HOSPITAL REHABILITATION IN HUMANITARIAN SETTINGS - CHALLENGES AND TAILORED SOLUTIONS
B. Gohy1,2, A.J. Majok3, J.N. Yadav4, P. Moreau5
All authors, affiliations and abstracts have been published as submitted.
1Humanity & Inclusion, Rehabilitation Division, Brussels, Belgium, 2Karolinska Institutet, Department of Physiotherapy, Stockholm, Sweden, 3International Committee of the Red Cross, Hai Referendum Hospital, Juba, South Sudan, 4Humanity & Inclusion, Sana, Yemen, 5Médecins Sans Frontières, Paris, France
Learning objective 1: Create awareness on challenges and specificities in providing hospital rehab in humanitarian settings
Learning objective 2: Demonstrate practical examples on solutions to provide hospital rehabilitation in humanitarian settings
Learning objective 3: Illustrate innovative solutions to provide hospital rehabilitation in humanitarian settings
Description: There is an estimated 2.4 billion persons in need of rehabilitation worldwide, of which more than 1 billion suffering from acute conditions (either musculoskeletal or neurologic) (Cieza et al. 2020).
For those patients with acute conditions, hospital rehabilitation aims at reducing the risk of complications and optimizing recovery, while also facilitating early discharge and appropriate referral for community follow-up, and is therefore recommended (WHO, 2017).
The Rehab 2030 initiative has been promoting the integration of rehabilitation services into and between primary, secondary and tertiary levels of health system, including hospital rehabilitation, ensuring a continuum of care.Furthermore, hospitals should include specialized rehabilitation units for inpatients with complex needs. However, there are misconceptions towards hospital rehabilitation, considering it as a luxury service or seeing rehabilitation as only targeting patients with chronic disabilities, which hinders its implementation (WHO, 2017).
The rehabilitation needs are still largely unmet, including at hospital level, especially in low- and middle-income countries (LMICs) and humanitarian settings (Jesus et al. 2019), due to challenges such as:
- Lack of skilled rehabilitation staff in hospitals: most LMICs have only one-tenth of the needed rehabilitation workforce (Jesus et al. 2019). This situation is worsened in countries affected by conflict where health systems are weakened with health facilities destroyed and exodus of skilled health human resources. Additionally, there is a lack of awareness around early rehabilitation from patients, caregivers and hospital staff (Barth 2021).
- Lack of multidisciplinary rehabilitation and specialized rehabilitation for patients with complex needs (such as patients with multiple trauma or burns): though proven beneficial for patients with complex needs, such integrated rehabilitation services require dedicated human and material resources that are often lacking in LMICs (Khan et al, 2012).
- Lack of continuum of care: There are important difficulties setting up outpatient rehabilitation services for long-term treatments (2 years for burns for example), which is even more crucial considering the lack of discharge options and living conditions in some settings (Wickford and Duttine, 2013).
On top of those challenges, in LMICs and in humanitarian settings, types of patients admitted to hospital tend to be younger than in HICs, most often males, with complex needs such as severe burns and more penetrating injuries (Wild et al. 2020; Peck, 2011).
Applying rehabilitation models from HIC to LMICs (Barth et al. 2021) has been proved unsuccessful, calling for tailored solutions.Each of the abovementioned challenges will be illustrated by an example, as well as some of the solutions applied:
In Yemen, the hospital staffs, including rehabilitation and other healthcare providers are often not aware of early and functional rehabilitation and the use of assistive devices that help in early mobility and prevention of further complications following injuries.HI has set up an awareness raising and capacity building program, targeting not only the rehabilitation staff, but also the other healthcare providers and the hospital management, at all three level of health facilities.HI has also been working with the Ministry of Health for the integration of rehabilitation into the health system and with the university to update the bachelor curriculum by adding early and emergency rehabilitation in the syllabus.
In Haiti, following a series of natural disasters, and among ongoing political and economic crises, Haiti’s healthcare system remains precarious. There are many victims of burns coming from urban areas where precarious living conditions increase the risk of domestic accidents. MSF provides specialized and multidisciplinary care for patients after burn, including physiotherapy, from the acute phase throughout the entire healing process lasting up to 2 years. New innovative solutions have been implemented on MSF fields, such as telemedicine for remote clinical support associated with 3D technology for facial orthosis. Clinical research is currently ongoing for assessing replicability on other fields.
In South Sudan, as it is often the case in LMIC,patients don’t have access to continue rehabilitation for post-acute care as there are no facilities providing this type of care (Hakim, 2012) and a lack of funding and awareness about the utility of such services ( Brau and Blake, 2015) . Patients are discharged home without further treatment after acute care in hospital. A specific referral pathway was elaborated by the ICRC between the hospital and the rehabilitation program to meet long-term rehabilitation needs.
For those patients with acute conditions, hospital rehabilitation aims at reducing the risk of complications and optimizing recovery, while also facilitating early discharge and appropriate referral for community follow-up, and is therefore recommended (WHO, 2017).
The Rehab 2030 initiative has been promoting the integration of rehabilitation services into and between primary, secondary and tertiary levels of health system, including hospital rehabilitation, ensuring a continuum of care.Furthermore, hospitals should include specialized rehabilitation units for inpatients with complex needs. However, there are misconceptions towards hospital rehabilitation, considering it as a luxury service or seeing rehabilitation as only targeting patients with chronic disabilities, which hinders its implementation (WHO, 2017).
