: the case of a person with disability Haider Darain BSPT MSc PhDa, Abdulhameed Alkitanib, Muhammad Kashif MSc BSPTc, Najat Soboh El-ziq MScd, Javaid Ghani PPDPt BSPTe and Muhammad Ibrar PPDPt BSPTf a Assistant Professor,, Khyber Medical University, Institute of Physical Medicine and Rehabilitation, Peshawar, Pakistan b PhD Student, Queen Margaret University, Edinburgh, Scotland, UK c Assistant Professor, Anglia Ruskin University, Cambridge, UK d Programme Co-ordinator for Community-Based Rehabilitation Programme, Institute of Child Health, University of London, London, UK e Physiotherapist, Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS), Peshawar, Pakistan f Physiotherapist, Isra Univeristy, Islamabad, Pakistan
Abstract Background and purpose: Community-based rehabilitation programs focus on identifying available resources in the community in order to support the patient. Resource Information Centers (RICs) play a vital role in mobilizing these resources by disseminating appropriate information among the stakeholders. However, little has been reported in the literature about the specific roles associated with RICs. In this study, we report the role of Resource Information Center (RIC) as part of a community-based rehabilitation program (CBRP) for a person with disability. Method: A 34-year-old male with left leg above knee amputation was identified during our field visit. The field visit was undertaken by members of a RIC visit to the areas affected by an earthquake in Pakistan in October 2005. The Government of Pakistan, in collaboration with some national and international organizations, had introduced a 3-year program (20072010) in which community-based rehabilitation programs were made available for areas affected by earthquakes. The patient was initially referred to another organization that was working on providing rehabilitation service for persons with disability. He was provided with an artificial leg prosthesis to which he had been referred. Results: After receiving the artificial limb, the patient managed to return to his previous occupation which ultimately improved his financial status. Moreover, an improvement in his social integration was observed in the form of his ability to attend social meetings and ceremonies. Conclusion: The patient case we discuss is, we suggest, illustrative of the majority of people with disabilities (PWDs) in countries such as Pakistan are unaware of the exiting services designed to help them to manage their disability. The financial constraints of the PWDs might be overcome by offering guidance on how to access the available resource in their community. Such actions significantly increase the provision of person-centered healthcare. Keywords Community-based rehabilitation, developing countries, disability, multidisciplinary care, people with disabilities (PWD), person-centered healthcare, rehabilitation, resource information centres Correspondence address Dr. Haider Darain, Institute of Physical Medicine and Rehabilitation, Kyyber Medical University, Peshwar, Pakistan. E-Mail:
[email protected] Accepted for publication: 1 December 2014
Introduction The increasing number of natural disasters, road traffic accidents, increases in life expectancy and aging populations have made people with disabilities (PWDs) a substantial minority of the World’s population totaling, by some estimates,650 million people and thus almost 10% of the World’s population [1]. of these, the majority of PWDs live in developing and poor countries where they often become marginalized from the mainstream population [2]. Community-based rehabilitation (CBR) approaches play a vital role in the improvement of the quality of life of
PWDs and their families by providing them with equal opportunities to access the available resources in the Community [3,4]. These approaches were introduced by the World Health Organization (WHO) in the mid-1980s and had been reported as effective methods for ‘mainstreaming’ PWDs in the communities in which they live. The Government of Pakistan, in collaboration with various national and international organizations, introduced the same approach for the rehabilitation of PWDs in the areas affected by the earthquake that occurred in Pakistan in 2005 [5]. As a result, Resource Information Centers (RICs) were established in the affected areas. RICs 249
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were designed as hubs of different activities for PWDs in the earthquake affected areas with the aim of forming linkages between PWDs and organizations working with disability or any components of CBR programmes. In order to facilitate linkages between PWDs and community resources, a systematic referral system had been established by the RIC Team in the form of mapping available facilities for PWDs in the affected areas and referring them to the resources available. A recent commentary based on field experience work by Darain et al. [1] reported a detailed mechanism by which RICs facilitated linkages between PWDs and the Community in the areas affected by the earthquake. According to the latter commentary, regular field visits to remote parts of the earthquake affected areas were undertaken by the RIC staff. During these field visits, PWDs were identified and individual meetings with them were conducted by the RICs members. A list of priorities regarding the important needs of the PWDs was finalized by members of the RIC. This case report is based on the same field experience discussed above where a PWD was identified who had failed to gain access to rehabilitation services.
Patient case study A 34-year-old man with left leg above knee amputation was identified during our field visit to one of the remote areas of District Muzaffarabad, Azad Jammu Kashmir, Pakistan. The field visit was one of the visits conducted routinely by members of the RIC for the purpose of identifying persons with disabilities. Information about our project was given to the patient and his informed consent sought and obtained in order to register him into the project. A list of priorities and important needs for the patient was finalized by field officers. Additionally, a comprehensive assessment of the rehabilitative needs of the PWD was conducted by a qualified physiotherapist who worked as a Technical Officer in the project (M.K). The list of priorities and assessment by the Technical Officer revealed an urgent need to provide the patient with a prosthesis. Consequently, the patient was referred to another organization (The Helping Hand Rehabilitation Centre) which had been providing artificial limbs to the PWDs in the district detailed. At that organization, the patient was systematically assessed by a prosthetics technician and an appropriate artificial limb was prescribed. With continuous follow up from the RIC staff, the patient received his artificial limb within 10 days after the prosthetic assessment. The patient received proper gait training under the supervision of a qualified rehabilitation team at the organization.
