A nation without medical rehab: Unfortunately, more stroke, accident survivors may die, experts warn
By Chioma Obinna
Disability is not strange to Nigerians. Everyone knows one or two persons living with disability. According to the World Health Organisation, WHO, estimate, more than one billion people in the world experience one form of disability or another. Nigeria has its fair share of the burden as it ranks second in road traffic accidents in the world which has been adjudged as a major factor fuelling mobile disability.
Also, according to the National Bureau of Statistics, NBS, 2016 Road Transport Data, 11, 363 road accidents were recorded in 2016 out of which 30,105 persons were injured adding up to the already swollen number of disabilities from diseases such as stroke, polio, injection palsy, down syndrome and autism, among others. Unfortunately, these Nigerians end up with poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty.
Although secondary and tertiary health care institutions offer therapeutic health services, these institutions are usually not an easy-reach for most patients with disabling conditions due to several barriers ranging from acute shortage of medical rehabilitation experts to lack of comprehensive centres in Nigeria.
Consequently, the conditions of many patients become more complicated either as a result of seeking inferior care from quacks or from absence of care. However, experts say to achieve the sustainable development goals on disabilities, the procedure of medical rehabilitation has to be comprehensive, through a team approach that involves various disciplines and having a one stop rehabilitation centre. Chioma Obinna writes…
Disability is not only a public health issue, but also a human rights and development issue.
WHO describes the conditions of people living with disability, PLWD, as disturbing and urgently seeking solutions by formulating actions to tackle them.
According to experts, persons living with any form of disability or congenital conditions require close monitoring, frequent consultations and visitations as part of the rehabilitation procedure. Unfortunately, most times, there is usually an array of challenges that hinder the punctuality, availability and accessibility of the patients to the needed health services irrespective of the patients’ health-seeking behaviour.
Studies have shown that rehabilitation is instrumental in enabling people with disabilities, whose functions are limited to remain in or return to their home or community, live independently and participate in education, the labour market and civil life.
Whereas many persons living with disability receive adequate care in other climes, such is not to be said about PLWD in Nigeria. The absence of care, including shortage of health professionals, has forced some Nigerians who can afford the huge cost to seek help outside the country. Sadly, this adds to the one billion US dollars Nigeria loses to medical tourism annually. Worse still, those who cannot afford the treatment here or abroad live in penury till they die.
For instance, a young and energetic journalist, Jude Ikegwuonu, in 2013, was involved in a road traffic accident that changed his life. Jude became quadriplegic (paralysed from the neck and chest down). Jude and his elder sister had travelled by air to Abuja and were on their way by road to Minna, Niger State, when a cow strayed onto the road in front of the vehicle in which they were travelling. The driver lost control while trying to avoid the animal. According to Jude, one thing about having a spinal cord injury is that people don’t usually understand how terrible it can be. He was taken to India for treatment. “Before the trip to India, I could barely move my neck and even then I had a neck collar on. While abroad, I did intensive physiotherapy and occupational therapy that stretched my hands. Previously, my hands could not be stretched and I could not move my fingers”, he narrated.
Jude permanently lies on an electronically controlled compressed air bedspread to prevent bedsores. To manage him is quiet expensive. Only a few can afford it.
He seeks to improve his physical and psychological state, as well as be reintegrated into the society, but the lack of facilities or regulations to make public buildings accessible to people with physical disabilities is a huge challenge for him to leave his room, let alone outside the house where he would need to be carried up and down the stairs.
Modern technology has invented mobile ramps and an electric stairs-climbing wheelchair to make life less frustrating for a quadriplegic like Jude. Unfortunately, they are damn too expensive for an average Nigerian. The stairs-climbing wheelchair alone costs over US$20,000 not to mention the cost of mobile ramps which go for about US$3,000 (depending on weight and length).
Jude’s plight is just one out of the thousands of cases in Nigeria.
Meanwhile, not all are alive to tell their stories. In 2015, Mr. Ejike Obi had stroke and was taken to hospital. He was immediately admitted. A week later, he was discharged after the blood pressure had been brought back to normal. Unfortunately, Ejike was ignorant of the fact that he needed the services of other professionals in his rehabilitation process. He went home. His condition worsened and, a year later, he died. Experts say if Ejike had involved other experts in his medical rehabilitation, he may still be alive today.
Studies have shown that medical rehabilitation is prescribed after many types of injury, illness or disease.
