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Spinal Cord Injury Project for Pakistan Earthquake Rehabilitation (SKIPPER), Balakot, Pakistan
Fall 2009 |
| By Haamid Jaffer, Member, CHAL Network Steering Committee |
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| CHAL Network came together to serve the physically challenged persons of the 8 October 2005 earthquake that hit Northern Pakistan. We committed oversight of rehab centres established by our Network partners for three years. It was foreseen that these centres would be integrated in the District HQ Hospitals that were under construction anew in Kashmir and NWFP. |
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| Three fiscal years ended June 30, 2009. The DHQ Hospitals will take yet another two years to complete. By then young persons from Bagh, Besham and Battagram will qualify with a BSc degree from PIPOS Peshawar as prosthetists and orthotists. They will sustain the rehab centres and provide care to the affected persons in the future. |
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| Pakistan Petroleum Limited Employees Welfare Trust agreed with us to ring-fence left over funds on 30 June 2009 to sustain rehab centres that have been under our oversight. Rs 75 million (under $1m) have been set aside. Income from this ‘Endowment’ will serve physically challenged persons, 70 spinal cord injury persons (SCIP) and a 100 amputee children in particular in the long term.
We will continue to solicit funds, including zakat, to meet extraordinary expenses for such persons, in particular to make up shortfall on account of Rupee depreciation against international currencies and inflation. Components for modular limbs are imported from Germany. |
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| Your Zakat and donations will help them today and in turn they will become contributors of Zakat and taxpayers in years to come. This in essence is true rehabilitation, to quote Sir Ludwig Guttman.
We are indebted to you for having reposed the confidence in us and given generously in support of our cause. A detailed close out report has been uploaded in the Files section. If you have queries, please email: chal.khi@gmail.com or write to us. Details of how you can help and send your contributions are given in the close out report. |
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PRSP - SCIP (Spinal Cord Injured Persons) Centre Balakot
Operational Report January-December 2008
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March 2008
By Dr. Bakht Sarwar, Director, PRSP and Dr. Zahoor Uddin
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Description: Balakot Rehab Centre was one of the focal points initially planned by Pakistan Institute of Prosthetic & Orthotic Sciences (PIPOS) to provide orthotic and physiotherapy services to this area hit by a severe earthquake. The centre started in May 2006 in a tent and later on shifted to a prefabricated building. The services were planned for one year and were supposed to be shifted to PIPOS Rehab centre at DHQ hospital, Mansehra. However during its 1st year performance it was realized that the need was different and more serious than was initially planned.
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SCIP started in a TENT, now has its own building. In anticipation and assessing the ground realities, PIPOS initiated discussions with stakeholders interested in serving spinal cord injured persons (SCIP). It led to collaboration with DIRECT RELIEF INTERNATIONAL and SCIPPER (Real Medicine Foundation) in California, and Murshid Hospital & Health Care Centre (MHHCC), CHAL Network, supported by Armed Forces Institute of Rehabilitative Medicine (AFIRM). Handicap International handed over the centre to PIPOS on June 30, 2007. MHHCC pledged Rs 6.0 million ($100,000) to meet operational expenses of one year of the centre. DRI & SCIPPER through RMF contributed $50,000 & $10,000 respectively. Thus funding for about under two years was assured. Balakot Rehab Centre is now an active referral Rehab centre for Spinal Cord Injury Persons of the area who survived. Its key objective is: |
“To help facilitate SCIP to attain full potential of their life expectancy and to help them lead an independent life through rehabilitation and occupational therapy so that they are integrated as participatory members of their society”.
The key tasks of the centre are:
- Detection and assessment
- Medical rehabilitation (to avoid complications)
- Physical therapy
- Orthotic management
- Vocational/skill training
A. Implementation: The SCIP program is implemented at different levels:
- Multidisciplinary team holds Rehab Clinics at the centre
- Centre Team does Home Visits to SCIP
- SCIP do Centre Visits
- Each SCIP is admitted once a year or complicated ones undergo Hospital Admissions (CMH Abbottabad or specialized tertiary care ones, if needed).
