Spinal cord Injury rehab
Spinal cord Injury (SCI) rehab was established in the UK in 1942 but did not begin in Madagascar till our trustee, Dr Ram Hariharan, started it with one of the graduates of Leeds teaching, which culminated in a mid-level university diploma for 8 doctors in 2013.
Dr. Renaud, the pioneer graduate working with Dr Ram, then started working with his neurosurgeon colleagues in the University hospital, HJRA, in Antananarivo. They developed a dedicated team in 2015 and after much effort, a ward in 2019. In May 2019, Dr Ram and Dr Renaud set out to train rehabilitation staff in Fianarantsoa, some 7 hours north of the capital, with the aim of providing this part of the country with a dedicated SCI rehabilitation service.
What does this mean for local people? Some now survive where almost none would not have done so. Many have less complications and some are able to manage at home (though few have the resources to lead a long and independent life). We know there is much to do, but this is significant progress almost unique in Sub-Saharan Africa.
Here are 2 stories:
A school teacher, Heri, in a very remote part of the country, was severely injured in a road traffic accident in August 2016
He lost the use of his legs, which had no feeling, and he had no control of his bladder or bowels. Without specialist help he would surely soon die.
But 2 weeks later he arrived at the university hospital in the capital, Antanarivo, where the neurosurgeons work closely with Dr Renaud, whom we continue to support. Heri was operated on and then given as much rehab as was available. A month later, he went home able to manage his activities of daily living, his skin and his wheelchair.
He was unable to retain these abilities, unsupported, and he lived so many miles away that the team did not have the resources to visit. But somehow, when he deteriorated, they managed to do so. They retrained Heri and trained his family. This time, they set up regular phone support and monitoring contact so that he has got back to his previous level of abilities and continues to improve (the photo shows him practising how to stand and maintain his trunk support).
The result is amazing. He is now ready to return to school teaching.
How many countries in Sub-Saharan Africa have a team capable of getting such results?
A nursing student, John, sustained a severe spinal cord injury as a result of a road traffic accident and immediately lost the use of and sensation in his legs.
He was brought rapidly to Dr Renaud ‘s department but was unable to afford the neurosurgery needed to stabilise the spine. So, he had as much rehabilitation as the rehab team could provide and, a month later, he had gained sitting balance (needed to live in a wheelchair and transfer to a chair, bed or car and a fundamental step to walking). He was able to go home. After several months, he is still able to live at home, albeit with difficulty. Many of the population’s homes, even in the capital, have very modest washing facilities; some in the country don’t even have running water. What we regard as normal equipment for a disabled person is often lacking. Outside, the pavements are broken, uneven and difficult to navigate, even on foot.
John now aims to train in computers but this will not be easy.
Some of those helped by rehabilitation will, hopefully, become role models for others, perhaps play in a Para-Olympic team, perhaps be able to help influence national policy.