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ICRC Physical Rehabilitation Programmes, Annual Report 2001

14-04-2002 by Theo Verhoeff

Health Services Unit, Assistance Division, ICRC

 

   
 
Introduction 
 

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance.

In 1979 the ICRC set up a unit for the physical rehabilitation of war victims. Since then, 65 projects have been set up in 25 countries. Two-thirds of the projects are carried out in close co-operation with government authorities. The others are run by the ICRC alone or in partnership with local non-governmental organizations or National Red Cross/Red Crescent Societies.

Since the unit was formed, 159'300 individuals have been fitted with a total of 179'206 prostheses and 74'254 orthoses, while others have received crutches (234'485 pairs), wheelchairs (13'422), physiotherapy, etc.

Programmes in 11 countries (Chad, Colombia, Eritrea, Lebanon, Mozambique, Nicaragua, Pakistan, Rwanda, Syria, Viet Nam and Zimbabwe) have been handed over after an average period of 10 years'full-time ICRC involvement. In some countries (Ethiopia, Myanmar, Sudan and Uganda), the ICRC resumed its assistance because of extensive unmet needs and the persistence of a conflict situation.

It is essential that projects that have been handed over, continue to pro vide services for the disabled, whose needs for replacement and repair of orthopaedic appliances are lifelong. After their hand over, most of the programmes are monitored and assisted on a smaller scale through the ICRC's Special Fund for the Disabled.

 
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Assisted persons in 2001 
 

After 4 consecutive years of growth, the year 2001 showed a stabilization in the total number of assisted disabled persons. Amputees were fitted with 16'501 prostheses, while other disabled were fitted with 11'523 orthoses. The proportion of mine victims among the fitted amputees remained the same (59%). Most projects showed a slight overall decrease in assisted patients, with a proportional increase of patients fitted with a replacement prosthesis. Some projects, notably Myanmar and Ethiopia, assisted significantly more patients this year.

    

   

    

Three additional projects were initiated in 2001, in Sudan (Juba) , Afghanistan (Faizabad) and Iraq (Baghdad) . This increased the total number of assisted prosthetic/orthotic centres to 40, in 14 different countries. The assistance program in Uganda (Fort Portall, Gulu and Mbarara) was ended by December 31.

Technical assistance was p rovided by 38 expatriate specialists who were based permanently in 40 field projects, assisting 1,129 local staff. During the year, 13 project visits were carried out by headquarters staff or regional specialist s, including needs assessments in Namibia, North Korea, Northern Caucasus, Sierra Leone, Algeria and in Yemen. In addition, 8 congress-, donor- or other assistance agency meetings were attended, including the ICRC participation at the tri-annual World congress of the In ternational Society of Prosthetics and Orthotics (ISPO) in Glasgow.

 
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Developments in Program Approach  
 

   

The three main objectives for 2000 – 2005 are the following:

 To develop, together with the partner, project guidelines for the treatment of amputees  

    

Based on existing generally accepted policy guidelines on Physical R ehabilitation and based on the in-house accumulated experiences, the aim of t he " ICRC’s Physical Rehabilitation Round Table Conference on Practical Project Guidelines " held from May 28 - June 01, 2001 in Ecogia, Geneva was to arrive at a set of practical recommendations to be used in projects. This became a part of t he Orthopaedic Reference Manual ( ORM) which includes general and practical guidelines , management tools and report formats plus examples of good working practices for ICRC heads of prosthetic/orthotic programs . Its aim is to optimise and to harmonis e the ICRC's Physical Rehabilitation program approach in new and existing programs world-wid e. The ORM is a working document, which will be continuously updated over time. Relevant parts of the contents, especially the Practical Project Guidelines are now shared with and developed together with the national staff and national partner organisation in a number of programs, leading to specific " standard operating procedures " for each project.

One of the developed tools in the ORM is the Patient Management System (PMS), originally designed by the ICRC, and greatly improved by the American Red Cross for use in its rehabilitation program in Cambodia. The PMS has been developed for the prosthetic/orthotic centre's and should render the management of patients and of their appliances easier and more effective. Thanks to the American Red Cross, who agreed to share their application with the ICRC, the ICRC enhanced it to make it usable in any country as a tool to manage patients in orthosis, prosthesis and rehabilitation clinics. The first version of the new application is now being applied in various countries for feedback. The appli cation is also available for prosthetic/orthotic centre's not assisted by the ICRC (according to stock).

