If you were to break your arm, would you consider yourself disabled?
Maybe not. Maybe you would expect to be treated in a hospital, your arm to heal, and your life to continue normally afterward.
However, what if you couldn’t access a hospital because you lived so far away, or you couldn’t afford to pay for your treatment? What if because of inadequate treatment, the break didn’t heal, and you couldn’t use your arm? What if those around you see your disfigurement, and avoid you out of fear? Would you now consider yourself disabled?
People living in Low and Middle-Income countries (LMICs), like Sierra Leone, are not only at high risk of encountering injury, illness and disease because of poverty, but are also much more likely to end up with a resulting disability. Around 15% of people globally have disability, but 80% of these live in LMICs.
Living with a disability not only impacts on the individual themselves, but also on those around them. In Sierra Leone, there is no social system to provide care at home, so families must take on this role if it is needed. If a parent is disabled, their children may have to leave education to work and support the family. As a result, a cycle of poverty, impairment and disability is maintained.
Reducing disability in Sierra Leone is therefore immensely important, and I admit that the scale of the task was initially daunting when I joined KSLP in November 2017. However, my Sierra Leonean physiotherapy colleagues are incredibly dedicated, and so together we are already taking positive steps towards this.
Sophie (back) pictured with attendees of the Stroke Training Day for physiotherapy assistants, ward nurses and dieticians at Connaught.
One key aspect of my role has been to support the Sierra Leone National Clubfoot Programme (SLNCP), through a grant supplied from the Isle of Man. Clubfoot is a congenital condition causing a baby’s feet to turn inward which, if left untreated, can cause immobility. However, it can be fully corrected with a simple manipulation, casting and bracing protocol – usually completed by 3 years of age. The SLNCP has been treating clubfoot successfully for several years, and it is fantastic to see the progress made by children they have worked with. However, now that they have functioning clinics, it is essential that they have effective monitoring and evaluation systems in place, to ensure their sustainability. Since November, we have therefore collaborated on improving clinic data collection and interpretation at a local level. We have also reviewed methods for clinic evaluation, to ensure continued professional development and support of staff.
Another aspect of my role is to help improve access to Physiotherapy for all patients who need it, regardless of their age, diagnosis or socio-economic standing. The Ministry of Health and Sanitation currently employs only 5 Sierra Leonean Physiotherapists, supported by a small number of ‘mid-level therapists’ and nursing staff (many of whom volunteer). As a result, it is extremely challenging to reach all those needing rehabilitation, especially in rural areas. To address this, we are also supporting the leadership of the National Physiotherapy and Rehabilitation Programme in the Ministry of Health and Sanitation. We are mapping the services that are available (including private and NGO centres) to identify the most significant resource gaps, and redeploying staff where appropriate. We are also assisting the Sierra Leone Physiotherapy Association to develop an in-country BSc., to address the increasing demand for qualified physiotherapists. Finally, through collaborating with the Ministry we aim to ensure that rehabilitation remains a priority of theirs, so that these graduates will secure employment.
Additionally, whilst there remains a dearth of trained physiotherapists, we are encouraging other members of the healthcare team to integrate some rehabilitation in to their role. For example, stroke is one of the most commonly seen conditions in Connaught hospital, and patients who suffer from stroke are often left with severe impairments. Their optimal window for recovery is in the first few months post-stroke, however presently ward patients often do not receive physiotherapy until much later, if at all. Therefore, we have been training ward staff in fundamental principles of stroke rehabilitation, such as how to facilitate functional activity and prevent secondary complications.
Whilst it will never be possible to eradicate illness and disease, it is possible to reduce the burden of this on an individual, and to improve greatly their quality of life. This goal is driven by the unwavering dedication of the local team, making it an incredible time to be working with KSLP in the field of rehabilitation.