Tuesday, October 15, 2013

Wheelchairs should be a sequential & human right based approach of the service delivery


Oh! My god, “what I did before could have been better done”. I think, in most of the stances health professionals could be thinking as I thought on the first sentence. Sometime things humiliate us in such a way that gaps and the challenges that have been executed unknowingly in the past are realized after some period of the time. In fact, I should not term them as a gap and challenge rather I should say it as a lesson learnt and obviously I am going to replicate and disseminate the lesson learnt in the mass of people who need it.

As we all know that medical modalities or intervention is followed based on the weightage of the evidences behind it. The practice at present in comparison to the past couple of decades is of high difference. With the passage of time, medical interventions and approaches goes on upgrading and updating day by day. One should not term the previous practice a mistake as that could be the best evidence based practice of that particular period of time. But it’s very mandatory to be updated on the new findings and start incorporating it in supervision and then finally autonomously.
Now I would like to correlate my above thoughts into real life incident that has been faced recently. World Health Organization (WHO) has developed the basic wheelchair service training targeted for the people who work in wheelchair service provision. Let’s go little before, in 2008, WHO had produced a guideline on, “Provision of manual wheelchair in less resource setting”.  This guideline was targeted to all technical and non-technical workforce involved or to be involved on the wheelchair services. Based on this guideline, the WHO has made the basic level training specially targeted for the technical work force involved or to be involved in wheelchair service provision. Physiotherapists are one of the core technical workforces required for the proper wheelchair service provision. Thanks to organizers and my organization for providing me this golden to be the part of this training in June 2013.

The training content presented the wheelchair service as the human right based approach of the service delivery. It correlates the wheelchair service with the article 20 of UNCRPD-Personal mobility(http://www.un.org/disabilities/default.asp?id=280). In fact the concept is beautiful and should be respected too. We as a physiotherapist have a most often tendency of looking or judging the world from the angle medical sciences only but there are the lots of dormant psychosocial factors that is directly or indirectly affecting the activity of daily living and social participation of the person. We should be proud of our profession as we are delivering the services which are directly related to supporting our beneficiaries for the achievement of their rights & benefits and equalization of the opportunities. Not only on the wheelchair service delivery, we should be equally elaborative on considering the bio psycho-social   and human right based approach of service delivery to all our beneficiaries.

Let’s come again on the WHO made wheelchair service training. It consists of 8 thorough steps right from the referral/appointment to the follow up /repair. It’s very important to follow the entire step in a sequence otherwise it attributes to the violation of human right based approach, obviously harming and this is also against the oath that we have taken at our graduation day. Delivering the wheelchair for the new user may take more than 3 days following this approach. Any one may think that it’s too time consuming process, but what I think is, this is a team work. That’s why people in a team need to know this and implement it based on the individual job responsibility. One of the step of this package is user training, where a user and family member need to know how to handle and maintain wheelchair in different circumstances. Remember the time when you started learning riding the bicycle. I bet, it takes a time and practice and also think that your body parts were mobile that adjuncts the fast learning of bicycle riding. But the person with disability may not have all body parts mobile. Proper user training limits the chances of wheelchair accident and prevent person from injury or impairment (which again can result the disability). Similarly the user training supports family member and user on maintaining the wheelchair making it more durable and long lasting (the cost of wheelchair commonly used in Nepalese community ranges from 13000-35000)
The WHO recently made service training package has been uploaded in a website-http://www.who.int/disabilities/technology/wheelchairpackage/en/. It’s very important for all to be familiar with this package. It’s not too complex, it’s a beautiful collection of the simple interventions which are easy to learn and replicate. In the much part of the country, still wheelchairs are distributed in a charity basis in a mass without proper assessment, prescription, fitting, user training and follow up.  It is equal to giving medicine without doctor assessment and prescription and this can be fatal. Distribution of wheelchair without following the proper sequence violates the principle of no harm and is the wastage of resources in less resource set up like ours.
Though the government of Nepal has a provision of free health services to poor/impoverished person with disability, still delivery of the physical rehabilitation including the proper wheelchair services has not been sighted. The recent announcement of government of Nepal on financially supporting the person with spinal cord injury should be applauded but again the rehabilitation and provision of proper wheelchair service after the medical management should also be equally realized and implemented. The accessibility guideline prepared by government of Nepal is definitely a praiseworthy step which has definitely provided the glimpse of increasing accountability takeover by state party for the equalization of rights and benefits of the person with disability.

We should also appreciate the distribution of wheelchairs through local clubs and NGOs to the person with disability. Being an important person (physiotherapist) of the wheelchair service provision, we should never step back on supporting and strengthening those clubs or NGOs by educating or providing our technical expertise.

Sunil Pokhrel
Physiotherapist


No comments:

Post a Comment