Oconnell rapid sci training.post eq haiti-crdr.disaster.symp.poster.isprm11

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Oconnell rapid sci training.post eq haiti-crdr.disaster.symp.poster.isprm11

  1. 1. ISPRM Symposium on Rehabilitation Disaster Relief at the 6th ISPRM World Conference in Puerto Rico 2011 <br />13 June 2011San Juan Puerto Rico<br />Rapid SCI Rehab Training<br />Post-Earthquake Haiti<br />Colleen O’Connell MD, Fiona Stephenson RN<br />Healing Hands for Haiti/Team Canada HH<br />Training of MSF nurses in intermittent catheterization by nurse newly trained in SCI (in wheelchair, bottom right) <br />-Photo with permission, N.Bernavil<br />With a Train-the-Trainer model, nurse Nadia, herself sustaining an SCI in the earthquake, now trains other nurses and patients in bowel and bladder care. She is the SCI patient educator and nurse at Healing Hands Klinic in Port au Prince<br />Abstract The 2010 earthquake in Haiti resulted in over 150 persons sustaining spinal cord injuries. Haiti had few resources for SCI rehabilitation and no pre-quake inpatient SCI facilities. Small non-profit organizations assumed responsibility for providing acute and rehabilitative care. Rapid training of local health providers in SCI management was critical to the survival and successful rehabilitation of SC injured, and has laid the foundations for SCI care in the country.<br />Introduction<br />Methods & Materials<br />Results<br /> Both HHA and SBF sites each provided rehabilitation care for over 30 SCI patients with local nurses, physicians and therapy aides.<br /> SCI teams of physiatrists, nurses, occupational therapists and physiotherapists from Canada, USA and Switzerland rotated at sites for typically 2 week blocks, over 5 months, delivering training and assisting in care. Expatriate and key national staff at each site provided overall coordination and leadership. <br /> At 1.5 years post quake, only one death has occurred among these patients (from non-SCI cause) and only 4 remain at the centres due to lack of housing.<br /> Both sites have committed to continue SCI rehabilitation, and continue to admit and care for newly injured patients. SCI training workshops and site visits continue as does the Haiti SCI Working Group.<br />In the 21st century, rehabilitation challenges for persons with spinal cord injury (SCI) in low-resource settings remain large, whether in disaster situations, or in daily life. Average survival for a person with paraplegia in low-resourced countries is 2 years, whereas those with tetraplegia rarely survive initial injury. <br />The Haiti earthquake resulted in significant loss of life, thousands of catastrophic injuries, and widespread destruction of infrastructure, including medical facilities. Spinal cord injuries were identified emergently, necessitating rapid coordination of a process for acute care and rehabilitation. <br />Pre-earthquake, Haiti had no in-country resources for the emergency and acute management of such catastrophic injuries, and had few trained therapists or physiatrists. There were an estimated 150-200 early survivors of SCI in the earthquake; with the influx of specialized surgical teams resulting in improved survival rates, the emergent need for specialized rehabilitation services for acute and long term care including community reintegration of these patients became paramount.<br />Acute management was provided at facilities providing emergency medical and surgical care in Haiti, including:<br /><ul><li>Project Medishare (surgical and medical tent with rotating volunteers from USA)
  2. 2. HopitalSacre Coeur in Milot, northern Haiti (permanent hospital run by international non-profit)
  3. 3. USNS Comfort hospital ship, off shore Port au Prince). </li></ul>As patients were stabilized, beds needed to be freed for waiting injured. Three main sites in Haiti assumed responsibility for SCI rehabilitation care, with little to no prior SCI expertise or experience. The need to rapidly train the health workers at these sites, while simultaneously ensuring patients were receiving appropriate care, was paramount. <br />We describe the experience at two of the sites, with aims of informing potential process for future disasters.<br />Three main health service sites in Haiti volunteered to admit patients for rehabilitative care following acute stabilization; Haiti Hospital Appeal (HHA), St Boniface Foundation (SBF) and Project Medishare. HHA and SBF operated pre-earthquake general medical facilities, with local physician and nursing support. Both became essentially dedicated SCI rehabilitation hospitals.<br />Collaborative efforts by small non-profit organizations (all with pre-earthquake Haiti experience) led to rapid deployment of expatriate SCI teams to join National and expatriate staff at both HHA and SBF. A basic but thorough curriculum to train local staff in SCI care and rehabilitation was developed, delivered through rotations of expatriate volunteers, assisted by local experts. Patients and families participated in the education sessions, as did community health workers and trainees. Education model combined peer-mentoring with hands-on delivered care, particularly in the first 4 months following the earthquake. Formal workshops with dedicated instruction on key SCI topics and skills complemented the hands on experience.<br />A Haiti SCI Working Group was formed, with collaboration for training needs, advanced education topics, and discharge planning.<br />Conclusions<br /> The resulting increased capacity to deliver SCI rehabilitation by local health providers has led to the formalization of the first SCI rehabilitation centres within the country, and improved outcomes including community discharge for patients surviving their injuries. National staff are now training other health workers in SCI care. This highlights the critical importance of education and training, even in disaster situations, in delivery of rehabilitation care.<br /> The development of training curricula for use in disaster situations in countries with limited resources would facilitate rapid training in appropriate skills and knowledge.<br /> A designated organization to coordinate SCI care post-disaster in countries without such resources is needed.<br />References<br />O’Connell C, Shivji A, Calvot T. Handicap International Report: preliminary findings about persons with injuries. Handicap International, January 29, 2010. http://wwww.reliefweb.int/rw/rwb.nsf/db900SID/ VVOS-82AMLC?OpenDocument.<br />Anthony S. Burns, MD, MSc, Colleen O’Connell, MD, FRCPC, Michel D. Landry, PT, PhD. Spinal Cord Injury in Postearthquake Haiti: Lessons Learned and Future Needs. PM&R, Vol. 2, 695-697, August 2010<br />

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