Handicap International’s rehabilitation team working with Naw Moe Wah, who has hemiplegia after a stroke, at Mae La refugee camp, Thailand. Copyright Erika Pineros/Handicap International
Handicap International’s rehabilitation team working with Naw Moe Wah who has hemiplegia after a stroke, at Mae La refugee camp, Thailand. Copyright Erika Pineros/Handicap International

Handicap International striving to put rehabilitation firmly on the global agenda

Physical therapists know the toll that chronic diseases and disability can take on individuals, populations and economies throughout the world. But what if international and national health organisations only seem to take notice of diseases that kill? Antony Duttine, a physical therapist working for Handicap International (HI), is trying to redress the balance.

If you hear about a natural or humanitarian disaster – in Syria, the Philippines, Haiti – it’s likely that Handicap International will be involved in relief efforts. It is an independent aid organisation working alongside disabled and vulnerable people in over 60 countries worldwide in situations of poverty, exclusion, conflict and disaster. Physical therapists are among the health professionals involved in its projects.  

The need for rehabilitation services in the face of traumatic injuries and obvious suffering is clear, according to Antony, who is Rehabilitation Advisor at HI. But after the immediate influx of relief teams to disaster areas, the ongoing need is consistently overlooked.

“A lot of our rehabilitation professionals who work in areas affected by conflict and disaster see that alongside the people affected by trauma, there are a great number of others with conditions such as cerebral palsy, stroke, diabetes, who have needs for rehabilitation services that go way beyond an immediate disaster. Yet this is rarely recognised, meaning that there are often not the attention or resources to help these groups in the longer term.”

Likewise, global health priorities – for example those encapsulated in the United Nation’s Millennium Development Goals – concentrate on child mortality and “killers” such as, HIV/AIDS and malaria. “This has created inequalities, so that people who need rehabilitation services after an emergency have become neglected and isolated,” says Antony.

In the face of this neglect, HI – founded in 1982, originally to respond to the needs of 6,000 Cambodian amputees living in refugee camps along the Thai border – has taken steps to try and bring rehabilitation into the mainstream of health services. “We want to give more of a voice to civil society in the health sector, both raising the visibility of people who have lived with illness and disability, and creating a more holistic picture of health than counting the number of deaths,” says Antony.

He ran a side session on the key role of the rehabilitation workforce in the changing health landscape at the Global Forum on Human Resources for Health for the world’s health policy makers in Brazil last November.

Antony invited WCPT to participate, because the two organisations have a similar aim of wanting to bring disability, rehabilitation and the role of rehabilitation professionals alive for human resource planners and policy makers. Unfortunately, but perhaps predictably, his session was poorly attended – illustrating that rehabilitation is not on the priority list of most people addressing health human resources.  

To try and get health planners to put more emphasis on living with disease and disability, as opposed to mortality, HI is aiming to create new partnerships with non-governmental health organisations working in community health around the world. Antony approaches these organisations to talk to them about the important needs of people with disabilities.

Their reaction to him, he says, is interesting. “At first they say: ‘We aren’t really involved in disability’. But the more I talk with them, the more it becomes clear to them that disability is very much a part of what they do. It’s just that they don’t describe it as disability. There are virtually no communities that don’t have disability within them.”

Recently, he talked to an non-governmental organisation that was active in initiatives to reduce neonatal mortality, aiming to improve birth facilities. It said disability wasn’t relevant to such life-saving work. “So I asked them what happens next? What if the mother has depression, or those babies who two years ago would not have survived are now living with complications?”

“We want to try to connect things in health and build partnerships. At the moment I feel a very small voice, but it’s a crucial time to be doing this, because with the current United Nations Development Goals about to come to an end, a new agenda on global health is being set. It should reflect the need for health services across the life course, and if it does that, it opens the window for rehabilitation wider.”

Brenda Myers, WCPT’s Secretary General, says that the parallel aims of HI and WCPT have brought the two organisations into closer collaboration. “Together, we are trying to make the case for the importance of rehabilitation in global health policy. The data that WCPT is collecting from its member organisations to create a global profile of physical therapy is an important part of this. So is being present at international meetings on human health resources.”

WCPT has developed a partnership with HI to produce a briefing paper on physical therapists working in emergency response situations, due to be completed this year. It involves representatives of other international emergency response agencies, WCPT member organisations and researchers. WCPT is also working with HI to help them recruit physical therapists into their emergency response teams.

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