SPINAL CORD INJURY IN DEVELOPING COUNTRIES

It is generally assumed that the incidence of Spinal Cord Injuries is around 15 to 30 per million populations in the Western World countries where figures are still lacking in most countries. No wonder then that such figures are unavailable for that “Third World” where 80 per cent of the population live. The few available epidemiological studies have quoted the incidence for Russia, Romania and Turkey as 29.7, 30 and 21 million respectively. The causes leading to spinal injury can be different from one country to another. In Western Europe, road traffic accidents account for about 50 per cent of the injuries whereas gun shot wounds seen to be frequent in the USA and Pakistan. Falling from trees (Nigeria and India) of from overloaded carts are other major causes.

Depending on the area of the spine that is affected these injuries can be complete (no sensation or motor information goes past the level of injury) or incomplete. They are devastating to the individual whose management will include testing the bony spinal fracture (either by surgery or using conservative means) as well as the bladder and bowel paralysis; and to the countries due to the complexity of this type of injury and the costs involved.

Thanks to the International Medical Society of Paraplegia, a few Doctors, Nurses and Therapists have been trained and are taking care of these patients in different countries: India, Cambodia, Bangkok, etc. But very often their efforts are isolated and lack the essential drive and co-ordination from the Ministry of Health. International Aid Agencies, like The International Committee of the Red Cross and the International Federation of Red Cross and Red Crescent Movement, have set up excellent centers in Pakistan (Peshawar), Armenia (Yerevan) and Romania (Bucharest), where the emphasis is on training of personnel and use of local resources.

The main problems faced by individual countries and international non-governmental organizations have been lack of funds. Spinal Cord Injury is possibly not as appealing and vote winning, for example, as sensitive issues of abandoned children. The International Red Cross seems to be less inclined to continue in the field of Spinal Cord Injury due to lack of donor support although it ahs paved the way with well designed policies, and projects.

What Can Be Done?

The following principles have guided the actions of the International Red Cross in these centers:

1. Conservative Management
The purpose is not to dispute the merits of surgery in early mobilisation but to emphasise the importance of using the meager resources economically so as to avoid that one item (surgery) that will use all funds available and therefore compromise the whole project. However, surgery will always be offered in certain selected cases.

2. Low Cost Technology
To ensure long term survival care here again be taken to manage the meager resources. Therefore orthoses, prostheses, wheelchairs, equipment for physiotherapy and adaptations for patients should as far as possible be made locally. In two of the Red Cross project, wheelchair factories have been set up with in the hospital. They now produce wheelchairs at around $100 each when the imported ones would have cost around $1500.

3. Training of Personnel
This would also include training of family members in order to bring down the cost of services while still ensuring good quality care. Carers participate in part of the care in the hospital and continue their involvement in the community.

4. Taking Into Account Architectural Barriers
So often patients live in remote villages or mountains, where there are no roads and inadequate houses. Much stress is laid during the rehabilitation programme in hospital on studying in detail all the problems that each individual patient will face back home with regard to the particular environment, and in trying to find solutions. This is far from being an easy task and much effort will have to be invested in future by architects and rehabilitations to look into these problems since they are common to so many poor countries where patients cannot get much help from the State.

5. Understanding The Culture of Individuals and Societies That We Treat So As Not to Blindly Apply Protocols Suitable For The West to Other Societies
At times patients have serious reservations with regard to the use of indwelling catheters intermittent self-catheterisation; bowel training and for various social, philosophical or religious reasons. We have found it useful to involve religious and influential social leaders in the rehabilitation programme to assist in distinguishing between superstition and religious teachings as well as social stigma. These aspects have to be handled with tact and skill

Conclusion :

Spinal Cord Injury care is most unsatisfactory in most parts of the developing worlds. We gave witnessed patients dying slowly of pressure sores or renal failures, through inadequate care, based often on inadequate knowledge or lack of goodwill. The governments might blame lack of financial means but we feel that most countries can offer a good quality of care with very little money. In fact every effort should be made to encourage governments and international agencies to keep down the cost of running spinal injuries centers.

"Spinal Cord Injury care is most unsatisfactory in most parts of the developing world we have witnessed patients dying slowly of pressure sores or renal failure, through inadequate care, based often on inadequate knowledge or lack of goodwill.”

"The government might blame lack of financial means but we feel that most countries can offer a good quality of care with very little money. In fact every effort should be made to encourage governments and international agencies to keep down the costs of running spinal injuries centres”