Lower limb amputations (FS-19)

Focused symposium

Angama L1Albarawi S2Duarte J3Shapin Ibne S4Taye SH5 
1International Committee of the Red Cross, Bogota, Colombia, 2International committee of the Red Cross, Gaza, Palestine, 3International committee of the Red Cross, Bogota, Colombia, 4International Committee of the Red Cross, Dhaka, Bangladesh, 5International committee of the Red Cross, Addis Abeba, Ethiopia

Learning objective 1: Discover and discuss innovative physical rehabilitation projects fitting needs and challenges of persons with lower-limb amputation in low, middle-income and war-affected countries.
Learning objective 2: Discuss strategies or activities that have been implemented to improve access to physical rehabilitation services and physiotherapy for persons with lower-limb amputation in low and middle-income countries.
Learning objective 3: Discover and discuss an instrument to measure physiotherapy intervention effectiveness across humanitarian programmes.
Description: This session will cover some unique, tailored-made projects in four different countries implemented by the Physical Rehabilitation Programme (PRP) of the International Committee of the Red Cross (ICRC). This ICRC has a wide expertise in this field and is currently active in 53 countries and one territory aiming especially at assisting persons with disabilities such as persons with lower-limb amputation (LLA) by providing them with mobility devices and physiotherapy since 1979 (ICRC, 2016). Conflicts lead to an increased number of persons with LLA, not only due to weapons, antipersonnel landmine and explosive remnants of war, but also due to the failure of the health system, poor access to medicine and treatments, which increases the number of persons experiencing health complications. In this context, the PRP has to tailor its approach to fit the needs and the priorities of each population and has developed different projects in each country to best ensure access and quality of services.
In Gaza Strip, there has been a peak in the number of persons seeking rehabilitation for LLA due to diabetes after the three last conflicts, the actual prevalence of diabetes being of 15.4 per 1000 (Obaid, Eljedi, 2017). The presentation will focus on how the ICRC had to adapt to this new demand, consider the entire continuum of care and promote a multidisciplinary team approach in order to address the underlying condition and to decrease the chances of complications by providing prevention measures, such as physiotherapy services, footwear and insoles among others. The access to these services are compromised by poverty, cultural constraints, poor health financing, unavailability of medicine and electricity worsen by an unclear future due to the complex political situation. 
In Colombia, detainees with disabilities, especially persons with LLA are particularly vulnerable, their number is increasing as it does worldwide and they have difficulties accessing health and rehabilitation services, especially in overcrowded settings (UNODC, 2009). The presentation will focus on a project that was developed to respond to this growing need and on the strategy that was implemented to assist directly around 80 detainees with mobility devices and physiotherapy in the country per year, to increase the quality of physiotherapy services provided in the prisons, and improve the accessibility to bathrooms, health and sport facilities for detainees with disabilities. 
In Bangladesh, in order to foster the full societal integration of persons with LLA and improve their resilience skills through crickets, various sport events were organized/sponsored such as the ICRC international T20 Cricket Tournament for Persons with disabilities, bringing together teams from Afghanistan, Bangladesh, England, India and Pakistan and which attracted more than 300 persons with disabilities. This presentation will focus on how this project started, was implemented and how it allows persons with disabilities, especially persons with LLA to share experiences, to be trained, recruited into the team, and learn that it Is not about what they can't do but what they can do (Rafi, 2017) which is still inspiring many others (Niloy, 2017).
Over the past years ICRC colleagues and external consultants from Teesside university developed the PT standards including an instrument which is meant to demonstrate the effectiveness of physiotherapy interventions in physical rehabilitation centers supported by the ICRC, applicable for the majority of services users; this instruments measures ICF functions and activities of individuals and is sufficiently precise and yet applicable in low and middle-income contexts. It is used at admission and at discharge in order to evaluate change overtime; it improves accountability and allows comparability across and between PRP projects through its worldwide application. The presentation will focus on its implementation in ICRC supported rehabilitation centers in Ethiopia.
Implications / Conclusions: There is no standard approach in regards to PRP for persons with LLA in low and middle income countries that fits all and that can be duplicated anywhere in the world. Each project needs to be adapted and implemented according to the prevalent needs, priorities and the context. Nevertheless, this complexity should not interfere with the necessity of measuring interventions effectiveness; instruments should be developed to meet this necessity and allowing comparison across projects. 
Key-words: 1. Physiotherapy for persons with LLA 2. Low and middle income countries 3. Humanitarian assistance
Funding acknowledgements: 
Relevance to physical therapy globally: Engaging into humanitarian and development work requires expertise, knowledge and experience and is often not part of physiotherapy curriculum and is underestimated when entering this type of work. This session will with allow participants to explore and get knowledge about innovative approaches tailored to each specific contexts and to give them an overview how strategies are developed and introduced in order to meet the needs and expectations of persons with LLA and other disabilities
Target audience: Program manager, international organisations, physiotherapists working in low-income countries, educators, clinicians, physiotherapists interested in the humanitarian sector