Pakistan

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.

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).

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

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

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

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.

(Annex A – GENERAL Sheet)

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.