The rehabilitation needs are still largely unmet, including at hospital level, especially in low- and middle-income countries (LMICs) and humanitarian settings (Jesus et al. 2019), due to challenges such as:
- Lack of skilled rehabilitation staff in hospitals: most LMICs have only one-tenth of the needed rehabilitation workforce (Jesus et al. 2019). This situation is worsened in countries affected by conflict where health systems are weakened with health facilities destroyed and exodus of skilled health human resources. Additionally, there is a lack of awareness around early rehabilitation from patients, caregivers and hospital staff (Barth 2021).
- Lack of multidisciplinary rehabilitation and specialized rehabilitation for patients with complex needs (such as patients with multiple trauma or burns): though proven beneficial for patients with complex needs, such integrated rehabilitation services require dedicated human and material resources that are often lacking in LMICs (Khan et al, 2012).
- Lack of continuum of care: There are important difficulties setting up outpatient rehabilitation services for long-term treatments (2 years for burns for example), which is even more crucial considering the lack of discharge options and living conditions in some settings (Wickford and Duttine, 2013).
On top of those challenges, in LMICs and in humanitarian settings, types of patients admitted to hospital tend to be younger than in HICs, most often males, with complex needs such as severe burns and more penetrating injuries (Wild et al. 2020; Peck, 2011).
Applying rehabilitation models from HIC to LMICs (Barth et al. 2021) has been proved unsuccessful, calling for tailored solutions.Each of the abovementioned challenges will be illustrated by an example, as well as some of the solutions applied:
In Yemen, the hospital staffs, including rehabilitation and other healthcare providers are often not aware of early and functional rehabilitation and the use of assistive devices that help in early mobility and prevention of further complications following injuries.HI has set up an awareness raising and capacity building program, targeting not only the rehabilitation staff, but also the other healthcare providers and the hospital management, at all three level of health facilities.HI has also been working with the Ministry of Health for the integration of rehabilitation into the health system and with the university to update the bachelor curriculum by adding early and emergency rehabilitation in the syllabus.
In Haiti, following a series of natural disasters, and among ongoing political and economic crises, Haiti’s healthcare system remains precarious. There are many victims of burns coming from urban areas where precarious living conditions increase the risk of domestic accidents. MSF provides specialized and multidisciplinary care for patients after burn, including physiotherapy, from the acute phase throughout the entire healing process lasting up to 2 years. New innovative solutions have been implemented on MSF fields, such as telemedicine for remote clinical support associated with 3D technology for facial orthosis. Clinical research is currently ongoing for assessing replicability on other fields.
In South Sudan, as it is often the case in LMIC,patients don’t have access to continue rehabilitation for post-acute care as there are no facilities providing this type of care (Hakim, 2012) and a lack of funding and awareness about the utility of such services ( Brau and Blake, 2015) . Patients are discharged home without further treatment after acute care in hospital. A specific referral pathway was elaborated by the ICRC between the hospital and the rehabilitation program to meet long-term rehabilitation needs.
References: - Barth CA et al. A Focus Group Study to Understand the Perspectives of Physiotherapists on Barriers and Facilitators to Advancing Rehabilitation in Low-Resource and Conflict Settings. Int J. Environ. Res. Public Health. 2021, 18, 12020.
- Cieza A, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;6736(20):1–12.
- Hakim E. Rehabilitation of patients with traumatic brain injuries in South Sudan. SSMJ. 2015; 5 (2)
- Jesus TS et al. Global need for physical rehabilitation: Systematic analysis from the global burden of disease study 2017. Int J Environ Res Public Health. 2019;16(6).
- Khan F et al. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. Br J Surg. 2012;99(SUPPL. 1):88–96.
- Peck MD. Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns 2011; 37: 1087 –100
- Rau B and L.Blake. Physiotherapy in conflict zones: the expertise of the international committee of the red cross supported hospital projects. Physiotherapy. 2015; 101 (SUPPL. 1): E1263-E1264.
- WHO. Rehabilitation in health systems. Geneva; 2017.
- Wickford J. and Duttine, A. Answering Global Health Needs in Low-Income Countries: Considering the Role of Physical Therapists. World medical and health policy. 2013; 5 (2)
- Wild H et al. Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors. World J Surg [Internet]. 2020;44(6):1863–73.
- Cieza A, et al. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;6736(20):1–12.
- Hakim E. Rehabilitation of patients with traumatic brain injuries in South Sudan. SSMJ. 2015; 5 (2)
- Jesus TS et al. Global need for physical rehabilitation: Systematic analysis from the global burden of disease study 2017. Int J Environ Res Public Health. 2019;16(6).
- Khan F et al. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. Br J Surg. 2012;99(SUPPL. 1):88–96.
- Peck MD. Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns 2011; 37: 1087 –100
- Rau B and L.Blake. Physiotherapy in conflict zones: the expertise of the international committee of the red cross supported hospital projects. Physiotherapy. 2015; 101 (SUPPL. 1): E1263-E1264.
- WHO. Rehabilitation in health systems. Geneva; 2017.
- Wickford J. and Duttine, A. Answering Global Health Needs in Low-Income Countries: Considering the Role of Physical Therapists. World medical and health policy. 2013; 5 (2)
- Wild H et al. Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors. World J Surg [Internet]. 2020;44(6):1863–73.
Funding acknowledgements: The different programs presented are implemented/supported by :
-Humanity&Inclusion (HI)
-Médecins Sans Frontières (MSF)
-International Committee of the Red Cross (ICRC)
-The Research for Health in Humanitarian Crises (R2HC)
-Humanity&Inclusion (HI)
-Médecins Sans Frontières (MSF)
-International Committee of the Red Cross (ICRC)
-The Research for Health in Humanitarian Crises (R2HC)
All authors, affiliations and abstracts have been published as submitted.