    

 To define a standard level of training and develop a teaching package for local staff  

The level of training is directly related to the quality of prosthetic fit for the patient and also to the prospects of sustain ability of the project. If training is essential to address quality, quantity and sustain ability, major constraints do exist. The training goal for the ICRC is therefore to identify and address first the priority needs in each project. Due to the limited existing health infrastructure, the priority needs most easily addressed are often first lower limb amputees, followed later by upper limb amputees and patients in need of orthoses. In consultation with the International Society of Prosthetics and Orthotics (ISPO) and others, a Training Work gro up has been established to standardise a modular and basic in-house training course with a corresponding teaching package. The course should offer prospects for upgrading to an internationally recognised level, if and when conditions allow. Where possible, training of national staff to Cat II and I level in regionally recognised schools is encouraged.

Meanwhile, representatives of the ISPO participated in the final examinations of a three years prosthetics/orthotics training course in Tblissi and Baku in the Southern Caucasus. Twelve students passed successfully the exams of the nationally and internationally recognized ISPO Category II Diploma.

 To improve and standardize affordable raw materials, including prosthetic components  

Using good quality/low cost materials decreases the risk that the patient should have to return frequently for a repair or a replacement of his/her orthopaedic device and it allows the staff to concentrate on the many other aspects of patient service provision which require attention. The development and production of good quality/low cost components at CR-Equipements (Coppet, Switzerland) continued on schedule. By the end of the year all basic prosthetic components had been developed and produced, including components for children. The components are subjected to internal and external tests to ensure and further improve the quality. Collaboration in this field with the Ecole Polytechnique Fédérale de Lausanne (EPFL) is ongoing and highly appreciated.

In 2001, CREquipment produced components for the production of some 20'000 prostheses. T he majority of the ICRC assisted projects were using these components.

Components from CR-Equipements have also been made available at cost price to other humanitarian organizations assisting projects in low-income countries and subject to the condition that local staff be trained in the use of the components. The regional training centre of the Special Fund for the Disabled in Addis Ababa, Ethiopia, has organized 7 one-month training courses, mainly for national technicians from assisted projects, but also for new ICRC expatriates.

The ICRC-assisted component factory in Phnom Penh, Cambodia, which has achieved a high degree of technical and managerial self-sufficiency, will continue to provide components for the national market.

 
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Activities per country programme 
 
Afghanistan: Kabul, Herat, Mazar-e-Sharif, Jalalabad, Gulbahar, Faizabad, 1987-2001 
 

    

 Background  

Despite the pressing need for physical rehabilitation services in Afghanistan, existing health-care facilities lack resources and professional skills. In 1981, the ICRC started assisting physically disabled Afghans in facilities just across the border in Pakistan. The organization has been present in Afghanistan since 1987 and has set up prosthetic/orthotic centres in Kabul, Herat, Mazar-i-Sharif, Jalalabad, Gulbahar and in Faizabad. The ICRC programme has developed steadily to meet the needs of amputees, and has also made significant progress in addressing the physical needs of non-amputees such as paraplegic patients, polio victims and others. The social re-integration of many physically disabled people has been facilitated by their inclusion in the workforce of the prosthetic/orthotic centres and other programmes. Small-scale projects providing education, vocational training and micro credit for the disabled have been equally instrumental in this respect. The ICRC physical rehabilitation programme in Afghanistan has the highest number of beneficiaries of any of the ICRC-assisted country programmes.

    

 Achievements 1987–2000     

  • Physical rehabilitation services were provided for patients, who received 35'035 prostheses and 13'861 orthoses.

  • The premises were renovated and new equipment was installed.

  • Support units were set up for paraplegic patients in three prosthetic/orthotic centres, together with an extensive home-visiting programme.

  • Some 700 disabled people took part in micro-credit programmes set up on the private initiative of the project leader.

  • Continued training was provided for technical staff.

  • Y 2000: access was improved through decentralizatio n and increased collaboration with the Afghan Red Crescent Society; 2 national workshops on physiotherapy and orthopaedic technology were organized; more management responsibilities for national staff; provision of components, including a training course, to other centre's.

    

 Achievements 2001     

  • Physical rehabilitation services were provided for patients, including the supply of 3'985 prostheses and 6'305 orthoses (76% of the fitted amputees were mine victims). Between September and November, when all ICRC expatriates had to leave Afghanistan, the national staff successfully continued the fitting of patients and successfully protected the equipment and premises.

  • Also, approximately 400 ICRC-produced components were supplied to centres assisted by the Swedish Committee for Afghanistan's Comprehensive Disabled Afghan Project United Nations Development Program (SCA-CDAP-UNDP) in Ghazni and by the Guardians in Kandahar.

  • The socio-economic program resulted in jobs for 78 disabled; 57 young disabled received vocational training; 493 children attended public schools and 61 children attended home classes; 376 micro-credits were provided for new activities. Additional micro-credit projects started in Herat and in Mazar-e-Sharif.

  • In March, an agreement was signed to open an additional prosthetic/orthotic centre in Faizabad, which became operational in August.

