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AN overwhelmingly large proportion of persons with disabilities in Pakistan suffer from physical disabilities such as cerebral palsy and other congenital disorders and those related to diseases including polio, muscular dystrophy and diabetes. Additionally, amputations and spinal cord injuries are on the rise due to higher occupational, machine-related and road accidents, bomb blasts, and natural disasters.
According to WHO, every year between 250,000 to 500,000 people suffer a spinal cord injury with related consequences such as pressure ulcers, thrombosis, chronic pain, UTI and respiratory complications resulting from inadequate medical and rehabilitation services. SCI and its consequential paralyses including paraplegia are some of the most traumatising of all disabilities.
In an article published in Newsweek in 2007, a person with paraplegia wrote: “You first learn how to sit up without passing out or falling over, because your centre of gravity is so high and your blood pressure is so low... While life as a paraplegic is physically very demanding, the mental aspects are even more challenging. You dream of walking in various places. You stare at your lower limbs for hours, trying to coax some movement from your legs — movement other than the frequent spasms that violently grab and twist your body.”
Another challenge for people with paraplegia is that their excretory organs cannot function properly. Unless rehab services are in place and urologists available at all rehab centres, these problems can frequently become life-threatening, and increase frustration, helplessness and depression among one of the bravest groups of people in the world.
Rehabilitation for paraplegics here is practically nonexistent.
Physical medicine and rehabilitation is a much neglected sector in Pakistan. According to a report on disability and rehabilitation medicine by Rathore et al, there were only 38 specialists in rehabilitation medicine in 2010, with 1,000 registered physiotherapists and 150 registered occupational therapists, while the Pakistan Nursing Council had no registered rehabilitation nurses. Out of these professionals, many were working abroad, some were running private clinics, and the rest were working at institutes run by the armed forces.
In 2007, the Institute of Physical Medicine & Rehabilitation was established at Dow University, Karachi, for musculoskeletal, cardiac, neurological and speech rehabilitation. There are also some facilities at JPMC Karachi and Mayo Hospital Lahore. The Armed Forces Institute of Rehabilitation Medicine (Afirm) is a 100-bed inpatient facility in Rawalpindi along with an artificial limb and appliances centre that has the capability of fabricating prostheses and orthoses.
During the October 2005 earthquake, a 100-bed spinal unit was set up at the National Institute of Rehabilitation Medicine with the help of international donors, but since 2012, it is facing an acute shortage of professional staff, technicians, urologists, orthopaedic surgeons and rehab consultants, with 200 posts lying vacant due to lack of funding, as after the 18th Amendment, it was placed under the Capital Administration & Development Division due to bureaucratic intransigence.
However, all these institutions are located in urban centres and do not cater to the growing requirements of the much larger semi-urban and rural populations. It should be a priority of the government to increase the mobility of persons with disabilities and proactively rehabilitate and employ them, enabling them to live in dignity as stipulated by the Constitution and existing laws.
Today, almost all the work in rehabilitation is being done by NGOs, such as ICRC, PSRD, Chal Foundation, PIPOS and Indus Hospital which are working for rehabilitation through provision of prostheses, orthoses, assistive equipment, physiotherapy and vocational training. Only ICRC and Afirm are using modern technologies for prostheses and orthoses: the rest are using more or less obsolete methods and equipment.
As a first step, the federal government should strengthen the role of the National Council for Rehabilitation of Disabled Persons and under its aegis, establish specialist rehabilitation centres at all 35 divisional headquarters in the country in collaboration with the ICRC and international donors, providing outreach services and forging linkages with community-based rehab centres. The community centres should be in all districts supported by the DCOs to register persons with different disabilities for developing a data base, and providing minimum benchmarked services to them including vocational training, opportunities for interaction with peers and social inclusion.
At the same time, the study of physical medicine and rehabilitation disciplines needs to be introduced in all provinces on a fast-track basis along with training of faculty, nurses, technicians, psychologists, and allied services which comprise a standard rehabilitation team. Apart from the increasing economic burden of disability impacting overall development targets, it is the duty of a representative government to make persons with disabilities independent, employable and happy.
Published in Dawn, May 25th, 2016