Nepal Spinal Cord Injury Working Group

Transcription

1 Nepal Spinal Cord Injury Working Group 19 June 2015 Overview by Fiona Stephenson Rehabilitation Cluster Meeting

2 Aim of the Nepal SCI Working Group Ascertain numbers of patients with SCI Find key actors to facilitate SCI care and transfers within Nepal Including plastic surgeons for PU s and urologists to assist with neurogenic bladder follow up To transfer patients back to a local SCI facility, near their family To share SCI specific resources (ie; wheelchairs) Highlight the need for trained Nepalese Occupational Therapists Increase SCI bed capacity in Nepal, with trained SCI multidisciplinary healthcare professionals

3 Objectives of the Nepal SCI Working Group Raise awareness of the specific needs, and Assist in the development of holistic multidisciplinary rehabilitation, For men, women, boys & girls in Nepal, Who have sustained a spinal cord injury, through, for example, The provision of holistic healthcare education to professionals, patients, their families and carers

4 SCI Facilities in Nepal SIRC INF Surkhet Green Pastures, Pokhara Tansen, Palpa District Chitwan

5 Chitwan Spinal Injury Centre Created in rd year anniversary on 16 June Doctor 5 RN 2 PT 1 Peer Counsellor 1 Helper 1 Volunteer 15 bed facility 8 patients with SCI at present 1 earthquake survivor (female adult) Spinal fixations available at the hospital

6 Rehabilitation at Chitwan

7 Green Pastures, Pokhara P&O Rehabilitation Department

8 Green Pastures, Pokhara Accessible SCI Unit 10 Nurses 2 Helpers 3 OT/Tech 8 PT 20 rehab beds; mixed beds for amputees, stroke, spinal TB (usually have 6-14 patients with SCI) 20 extra beds open for earthquake survivors could go up to 50 extra 8 Earthquake survivors (mostly incomplete tetraplegic) Open to transfers of earthquake survivors with a SCI

9 INF Surkhet Based in Birendranagar, this programme serves people in the middle-hill districts of Surkhet, Jajarkot and Dailekh, and the whole Mid Western Region through its leprosy centre. The programme includes:the 26-bed Leprosy and Disability Referral Centre which provides inpatient care for patients with severe leprosyrelated complications and patients with general disabilities [mostly spinal cord injuries] Tansen, Palpa District Tansen Hospital in Palpa District (Western Region) has also been identified as being able to care for a small number of SCI patients.

10 50 MDT staff increasing with increased capacity 2 Doctors 1 Head Nurse 18 Registered Nurses 1 Head of Department - Rehabilitation 12 Physiotherapists/aids 5 OT Technicians 2 Wheelchair Technicians 1 Social Worker 2 Psychologists 1 CBR Worker 2 Peer Counsellors 150 going to 200 beds, including 50 step down beds

11 The only rehab hydrotherapy facility in the PT Department Transportation facilities

12 SIRC Occupational Therapy Wheelchair Department following WHO guidelines

13 SCI - Update SIRC; Grand total of earthquake survivors to date = 132 including 5 children under the age of 18 years with SCI Pokhara; 8 Earthquake survivors with SCI Chitwan; 1 Earthquake survivor (female adult) with SCI Tansen; 0 Earthquake survivors at present with SCI Surkhet;?? Earthquake survivors with SCI

14 Kathmandu SIRC is operating an important outreach program to hospitals in Kathmandu to advise on spinal care prior to transfer to a specialized rehabilitation facility. Spinal injury patients continue to be identified - estimates range from in total. Patients with SCI awaiting transfer = 15 +

15 SCI referral process Identification of patient with SCI, CT scan, Xray, MRI Refer to SCI Centre (SIRC) Establish level of injury & stability of spine. Conservative/Surgical management. Liaise with SCIC Maximise spinal cord perfusion, safe log rolling and repositioning. PU prevention. Liaise with SCIC SCIC Acute Outreach Visit for SCI specific advice Transfer to SIRC/Other SCIC

16 General findings More incomplete spinal cord injuries reflecting standard of care for patients at site of injury More patients now being admitted with pressure ulcers will prolong hospitalisation & defer active rehab until PU has healed Evidence indicates that patients with spinal cord injury should be cohorted in specialist centres to optimize care. Coordination of bed space in these centres remains a priority. Discharge of patients with SCI difficult as 90% homes destroyed

17 SCI Working Group Educational Visits Pressure ulcer prevention. Bladder management, Bowel management, Autonomic Dysreflexia Cough assist techniques for the tetraplegic patient Safe repositioning and log rolling of the SCI patient

18 Risks associated with a Spinal Cord Injury Bladder UTI, Pyelonephritis, Renal stones, urethral erosion Bowel constipation, impaction, perforation Deep Vein Thrombosis Pulmonary embolism Respiratory Infection Autonomic Dysreflexia Pressure Ulcers preventable!!! Worsening neurology poor handling Take vital signs To know and Monitor your Patient at least daily!

19 The way forward Establish regular communication between SCI facilities Continue links with local plastic surgery specialists Continue Urologist services at SIRC to assist with neurogenic bladder management Safe transfer process Transfer patients with SCI to local units (Gorkha patients to Green Pastures SCI facility) Safe step down process to accessible accommodation Provide education opportunities for healthcare professionals working in general hospitals Provide education opportunities for healthcare professionals working in SCI facilities To encourage prevention of spinal cord injury strategies

20 SCI Resources - Free International Spinal Cord Society International Network of SCI Nurses International SCI PT Network International SCI OT Network

21 Final message from the SCI Working Group Please ensure that healthcare providers and carers are educated in safe moving & handling Keep an incomplete SCI incomplete INCOMPLETE Thank you