Spinal cord injury and its associated challenges to rehabilitation of patients in Pakistan

Abstract

Spinal Cord Injury is, perhaps, the most devastating injury known to mankind and is associated with incredible human sufferings and financial burden (1). Paralysis, musculoskeletal deformities, osteoporosis and heterotrophic ossifications, bowel and bladder incontinence, neuropathic pain, respiratory complications and sexual dysfunction are some of the common secondary problems in patients with spinal cord injury (2). Besides physical sufferings SCI has profound social, financial and psychological implications (3). Though SCI is incurable but rehabilitation strategies aim to minimize complications and maximize independence according to patients’ functional capabilities (4, 5). Pakistan, a developing country, where even basic health care facilities are not available, rehabilitation of SCI patients are never considered in health care system. This is partly due to the complexity of rehabilitation protocols and partly due to lack of awareness and lack of resources. Though there are some research studies conducted in Pakistan regarding SCI but majority of these studies are single centre-based studies and only reported demographics and complications of SCI patients (6-11). Due to lack of reliable information, exact burden of SCI in Pakistan cannot be estimated. In Pakistan, rehabilitation of SCI patients is subjected to a number of potential barriers. These barriers range from policies level to societal and individual level. Despite the fact that rehabilitation is one of the major pillars of modern medicine, yet in Pakistan there are no such policies to promote rehabilitation medicine. Lack of specialized SCI rehabilitation centers in Pakistan is a proof of the fact that policy makers are not interested in the field of rehabilitation medicine (10,12). Though there are some general rehabilitation centers where wide range of neurological and musculoskeletal conditions are addressed but there is lack of specialized SCI rehabilitation centers in Pakistan. Besides lack of funding and infrastructure, lack of proper referral system, lacks of multidisciplinary team approach and workforce shortages are also major challenges to rehabilitation of SCI patients in Pakistan (13, 14). After initial management of SCI patients in neurosurgery or orthopedic wards, majority of SCI patients are sent to their homes instead of referring them to rehabilitation centers. Most of these SCI patients are referred to rehabilitation centers after developing serious complications. Similarly, paucity of specialized clinical staff in managing SCI patients is another hinder in rehabilitation of SCI patients. Poverty, lack of awareness and education, cultural barriers and lack of research regarding SCI are also major challenges to rehabilitation of SCI patients in Pakistan. Despite the challenges, rehabilitation of SCI patients is important in order to enable them to reintegrate into community life. The challenges to rehabilitation of SCI patients presented here and in previous studies are alarming. Yet, an exemplary specialized SCI rehabilitation center in Pakistan is Paraplegic Centre Peshawar, which provides free of cost, “comprehensive physical rehabilitation services” including, skilled physiotherapy, occupational therapy, orthotic management, psychological counseling, recreational activities, skills building, community re-integration, provision of custom made wheel chairs, adoptive/ supportive equipment and follow up services including minor home modifications along with medical and nursing to spinal cord injury patients. Now that a model comprehensive physical rehabilitation facility for the rehabilitation of SCI patients exists in the form of Paraplegic Center Peshawar, there is a dire need to establish, many more specialized centres in all provinces of Pakistan. Govt. should constitute a committee of experts with representation from all walks of life, including people with SCI, physical therapists, rehab doctors and all other relevant medical & physical rehab professionals, who can carve out a road map for the treatment & comprehensive physical rehabilitation of SCI patients, so that they can also play their role in the society, as equally dignified citizens. That brings us to the conclusion that there is light at the end of the tunnel and a well thought over, sincere effort can quickly fill the gap.