Discussion Forum 3

[Albert Erongu]

In Northern Uganda particularly Gulu District, the district has one Health Centre IV with no rehabilitation professional employed in the health care system. At the regional level we have Gulu Regional Referral Hospital, and St. Mary’s Lacor Hospital which provide; physiotherapy, occupational therapy, psychotherapy, and Orthopedic technology services. There are also a few Non-governmental organizations like; AVIS, and ACTV that are providing physiotherapy, occupational therapy, social work, and psychotherapy services in the region. Awach H/C IV and Angaya H/C III currently provides basic rehabilitation services through ReLAB-HS using the WHO Basic Rehabilitation Package – Clinical Resource.

[Hoeung HEAM “[email protected]”]

In Cambodia, rehabilitation service use interdisciplinary model in physical rehabilitation centers. There are three technical groups work there including physiotherapists, prosthetists & orthotists, and social workers (usually not high education graduates). Regarding locations in hospitals in Cambodia, rehabilitation take place in some all national hospitals (4) and most of the provincial level hospitals (25). Usually, the service is for OPD patients. However, some rehabilitation is also provide in IPD of different wards or departments. Only physiotherapy service is available. One national hospital and an NGO supporting service provide speech therapy.

To help reduce environmental barriers, in Cambodia, a regulation on accessible building has been adopted. However, the enforcement for implementation is not going well as we can see that many new building including government buildings are not accessible. There are some initiation under NGOs supporting fund to build ramps and rails to buildings of health settings like hospital and health centers. Regarding social barriers like behaviors, stigmatization, and belief, there are not clear-cut of a stance alone regulation. However, some laws and regulations in relation to Human and Disability Rights do indicate this area.

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I work in a busy, NYC hospital as a physical therapist. A huge part of our job is doing an initial evaluation of a patient in the hospital and assessing their rehabilitation needs upon discharge from the medical hospital. Patients can be discharged anywhere on the continuum of care from no rehab needs at all, up to inpatient acute care rehabilitation. Acute rehab is loosely defined as a multidisciplinary needs (PT,OT &/or SLP), ability to tolerate at least 3 hours of therapy a day, and achievable goals within a short time frame (~5-21 days). In between these two endpoints are home service, going home and attending community – or “outpatient” services, or “subacute” rehab which is inpatient rehab for those unable to tolerate a full three hours a day and/or have rehab goals/expectations spanning longer than 2-3 weeks.
In short, there are ample services available in NYC. The frustrating part is ACCESS to, and payment for services. For the small minority of patients who can afford the best services, they have it all at their fingertips. For most, they are restricted by what their insurance covers. There are patients who go home and require outpatient services but have a co-payment for each visit. Some patients have co-pays as high as $50 a visit. That cost, times multiple visits a week is prohibitive and discourages patients from fully utilizing services available.
I am interested in how to firstly ensure that these services are available in other countries, but also that they are accessible.

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