An Amputee rehab programme and helping establish an SCI centre

My final month in Madagascar involved joining two different rehab programmes based on Amputee rehab and Spinal Cord Injury (SCI). The training programmes were delivered through the Charity Opt in. Opt in have worked in Madagascar for 12 years delivering training based on the local healthcare needs, however this year they have decided to focus on working in other developing countries, therefore these programmes were the last of Opt in’s Madagascar based rehab programmes. Some of the members of Opt in have decided to continue their work in Madagascar and have set up a new charity called Global Rehabilitation. You can read more about their work here.

Amputee Rehab Training Programme- Mahajanga
The team delivering the amputee rehab training programme were from the Leeds Teaching Hospitals Trust and consisted of Dr Steve Halpin, a rehab Doctor, Lynn Hirst, a specialist amputee Physiotherapist, and Asad Khan, a specialist amputee Prosthetist and Orthotist. I wasn’t directly involved in delivering the training, but decided to join as I wanted to learn more about the different format Charities use to deliver training programmes in Madagascar.

The training was delivered over 4 days with Physiotherapists and Prosthetists travelling from all over the country to attend the training. The training was Multidisciplinary Team focused (MDT) and based on the attendees’ training needs. Practical sessions were used as the main teaching methods throughout, with local amputee patients joining the sessions to allow the team to get hands on and try out the treatment methods themselves. All attendees were presented with a certificate of attendance on completion of the training.

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Lynn teaching muscle strengthening exercises post amputation
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Teaching outdoor mobility, including ramps, stairs, and backwards chain
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The team proudly displaying their certificates!

Establishing a Spinal Cord Injury Centre
Following the Mahajanga training, I then travelled South to Fianarantsoa to join Dr Ram Hariharan, a Spinal Injury Consultant from Sheffield Teaching Hospitals deliver a training programme on Spinal Cord Injury (SCI) rehab. Dr Steve also came from Mahajanga to join the training. I first met Ram a year ago when he spoke at one of the Northern Network of International Rehab’s (NNIR) lectures on SCI and his work in Madagascar. Little did I know I would have the opportunity to join him in this work a year later!

The team in Fianarantsoa were hoping to set up the second SCI centre in Madagascar. The first SCI centre is in Antananarivo and was set up with Ram’s help in 2013. Ram explained that before he helped set up the centre, patients would have no option but to go home and die as a result of their injury as the required rehab and care was not available. He knew this was unacceptable and therefore decided to help set up a dedicated SCI centre. Dr Renaud, a rehab doctor and Leandrio, a Physiotherapist from the centre in Antananarivo joined the training and spoke about the challenges and successes of the work in their centre. It is hoped that the two centres will be able to work together in future in the ongoing rehab of SCI patients.

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Dr Renaud discussing his work in Antananarivo

The training was completed over a week long period and focused on the acute management of an SCI patient. Ram hopes that by helping the team get up and running with the centre, he will then be able to return in a few years’ time and deliver further training sessions on the more complex aspects of SCI management. The attendees consisted of a mixture of Neurosurgeons, Rehab Doctors, Physiotherapists, and Nurses who currently work on the neuro ward of the local hospital.

The training sessions were based around what the attendees wanted to gain from the training, and at the beginning and end of each day we would ask the attendees what topics they wanted to learn each day. The training topics delivered included: anatomy of the spine and spinal cord, mechanisms of injury and types of injury, functional expectations post SCI, autonomic dysreflexia, pressure sores, nutrition, and orthotics. I also led the practical sessions based on the moving and handling techniques used in the management of SCI, including chest management with the assisted cough technique, how to complete a log roll, and positioning techniques to reduce the risk of pressure sores.

We finished off the week’s training by presenting certificates to all attendees and having a party to celebrate their success!

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Teaching the team about functional expectations post SCI
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Teaching the team how to complete a log roll

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Team photo!

I really enjoyed attending and helping deliver the training sessions and feel that it was a great way to finish my work in Madagascar!

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