Yemen need physical therapy [Archives:2006/924/Health]
Amel Al-Ariqi
[email protected]
It is rare to find someone walking alone in this building. It is very crowded outside the building, but at the same time, it is very quiet, resembling a silent movie where all feelings and motions are illustrated only by face. Expectation, hope, fear and pain altogether can be seen on all faces. The scene becomes clamorous inside the building where conversations, whispers and sometimes cries can be heard.
The building is the artificial limbs and physical therapy center, the only center in Sana'a controlled by the Ministry of Health offering physical therapy to patients with disability, disease or injury.
“The only center I know and send my patients to is the artificial limbs and physical therapy center. This is the only center in Sana'a, and maybe in all of Yemen, that receives thousands of physical therapy patients from various governorates and villages,” plastic surgeon Dr. Saleh Al-Aidhani said. The center's physical therapist, Dr. Ahmed Ali Sawal, confirmed this, mentioning that the center daily receives more than 500 patients suffering disabilities or disfigurement due to car or work accidents and needing rehabilitation.
Children arriving at the center suffer meningitis and birth defects, which are common among Yemeni children. “We daily receive dozens of children with birth defect-related diseases such as heart or bone disease,” Sawal noted. According to him, women generally suffer bone diseases like Osteoporosis and rheumatism, whereas men mostly are affected by spinal column diseases. Physical therapy also is prescribed for patients with various orthopedic, neurological, vascular and respiratory conditions, which may result from congenital malfunction, inherited dysfunction or disability acquired from disease or trauma.
Center physical therapist Dr. Mohammed Al-Jawfi explained that treatments are designed to achieve and maintain functional rehabilitation, prevent malfunction or deformity, minimize residual physical disability, hasten convalescence and contribute to patients' comfort and well-being.
Patients don't know
Physical therapist Ahmed Al-Mudhwahi said Yemenis still have incomplete knowledge about physical therapy and its function. “Many patients come to me asking for medicinal herbs and oils,” he noted. “Yemenis think physical therapy means just massage or giving herbs or medical oil to apply to painful areas,” he added.
Al-Mudhwahi confirmed that physical therapy was used in ancient times, as ancient Greeks and Romans wrote about the beneficial effects of sun and water. Also, both exercise and massage were used by ancient Egyptians, Persians, Greeks and Chinese.
He mentioned that most physical procedures employed in modern physical therapy were used in ancient times. For example, physical therapists may employ one or more of the following treatments: heat treatments using water at various temperatures, infrared and ultraviolet lamps, ultrasonic waves that produce heat internally and diathermy, applying electric current to generate heat in body tissues.
One of the physical therapist's most important tasks is therapeutic exercise in various forms. It is used to increase strength and endurance, improve coordination, improve functional movement for activities of daily living and increase and maintain range of motion. Gait training is conducted with the assistance of canes, crutches, walkers, braces and artificial limbs. Physical therapy also employs massage, bandaging, strapping and applying and removing splints and casts. Physical therapists instruct patients and their relatives in exercise techniques and using prosthetic devices, such as artificial limbs.
Sawal referred to another problem physical therapists may face with patients. “Many patients enter the center asking for therapy without previous diagnosis by specialists. We try to convince them that we cannot offer such therapy without a doctor's instruction. Convincing is so difficult with poor patients who cannot afford to visit a doctor's clinic. Many times I suggested establishing a department where doctors can diagnose patients,” he noted.
According to Sawal, doctors and specialist must conduct diagnostic tests, as the center does not contain and diagnostic department. Among diagnostic tests used by physical therapy specialists are manual muscle testing, electrical testing, perceptual and sensory testing and measuring joint range of motion. Functional activity testing also is important to ascertain patients' capability to perform necessary tasks to care for themselves.
Occupational vs. physical therapy
Patients mostly come to the center from distant regions since it is one of the country's few centers controlled by the Ministry of Health and offering free services. “Many patients cannot keep their scheduled sessions because they cannot afford to travel from their village to Sana'a. So many discontinued the sessions and became subject to a relapse in their health,” Al-Jawfi explained. “So we mostly teach patients to practice the exercises at home. The center offers physical and occupational therapy in these cases,” he added.