Today, despite the fact that many types of injury, illness or disease afflict Nigerians, the country cannot boast of a comprehensive centre for rehabilitation services. The more significant part of the problem is that the nation is struggling with the dearth of qualified medical rehabilitation professionals like physiotherapists, occupational therapists, speech therapists and audiologists, orthotists and prosthetists, chiropractors and osteopaths.
These professionals are trained in the management of persons living with various forms of disability and to help restore them to a near normal condition, while also re-integrating them into the society.
Sunday Vanguard spoke to the Registrar, Medical Rehabilitation Therapists Board of Nigeria, MRTBN, Mrs. Olufunke Akanle, who said the country currently has only 4,000 registered professionals serving 170 million people.
The country is also battling with the lack of well-equipped medical rehabilitation centres, poor level of awareness on the roles of medical rehabilitations among patients, the public and the medical practitioners for prompt referrals and inappropriate compensations for individuals who sustained disability as a result of occupational hazards.
X-raying the challenges, Olufunke said that out of the 4,000 registered over a period of 25 years by the Board, physiotherapists are more than 90 per cent with about 45 per cent practicing abroad while about 30 per cent have no job due to the poor level of awareness on the services of medical rehabilitation professionals.
“In Nigeria, we have just about nine training institutions running physiotherapy and the highest each of the institutions produces a year about 50 physiotherapists. Coming to occupational therapy, as I speak, only Obafemi Awolowo University trains occupational therapists and the highest number it has been able to produce in one year is seven. In Ibadan, where they train speech therapists, speech pathologists and clinic cardiologists, we have the issue of considering them from master’s level because that is where they have made up their minds to go to the clinical management of persons with disability.”
The MRTBN Registrar queried a situation where a hospital with 800 beds and is supposed to have 80 physiotherapists employs only 10? “A stroke patient will present at the hospital, the only thing the doctors will do is to bring the high blood pressure and sugar levels down. The moment they are okay, the patient is discharged from hospital and leaves hopeless and dejected.”
She observed that there is a disconnect between when a patient is discharged from hospital and post-rehabilitation management, hence, the urgent need for the establishment of a one-stop national rehabilitation centre. “I visited a government owned rehabilitation centre in Singapore, it was wonderful; when they discharge patients from hospital they will send them there. There are places in South Africa where all these services are readily available but in Nigeria we don’t have all these.”
On how to reduce disability, Olufunke recommended the need for massive awareness about the causes of disability. Her words: “We have hundreds of cases of disabling conditions and each case has different means of prevention; how you prevent polio is different from how you prevent cerebral palsy, down syndrome, stroke or spinal cord injury.
“Another thing is early intervention. If the patients are treated at the right time, we are bound to get the best result out of the treatment.”
Also speaking, a Consultant Ergonomics Physiotherapist, College of Medicine, University of Lagos, CMUL, Dr. Udokar Okafor, who accused government of paying lip service to the management of disabilities, said a lot of money had been spent on conditions such as polio by the government but nobody is talking about when it happens how victims survive.
“We see many of them on the streets begging. Many of them cannot function very well in the society and many of them do not have basic inclusion in the society. What is government policy in taking care of these people? Physiotherapists and other people are needed in the rehabilitation of polio cases. How many polio rehabilitation centres have been built by government? We cannot say. I think this is a wake-up call on government to do something about some of these diseases”, Okafor said.
“We talk spinal cord injuries, polio mellitus, injection palsy, even stroke. Everybody has recorded one case of stroke in his immediate family or among friends and there is direct relationship with the nose-diving of the Nigeria economy and the recent rise in the cases of stroke. As the economy of Nigeria is nose diving, the incidence of stroke keeps increasing”.
He posited that government should build a one -stop shop in each of the six geopolitical zones of the country to bring together experts in the rehabilitation business.
“The wheel chair cannot enter any bank in Nigeria today. The average bank doors have security and what is the provision for these people with physical disability?”
The consultant stressed the need for inclusion policy for persons with disability.
Okafor regretted that many Nigerians with disability are shut out of areas where average persons can go to. “Does it mean that when you come down with some of these challenges you won’t be able to go to where other people are going to even when your brain is intact? The only problem is that your legs and hands cannot function like those of an average person. But it does not limit you to having access to other social amenities that you should,” he stated.
On his part, a Consultant Audiologist, Mr. Barnabas Vangerwua, who raised the alarm on the increasing cases of communication problems among Nigerians, particularly due to the high number of stroke patients, said it had become very difficult for victims to access services both in the rural and urban areas.
According to him, government should harness the resources and information and draw out a plan that would be able to take care of stroke and other communication disorders.
He said people with language deficits, such as stammering, if not arrested early, becomes difficult for the person to cope in the society.