Academic journal article Bulletin of the World Health Organization

Rehabilitation Services in Disaster Response

Academic journal article Bulletin of the World Health Organization

Rehabilitation Services in Disaster Response

Article excerpt

The United Nations Convention on the Rights of Persons with Disabilities has firmly placed disability in a human rights perspective. In the context of the Convention, disability refers to activity limitations and participation restrictions that result from the interaction of an impairment of body function or structure with environmental factors. The Convention addresses the rights of persons with disability in all aspects of life, including education and community integration and their right to equal access to services, such as schools, medical facilities and communication. Articles 25 and 26 explicitly state the right to health and access to health-related rehabilitation for persons with disabilities, (1) in all settings and situations, including during emergencies and natural disasters. Adherence to the Convention however, can be particularly challenging in a disaster response given the different economic and social vulnerabilities including poverty, as well as environmental hazards and damaged infrastructure. This can be further compounded by the limited time emergency medical teams are typically deployed for as part of a disaster response. (2,3)

Often when disasters occur in low-and middle-income countries, there is an influx of specialist health workers from high-income countries. In affected countries where health systems are weak, and health-related rehabilitation services are not a priority, this influx of specialist health workers can result in individuals with certain types of traumatic injuries--such as spinal cord injuries, amputations, brain injuries or peripheral nerve injuries--surviving with long-term impairment and associated disability, in an environment with limited capacity to address their ongoing needs. (4) Until recently, rehabilitation professionals have been underrepresented in emergency medical teams. In recent years however, guidance documents have started to promote the importance of inclusion and/or close coordination of rehabilitation professionals with these teams. (5,6) Inclusion of rehabilitation personnel in emergency medical teams indicates a trend towards patient-centred care and offers timely access to rehabilitation intervention to those who have sustained injuries, which has been found to prevent complications, speed recovery and optimize functional outcomes for the injured. (2,3) Rehabilitation personnel in emergency medical teams are also well placed to provide mentorship and support local staff to manage the surge of individuals with traumatic injuries and the ongoing care needs of those affected.

A multidisciplinary response

Historically, a medical model -where a persons impairment is perceived to be the problem, and the focus is on fixing the problem--has dominated emergency medical teams. However, the Convention with its focus on a social model of disability, in which disability is seen as a function of the interactions between an impairment and the barriers in the environment, implies the need to provide a patient-centred, multidisciplinary model of care in hospital settings. Article 26 in particular implies the need to incorporate rehabilitation professionals into staffing arrangements starting from the acute care phase. Having a multidisciplinary team and an effective coordination mechanism allows emergency medical teams to address the needs of their patients holistically and link appropriately with other service providers, including specialists, facilities and disability-orientated nongovernmental organizations. In light of the surge in traumatic injury seen in disaster events, it is crucial that emergency medical teams assess their capacity and prepare themselves to coordinate with both local and international agencies. Such coordination will allow for patient care to continue beyond the medical teams' departure and better preparation of the injured for social and economic inclusion.

The classification and minimum standards for foreign medical teams in sudden onset disaster (7) acknowledges the need for multidisciplinary management of disabling injuries. …

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