Occupational therapy, sometimes called rehabilitative therapy, uses activities of everyday living to help those with physical or mental disabilities achieve maximum function and independence at home and in the workplace.
Occupational therapy differs from phy
sical therapy in that physical therapy chiefly deals with restoring physical strength, endurance, coordination and range of motion by such means as exercise, massage and cold or heat therapy. Occupational therapy focuses on personal and work activities, both to help those with disabilities find ways to master these activities and use them to continue physical therapy goals.
According to Al-Jawfi, occupational therapy can teach someone with swallowing difficulties how to eat and drink safely, as well as show someone how to use special tools to put on shoes and socks, close zippers and button shirts. Occupational therapy also is widely used with children suffering physical and mental disabilities.
Not for all patients
Ibrahim, 25, was attached to equipment stimulating the nerves in his left arm. “I was shot seven months ago and lost the ability to move my arm. After undergoing two surgeries, my doctor sent me to this center to finish my recovery,” he said.
Al-Jawfi confirmed that more than 50 percent of the center's male patients are youths. “These men, mostly living outside Sana'a, are victims of car accidents and gunshots,” he said.
Salah, 57, suffered a brain clot two years ago, causing paralysis in his right arm and leg. He has continued visiting the center since then, looking for complete recovery. “I let my son direct the bookshop I own because I lost my ability to move and concentrate. However, I'm better now and I believe I can return if I continue this therapy,” he said.
Al-Jawfi confirmed that physical therapy cannot recover all patients. “Those who suffer clots or mental diseases never return to normal as they were. In these cases, our task is to minimize residual physical disability,” he explained.
The center cannot receive all patients needing rehabilitation; for example, burn victims who may have lost their movement ability cannot receive proper treatment at the center. “We cannot deal with all burn victims – only those who had surgery and need certain treatment for their skin,” Al-Jawfi explained.
Discrimination
There are only 30 nurses and physical therapists at the center, some non-Yemeni. According to Al-Jawfi, the Ministry of Health pays foreign therapists $500 (about YR 100,000) in salary, whereas Yemeni therapists earn only YR 30,000 (about $150). “I believe it's better for the Ministry of Health to qualify local therapists rather than bring in foreigners who require qualification themselves,” he asserted. “The Ministry of Health brought in people without investigating their abilities, skills or careers. So we trained them before they began working in the center,” he confirmed.
It is not only local staff who feel discrimination, as patients also feel a sense of discrimination regarding services. A therapist wishing to remain anonymous confirmed that there is a section containing equipment not open to all patients. “This section is only for those patients related to high-class society.” The section contains equipment unavailable in other sections, for example, hydrotherapy pools. “We rarely use these pools due to lack of water, which must be changed constantly. We change the water and prepare these pools only for influential patients in high positions in society,” he confirmed.
Official support
Al-Jawfi confirmed that the center contains equipment and machines; however, there is a lack in staff ability to use the equipment. “It is important to find and increase qualified staff to use these medical machines.”
“Unfortunately there, is no official attention to or support for this scientific field. The center must be provided with new techniques and staff require constant training. There is something new every day and I'm afraid that if we can't follow progress and new developments in this regard, we won't be able to offer proper treatment to patients,” Al-Jawfi warned.
Al-Mudhwahi pointed to the fact that there is no department teaching physical therapy in Yemeni medical colleges. The majority of staff working in this field has nursing certifications and some training courses. Internationally, the minimum degree is a bachelor's, which is a four-year college course combining approximately two years of liberal arts study with two years of professional education, including clinical instruction and experience in providing patient physical therapy.
The Institute of Health graduated 200 physical therapists in 2003; however, the therapists themselves still regard their future as unknown. One such graduate, Al-Mudhwahi, revealed that he and some of his colleges are preparing to announce a physical therapists syndicate. “We believe that if we can organize ourselves, we can enact a program to enhance public awareness of the importance of and the need for physical therapy in Yemen.”
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