Rehab procedures/activities and sessions that SCIP undergo are:
- ASSESSMENTS BY A FULL FLEDGED REHAB TEAM
- POSITIONING FOR PREVENTION OF BED-SORES
- MOBILIZATION AND TRANSFERENCE ACTIVITIES
- STRENGTHENING AND STRETCHING EXERCISES
- FRAME STANDING AND BALANCE ACTIVITIES
- CASTING & CAST FITTING FOR ASSISITVE DEVICE
- FITTING & GAIT TRAINING WITH ASSISTIVE DEVICE
- BLADDER & BOWEL MANAGEMENT
- WOUND MANAGEMENT & DRESSINGS
- CATHETERIZATION
- ACCESSORIES AND MEDICATIONS
- URINARY TRACT INFECTION (UTI) MANAGEMENT
- DIAGNOSTIC PROCEDURES/TESTS
- SURGERY
- COUNSELING, EDUCATION & PSYCHOSOCIAL SESSIONS
- VOCATIONAL TRAINING ACTIVITIES
Clinical Record/output: During the year, the centre worked on the structured rehab format starting April 2008 focusing on SCIP survivors. 79 SCIP were registered through an extensive survey of the area. At the same time the centre continues to receive other physically disabled persons for orthotic and physiotherapy treatment. The registered SCIP underwent over 6400 different rehab activities / procedures. (Annex A - SCIP Sheet).
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1. Multidisciplinary Rehab Team Clinics:
Quarterly visits (each visit for 2-3 days) by a full-fledged Rehab Team from AFIRM and PIPOS specialized in SCIP care were planned and held during the year under review. During these visits the team formulates the treatment/rehab protocol for the individual patient and performs various procedures as listed above.
The Team held three rehab clinics for:
- Total Clinical days: 07
- Total Patients seen: 60
- Total procedures/sessions performed: 430
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Activities during a multidisciplinary team visit
2. Patient’s Home Visits by SCIP rehab teams: The centre has trained personnel employed to follow the rehab protocol formulated by the multidisciplinary team. The centre has two teams each consisting of a physiotherapist, physio assistant, rehab nurse trained in bowel and bladder management, wound dresser, orthotist and social worker. Depending on the status of the patient and rehab protocol the visits to a patient may be as often as every second day or only once in a week.
During the year 2008 the two teams performed:
- Total visits at patient homes: 555
- Total procedures/sessions performed: 3221
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Activities at the home visits by a rehab team
3. Centre Visits by SCIP: They are encouraged to visit the centre once a month. The centre provides transport. SCIP spend much of the day for rehab, counseling and participate in different activities. Persons who are given assistive devices are initially brought to the centre daily to help train them to use these. Furthermore, a rehab consultant runs a clinic for these persons on the last weekend of the month.
The centre saw and provided:
- Persons visited: 270
- Procedures/sessions performed: 1169
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Activities at the SCIP-Centre
4. Hospital Admissions: To avoid future complications the centre admitted 2 to 4 SCIP each month for routine tests and other procedures in CMH (Combined Military Hospital) Abottabad under the supervision of a rehab specialist consultant. SCIP who needed urgent treatment were also admitted there.
- Patients Admitted: 33
- Total days spent in the hospital: 222
- Procedures/sessions performed in the hospital: 1593
Fortunately, thanks to timely assessments and attending to needs of registered SCIP during the different visits there were no emergency admissions to tertiary care facilities necessary.
Since we have not obtained approval to publish pictures of patients admitted to the Military Hospital, at this stage we do not have pictures available for this report".
B. General Patients: The centre continued to provide physiotherapy and orthotic services to other disabled patients of the area. During the year 2008 the centre manufactured/maintained and fitted 173 assistive devices (159 orthoses and 14 prostheses) and 986 physiotherapy sessions to 262 general patients in 517 visits they made to the centre.
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| (Annex A – GENERAL Sheet) |
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Financial Record: All services are provided at no cost to individuals. However, during the year 2008 it cost the centre PKR 3.5 million. (Annex A – FINANCIAL Sheet). During July to December 2007 a total of Rs 1.3 million were expended. The expenses (Rs 4.8mn) were met proportionally from funds contributed by MHHCC (CHAL), DRI and SCIPPER through RMF. We have a balance of Rs 4.8 mn that should help us maintain the Balakot SCIP Centre for another year and a half at present operating costs. However, being conscious that the SCIP require lifelong support, we are making efforts to find other sources of funding including collaborating with Federal and Provincial Governments mandated to serve the disabled persons of the earthquake hit areas, like ERRA, Pakistan Poverty Alleviation Fund and others, so that the rehabilitation of SCIP is assured on a sustained basis
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The Spinal Cord Injury Project for Pakistan Earthquake Rehabilitation (SCIPPER) is an international collaborative effort aimed at facilitating the rehabilitation of survivors who have sustained spinal cord injuries (SCI) from the devastating 2005 South Asian earthquake.
