The physiotherapy in MSF missions
currently • Haïti (Drouillard): 1 expat + 6 nat.staff + 3 students IPD & OPD : ortho, burn in acute phase • Jordanie (Amman): 1 expat + 11 nat.staff IPD & OPD : ortho, reconstructive surgery, maxillo-facial • Yémen (Aden): 1 expat + 2 nat.staff IPD & OPD : ortho • Syrie (Alpha) : 1 expat + 3 nat.staff (Bravo): 1 expat + nat.staff IPD & OPD : traumato, brûlé ++ • Gaza : 3 nat.staff OPD : hand rehabilitation, burn in secondary phase, ortho 60 613 sessions et 4727 patients (January to september 2013 )
Areas of intervention •
Orthopedic :
• • • •
Neurology: peripheral & central nerve damage Burn ICU Respiratory infection : bronchial clearance, improvement of the
• •
o Pre-op (tractions) o Immediate post-op (from J1) o Ambulatory care
respiratory function.
Gyneco-obs : peri-operative, prevention of sequelae (need to be enhance) Pediatric (malnutrition) : motor delay and bronchial clearance (need to be
enhance)
Objectives -
Pain management (cryo, electro, massage...)
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Prevention and treatment of bed rest complications
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Recovery of the limb mobility (RoM, strenght, endurance)
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Recovery of the limb function
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Maximal autonomy, socio-professional reintegration, quality of life. → Reduction of the lenght of stay
– – – – –
Musculo-skeletal (muscle atrophy, equinus foot, joint stiffness…) respiratory (encombrement, volumes…) cardiovascular (DVT, swelling) Cutaneous (bed-sore) Psy
Earlier is the rehabilitation and easier to prevent are the disabling sequelae. The disability impacts the patient, his/her family and the society as a whole.
Means of action •
The physio intervenes : o IPD : bedside sessions (under medical prescription) o OPD : physio room (basic equipement) o At home
•
Techniques: o o o o
•
Manual techniques +++, Early mobilization and raising, Patient and his/her family education +++ Chest physio…
Equipement required: o o o o o
Essentially, physio’s hands and imagination Small equipement (cheap and local) Splint (plaster, thermoformable) Mobility aids (Electrotherapy)
Multidisciplinary collaboration • Nurse & Physio in IPD and OPD:
o Concistency of care (dressing & session) o Pain management o Consistency of instructions
• Surgeon & Physio :
o Consultation/admission (advices, common therapeutic objectives) o discharge (socio-economic context, autonomy, functional gain …)
• Clinic case: • • •
Haïtian patient, 30 years, femur closed fracture, treated by femur nailing Discharge with 2 crutches and weightbearing prohibited Back in physio OPD 2 months later, still without weightbearing → lower limb impairment, permanent partial disability → Treatment failure
To avoid that: pre-discharge consultation between Surgeon/Doctor/Physio/Nurse
Partners in the field • Handicap International : long term rehabilitation, orthesis, prosthesis, socio-professional inclusion.
• CICR : Orthesis and prosthesis • Local structures and ressources (NGO, associations, clinics…)