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Tupetz A1, Landry M2,3, Sultana M4, Hoque KI5
1Duke University, Duke Global Health Institute, Durham, NC, United States, 2Duke University, Doctor of Physical Therapy Division, Durham, United States, 3Duke University, Duke Global Health Institute, Durham, United States, 4Centre for the Rehabilitation of the Paralysed (CRP), Savar, Bangladesh, 5International Committee of the Red Cross (ICRC), Cox's Bazar, Bangladesh
Background: Road traffic injuries are predicted to become the seventh leading cause of death by 2030. The vehicles that are used in low and middle income countries (LMIC) can be equally dangerous as the overcrowded roads and traffic infrastructure. This study presents the impact of a near fatal type of traffic injury in Bangladesh, referred to as Scarf Injury, that almost exclusively affects females. A growing number of passengers of a recently-introduced battery run taxi, called the `easy bike´, are sustaining complete cervical Spinal Cord Injury (SCI) and anterior neck lacerations, after their traditional scarves become entangled in the taxi´s engine drive shaft.
Purpose: This study aimed to gain a deeper understanding of the risk factors and long term consequences of this injury, by learning about the specific barriers towards living an independent and empowered life with a disability.
Methods: A total of 18 semi-structured in-depth interviews were conducted with 12 scarf injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. A maximum variation sampling strategy was used.
Results: Four major themes emerged:
(1) Emergency response,
(2) Quality of acute care,
(3) Knowledge of SCI,
(4) Barriers to Quality of Life.
Identified barriers to accessing quality care were the lack of knowledge and awareness of acute SCI management from the general population providing first aid, as well as medical professionals. Patients felt that they were not safely or adequately transported to a health facility and in at least one case the patient even denied care due to a suspected suicide attempt, further delaying diagnosis, treatment and education. Almost no patient or caregiver had prior knowledge of SCI and scarves as a risk factor for such type of injury.
Regarding the patients´ QoL, the following barriers were identified: Community participation, social relationships, mental health, future goals and secondary physical complications.
All participants experienced a sense of social isolation and reported difficulties to return to work or school, due to logistical challenges, lack of trust in their own abilities to succeed or secondary complications. The participants´ perceptions and inability to formulate future goals were mostly influenced by their emotional state, which was highly impacted by the trauma they suffered and the use of coping strategies, in both, complete and incomplete Spinal Cord lesions. Several participants voiced their suicidal thoughts during the interviews, showing signs of severe depression.
Conclusion(s): Increasing awareness and knowledge about SCI emergency care would likely improve long-term clinical outcomes. Moreover, greater competencies among providers for this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would begin the coping process. Living with a disability as a female in Bangladesh and other LMICs creates a double burden from the perspectives of patients, families and the community.
Implications: To improve health, mentally and physically, empowerment and targeted long-term rehabilitation aiming for successful social reintegration is necessary. Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.
Keywords: Road Traffic Injuries, Access to Care, Social Determinants of Health
Funding acknowledgements: Duke Global Health Institute
Purpose: This study aimed to gain a deeper understanding of the risk factors and long term consequences of this injury, by learning about the specific barriers towards living an independent and empowered life with a disability.
Methods: A total of 18 semi-structured in-depth interviews were conducted with 12 scarf injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. A maximum variation sampling strategy was used.
Results: Four major themes emerged:
(1) Emergency response,
(2) Quality of acute care,
(3) Knowledge of SCI,
(4) Barriers to Quality of Life.
Identified barriers to accessing quality care were the lack of knowledge and awareness of acute SCI management from the general population providing first aid, as well as medical professionals. Patients felt that they were not safely or adequately transported to a health facility and in at least one case the patient even denied care due to a suspected suicide attempt, further delaying diagnosis, treatment and education. Almost no patient or caregiver had prior knowledge of SCI and scarves as a risk factor for such type of injury.
Regarding the patients´ QoL, the following barriers were identified: Community participation, social relationships, mental health, future goals and secondary physical complications.
All participants experienced a sense of social isolation and reported difficulties to return to work or school, due to logistical challenges, lack of trust in their own abilities to succeed or secondary complications. The participants´ perceptions and inability to formulate future goals were mostly influenced by their emotional state, which was highly impacted by the trauma they suffered and the use of coping strategies, in both, complete and incomplete Spinal Cord lesions. Several participants voiced their suicidal thoughts during the interviews, showing signs of severe depression.
Conclusion(s): Increasing awareness and knowledge about SCI emergency care would likely improve long-term clinical outcomes. Moreover, greater competencies among providers for this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would begin the coping process. Living with a disability as a female in Bangladesh and other LMICs creates a double burden from the perspectives of patients, families and the community.
Implications: To improve health, mentally and physically, empowerment and targeted long-term rehabilitation aiming for successful social reintegration is necessary. Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.
Keywords: Road Traffic Injuries, Access to Care, Social Determinants of Health
Funding acknowledgements: Duke Global Health Institute
Topic: Neurology; Disability & rehabilitation; Globalisation: health systems, policies & strategies
Ethics approval required: Yes
Institution: Duke University Health System
Ethics committee: Duke University Health System Institutional Review Board for Clinical Investigations
Ethics number: Pro00092024
All authors, affiliations and abstracts have been published as submitted.