The goal of this project is to promote the health, independence, quality of life, dignity and productivity of these individuals involving local and international cooperation.
Background
Women with Spinal Cord Injuries in an Islamabad facility
On October 8, 2005, South Asia was hit by one of the most catastrophic earthquakes in the last 25 years, only surpassed in devastation by the 2004 Asian tsunami and the 1991 Bangladesh cyclone. The 7.6 magnitude quake killed more than 74,000 and left 3 million people homeless in the treacherous Himalayan terrain. More than 76,000 people were injured, with various forms of crush injuries, including head and spinal cord trauma.
The World Health Organization has reported 667 survivors that sought medical care for spinal cord injuries. This is a much larger number than what has been reported from other recent major earthquakes. For example 90 SCI survivors were reported to survive the Turkish quake in 1999; 120 from the 2001 Gujrat, India earthquake and 150 in the 2004 Bam, Iran earthquake.
The majority of these survivors from the Pakistan earthquake are young women and children. They have become paralyzed from their neck (quadriparesis) or waist (paraparesis) down, often with lifelong bladder and bowel dysfunction that requires repeated catheterization and other medical care. In addition, many of them have lost members of their family and their homes and are still lying in shelters and tents with surviving family, in extremely sub-optimal living conditions. These shelters are scattered throughout the valleys and remote mountains of the Western Himalayas, in many cases, located far away from even basic health units, and only accessible, by jeep and a hard mountain trek. A visit by an SCI patient to a health facility usually requires two or three people willing and available to carry the SCI patient to the nearest dirt road from his or her shelter, and then, the resources to pay for a rental jeep, in which he or she must make a journey a few hours long before being evaluated at a poorly equipped rural health unit. Better facilities in distant cities are either too far away or unaffordable for most patients.
A 15-year old boy with a spinal cord injury, with deep and infected pressure sores and urine, carried to a mountain clinic from his shelter in the Balakot Mountains. December 2005
Some patients are still living in distant urban health facilities, like the NIH-D in Islamabad. A few of them have been abandoned by their families and others cannot go back to their family shelters because they are quadriplegics, and too fragile to be able to survive in the wilderness without trained and devoted caregivers. Many such paralyzed women are separated from their children who are cared for by surviving family members in their village of origin. Similarly a child with an SCI may be living at a distant health facility with a grandparent separated from his parents and other community members.
The difficult Himalayan terrain and the lack of rehabilitation resources and infrastructure in this region, make the long-term survival of these vulnerable spinal cord injury survivors, very unlikely. If appropriately rehabilitated, however, these individuals can survive and lead meaningful lives. A collective effort made by the local and international community which involves a collaboration and partnership between philanthropists, volunteers, experts, organizations, disciplines, institutions and governments, can make this challenging goal achievable. If this unique endeavor results in a successful outcome, the lessons learnt and the experience gained by everyone involved, will help generate novel ideas, guidelines and a model for the rehabilitation of survivors of disasters in other parts of the world.
Zeba Vanek, MD
Director: SCIPPER
Associate Professor of Neurology
Director:
UCLA Spasticity Clinic
Movement Disorders Program
UCLA Neurology
310-206-7400
zvanek@mednet.ucla.edu
Methods Proposed for Achieving SCIPPER Goals
- Ongoing Assessment of the Condition and Needs of the SCI Survivors
- Ongoing Assessment of Rehabilitation Infrastructure in the Affected Region
- Ongoing Interpretation of Data by Local and International Participants
- Recommendations and Solutions Proposed by Local Teams and International Input
- Implementation with Global Cooperation
The Current Immediate and Long-Term Principal Needs of SCI Survivors
- Basic Support for Survival
- Medical Rehabilitation and an Ongoing Sustainable System of Medical Care
- Psycho-Social Rehabilitation
- Educational and Vocational Rehabilitation
- Construction of Disabled-Friendly Homes
RMF will process the Zakat donations without charging an overhead and so
100% of the donation can be spent for the medical rehabilitation of SCI patients
Please make your donations to 'Real Medicine Foundation' (In Memo please
add 'SCIPPER')
