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
Email: physiosunil83@gmail.com
No comments:
Post a Comment