Results We compared the patient’s present status with his previous status in terms of his social integration and financial status. He was the sole ‘bread earner’ of his family prior to his amputation and had a tailoring shop in a small market
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which was two kilometers in distance away from his house. However, due to limited mobility caused by the amputation and the access challenges to the area where he worked, he was unable to walk to the market to continue his occupation. This had adversely affected his financial status resulting in the need for him and his family to live a new and difficult life with no regular income to support their basic needs. However, after receiving the new prostheses and adequately learning gait training from the qualified physiotherapist, he was able to walk to the nearby market to continue his previous occupation. Our initial assessment of his income revealed that he was generating from his occupation a sum of 10,000-12,000 Pakistani Rupees per month. This amount could be considered a reasonable amount for sustaining day to day living expenses in the area where he lived. Before the intervention of RIC members, the patient had a limited social life as most of the nearby places he wished to visit were either completely or partially inaccessible to him. He was occasionally visited by some of his close friends and nearby relatives. This limited interaction with other community members had badly affected his psychological wellbeing and, according to his family members, he was in a state of depression most of the time following the amputation. His depression was successfully managed by providing him with his new artificial limb, but also by offering him a number of psychotherapy sessions with the field psychologist. In this case study, we did not have the resources or specific tools objectively to measure the patient’s social integration with reference to his previous level of social integration. Nevertheless, we contend that the resumption of his daily activities, including daily visits to his tailoring shop and attending meetings arranged by RIC members, might be considered as an observable improvement in this regard.
General discussion The issue of disability in developing countries requires special attention as more than 80% of PWDs in these countries had been reported to live in isolated existence in the rural areas where access to basic facilities is limited [6]. The patient we discuss was one of such PWDs who lived in a similar environment where access to basic facilities was limited. Moreover, due to limited mobility caused by his leg amputation, he lived an isolated life and was only occasionally visited by some of his friends or relatives. The limited interaction of PWDs with other community members or limited participation of PWDs in educational, social or recreational activities has been reported as not atypical in developing countries [7,8]. Apart from the patient’s limited social integration, his house had been badly affected structurally by the earthquake with a general devastation to infrastructure and everyday human living in the affected areas [9,10]. In fact, the majority of the survivors of the earthquake were left with no homes and were reported to be living under the open sky or in temporary shelters which were not at all 250
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suitable given the weather at that time [11,12]. Moreover, more than half of the survivors were reported as living in stressful conditions [11]. The patient we discuss might be considered one of the survivors who faced post-traumatic depression due to exposure to the enormous casualties and deaths occasioned by the earthquake. The devastating earthquake attracted many national and international humanitarian organizations to Pakistan in an effort to provide relief and rehabilitation. In order to assist PWDs in the earthquake affected areas, Handicap International (which already had implemented CBR programs in developing countries including Nepal, Bangladesh and India), in collaboration with the Government of Pakistan, introduced CBR programmes. The vital role of CBR programmes for social integration of PWDs is clear from the fact that these endorse not only the basic rights of PWDs, but also investigate how to generate an environment where PWDs can achieve equal opportunities when compared to their "able-bodied" counterparts [8]. In an attempt to facilitate the process of rehabilitation of PWDs in the earthquake affected area, RICs were established by Handicap International in four districts [9]. The RICs arranged more than 90 medical rehabilitation camps in collaboration with the Government of Pakistan and with non-government organizations that were working with disability in these four districts of Pakistan. Through these medical camps, 4655 PWDs were referred to different hospitals and community centres in order to offer rehabilitation and inclusion in mainstream activities [13,14]. The patient we discuss here is only one of the PWDs who benefitted from these medical camps arranged by the RIC and functions well as an exemplar. Initially, medical rehabilitation including physiotherapy treatment and provision of prosthetic and orthotic services were provided by The Helping Hand Rehabilitation Centre. In addition to this, stress and psychological issues deriving from the exposure to the devastating injuries and death from the earthquake, which had negatively affected the normal recovery of the patient, were properly addressed by field psychotherapy sessions. A multidisciplinary team, consisting of general practitioners, physiotherapists, occupational therapists, psychologists and prostheticists and orthotists, were all involved as part of the medical rehabilitation services, with their respective expertise made available to the subject.
Conclusion The devastating effects of the 2005 earthquake have drawn the attention of policy makers, humanitarian and development agencies to the issue of disability, especially in Pakistan. However, much is needed to be done in order to reach out to and facilitate each individual PWD in their own developing countries. Physical inaccessibility in the areas affected by the earthquake severely affected the living standards of PWDs and this had, ultimately, kept PWDs unaware of the existing facilities and the rehabilitation resources available to them.
The RIC can play a vital role in bridging the gap between the needs of people with disabilities and the existing services which can help them. in doing so, it greatly increases the level of provision of person-centered healthcare to patients.
Acknowledgements and Conflicts of Interest The authors thank all members of The Helping Hand Rehabilitation Center and especially S.M. Ilyas, Iftikhar Shehzad and Jawad Hussain for providing assistance during the rehabilitation of the patient we discuss in the current paper. We declare no conflicts of interest.
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