Providing
Physiotherapy
By Limana Solaiman Mridha
With a population of over 160 million, Bangladesh is always in need for improvement in the healthcare sector, where many segments are severely understaffed or poorly equipped. This is also true when it comes to physiotherapy facilities in public hospitals in the capital and elsewhere across the country.
Physiotherapy treats people affected by injury, illness or disability through physical movement and exercise, manual therapies like massage and heat, light or water treatment, education and advice. It helps patients to manage pain and immobility, and return to leading a life as normal as possible.
Private institutions, such as the Centre for the Rehabilitation of the Paralysed (CRP), are offering training in the field, including graduation and masters degrees in the discipline. According to Bangladesh Physiotherapy Association, a voluntary professional organisation, graduation courses in physiotherapy, under the medicine faculty of the University of Dhaka, are available at Bangladesh Health Professions Institute (BHPI) and National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Courses have also been introduced in Peoples University of Bangladesh, Gono Bishwabiddalya, Bangladesh Medical College and State University of Bangladesh.
There is little or very limited scope for intensive research available in this field in Bangladesh and a pressing need for further education is a necessity. There are no public institutions on physiotherapy in the country. But according to CRPs head of programme, Sohrab Hossain, the government has designated land to set up an official educational institution, but work is yet to start.
Munir Hossain Sikder, a spinal cord injury patient shared his experience with the Weekend Independent in a telephone interview: I was a student of psychology when the accident happened. My father is a very strict man and he used to lock the gates of our residence by 10pm. My brother and I were coming home after he had already locked the gate and we live in Azimpur with densely packed buildings of the same height. We were jumping from one rooftop to another to get to our building and I slipped and fell. I was taken to Dhaka Medical (College Hospital) trauma unit and from there, after initial treatment, they sent me to CRP. It took some time for me to come to terms with what has happened, but gradually I got over it. CRP provides occupational therapy for wheelchair bound people and slowly I learned everything. I met my wife, Parveen Akhter, here and I am currently working here as well. My wife is also a peer support assistant here and she encourages people to live a better life.
Anisur Rahman Rana, a wheelchair bound basketball player and a volunteer at CRP talks about his accident and experience: The fateful day was July 2010, I fell on top of concrete from an eight-feet wall after being electrocuted. I was senseless and the locals tried to take me to the hospital by rickshaw and I fell off three times. Then they tried to take me on a motorcycle and I fell once again. This added to my injury as the people taking me to the hospital had no idea of the extent of my wound. At first, I was taken to the district hospital and from there, I was taken to the Noakhali General Hospital by CNG auto-rickshaw and I was made to sit, which was damaging for me. The hospital in return asked my parents to take me to Dhaka Medical College and I guess by then, the worst damage was done. It took four days for me to get initial treatment. I got operated on 24 days later and my parents did not tell me I was paralysed. They suggested that I go to CRP for further exercises and physical therapy. I did not get accommodation to stay in CRP, so my parents rented a place nearby where we reside for continuation of my treatment. I suffered bedsores and took therapy for one-and-half years before stopping. My situation might have been different if I had received proper treatment immediately after my accident and had not been dragged around and repeatedly dropped. I am appalled by the lack of primary treatment for this kind of injuries in our country, and I feel that the government should take initiative for the improvement of this sector as many people like me are suffering due to inadequate treatment.
About educational institutions for this discipline and physiotherapy institutions outside Dhaka, Sohrab Hossain said: There is a severe shortage of highly trained practitioners in this discipline. We will need at least 30,000 more trained graduates to meet the demand to some extent if they are dispersed properly around the country. At present, we do not have enough facilities to accommodate the need of the population. Every zila and upazila hospital needs to have properly trained and aptly educated physiotherapists so that patients get the initial treatment and diagnosis properly. We have requested the government to incorporate this department in all state run hospitals as it is a necessity. Many people are suffering due to lack of treatment.
Both CRP and Bangladesh Physiotherapy Association invite experts from abroad and conduct training sessions. Foreign and local experts work as a team to develop this sector through intensive training. This is being done once or twice every year. We hold monthly in-service training for practicing doctors and have a total of 160 therapists. There are a total of six sections of CRP operating around the country, but it is not sufficient. We have membership of the World Confederation for Physical Therapy, they represent physical therapists and their organisations around the globe. We receive many development instructions from them and act accordingly for the improvement of this sector. They helped us develop our educational curriculum and the Dhaka University School of Medicine approved it.
To ensure quality health services, the existing facilities should be improved and further education, including special education in orthopaedics, neurology, paediatrics, womens health, elderly care and cardio-respiratory therapy should be introduced in the educational programmes of the discipline.
We get a lot of brilliant students interested in physiotherapy, but the lack of government jobs in this profession has been discouraging for many. There are few posts for graduates in physiotherapy in government-run hospitals. Most graduates are working in private institutes or NGOs. There are physiotherapists in government hospitals and institutes, but not all are appropriately equipped to give a sound diagnosis as they only have diplomas and one needs to continue till graduation to be able to administer proper treatment and diagnosis. Moreover, many trained graduates are going abroad for lack of opportunities at home, furthering the scarcity.
Non-profit organisations like ASA provide physiotherapy services through arranging camps across the country, mostly in underdeveloped localities. Trained physiotherapists and nurses deliver the service using modern equipment and medical kits. Under the programme, 40,000 patients were provided treatment during 2015, according to its website.
When asked about possible malpractices in the field and how it is handled, Hossain said: There is a need to form a council of regulatory bodies as there is none now to curb malpractices. This wont be a problem if more scholastic institutions for this discipline are opened, with a uniform standard course curriculum. In 2009, the government designated land for construction of a college of physiotherapy in the Mohakhali area of the capital. At present, there is a slum existing in the location, but we are extremely hopeful that with government initiative, work will be swift and adequate.
The current situation is giving rise to about 40 percent malpractice. Many uncertified people, like technicians, are giving therapy at many known institutions, and the lack of an official regulatory body is letting the problem prevail. In Bangladesh, few individuals are conducting their own research as there is no official research centre for this discipline. Lack of funding is also a reason for so few research projects. I myself conducted four research recently on spinal cord injuries, complications and management. This work of mine will hopefully help in preventing complications and risk factors associated with spinal cord injury sufferers. It was a group initiative and two Australians professors and two from Bangladesh are also part of this research. We got a five-year funding from Sydney University Medical Council. It is one of the biggest research conducted in terms of its sample size as patients are not reluctant to participate or provide insight. More extensive research on a continuous basis is much needed for further development.
Every four years, there is a conference arranged by the World Confederation for Physical Therapy Congress and many publications are presented on various fields of physical therapy. Bangladesh also participates, but more active participation is required which will be possible if more scopes for research are created.
Photos: Courtesy, Internet