  • Between February and April, unsuccessful discussions were held with the authorities to organize (government al recognized) upgrading courses for orthopaedic technicians.

 
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Angola: Luanda, Huambo, Kuito, 1979–2001 
 

    

 Background     

The long-standing conflict in Angola has claimed many victims. More than 80% of the amputees in the country were injured by mines. The ICRC has co-operated since 1979 with the Ministry of Health in providing technical and material support for prosthetic/orthotic centres in Luanda, Huambo and Kuito. Appropriate technology has been introduced , including prosthetic components that have also been provided for centres assisted by other organizations. Flare-ups in the conflict have sometimes been accompanied by looting, famine and a general lack of security that have interrupted services. The longest period of standstill was between 1992 and 1994, following which, in 1995, the ICRC renovated the Huambo centre and rebuilt the Kuito centre from scratch. Recently, the focus has been on improving patient services, including making centres more accessible and achieving a better quality of fit and longer durability of prostheses. In 2000, at the request of the European Union, a new five-year plan for physical rehabilitation was adopted by the national authorities.

    

 Achievements 1979–2000  

  • Physical rehabilitation services were provided for patients, who received 22'271 prostheses and 152 orthoses.

  • Prosthetic components were delivered to up to seven centres assisted by other humanitarian organizations.

  • Renovation or construction work was carried out on the premises, new equipment was installed and a patient dormitory was set up.

  • Continued training was provided for 60 technical staff.

  • Y2000: 7 centre's received free of charge ICRC components for the production of 3'500 prostheses. Introduction of CREquipement components; local component production in Huambo was phased out.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 1'953 prostheses and 28 orthoses (81% of the fitted amputees were mine victims). The total number of assisted patients could be maintained at nearly the same level as last year, in spite of 6 months ICRC absence in the Neves Bendinha Centre in Luanda. The absence was due to prolonged discussions with the authorities about some modalities of the assistance.

  • Access difficulties due to security, poverty and lack of information continue to exist; radio information campaigns and dissemination campaigns among NGO's and community leaders were initiated. 756 treated patients received partial transport reimbursements while 117 treated patients were transported by ICRC plane.

  • The governmental input in all assisted centre's increased during the year; salaries of national staff were raised and also regularly paid. The ICRC continued to participate in discussions with the 2 existing national co-ordination groups in physical rehabilitation: the Orthopaedic Co-ordination Group, established in 1995 by the MOH and the Victim Assistance subcommission of the National Intersectoral Commission for Demining and Assistance, established in 2001.

  • Prosthetic components and crutch handles were provided free of charge to 6 centre's which are assisted by 4 other organizations (Handicap International Belgium; Veterans International; German Technical Co-operation; Intersos) for the production of 1'500 prostheses. It is planned that in the future all organizations will take care of purchasing the components autonomously. Two crutch fabrication units in Huambo and in Luanda are assisted by the ICRC, using recycled scrap polypropylene of used prostheses, aiming to cover the national needs.

  • A Stock Management program was developed and introduced ( " EasyOrtho " ); criteria for service provision which are based on incapacity's as opposed to diagnoses were developed and distributed; incentive policies to national staff were reviewed and redefined as well as job descriptions for expatriate- and national staff.

 
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Azerbaijan: Baku, 1994–2001 
 

 Background  

Azer baijan has 2 main prosthetic/orthotic centre's, both located in Baku, with 2 repair centre's in Ganja and in Nachichevan. Physical rehabilitation services have suffered since the collapse of the former USSR while needs have increased owing to the conflict in Nagorny Karabakh. The main problem is caused by shortages of manpower and of raw materials. Since 1994, the ICRC has been providing assistance to the Darnagul Prosthetic Orthotic Centre in Baku which is managed by the Ministry of Labour and Social Protection (MOLASP ) and where patients are assisted free of charge.

    

 Achievements 1994–2000  

    

  • A nation-wide survey of needs was conducted together with the government in 1996, indicating approximately 2000 amputees in need of prostheses.

  • Physical rehabilitation services were provided for patients, who received 2'189 prostheses (amputees) and 358 orthoses (other beneficiaries).

  • The premises were renovated, new equipment was installed and a patient dormitory was set up.

  • Continued training was provided for 17 technical staff

  • Year 2000: 7 staff passed successfully the Certificate of Professional Competence (CPC); governmental recognition and a matching salary scale for new staff was approved; a patient management database, using the Cyrillic script was introduced; accessibility was improved by initiating outreach programmes in the Mingachevir and Lenkoran distric ts.

    

 Achievements 2001     

  • Physical rehabilitation services were provided for patients, who received 292 prostheses and 545 orthoses (16% of the fitted amputees were mine victims).

  • In January 2001, the management of the patient dormitory and of the prosthetic production was taken over by MOLASP staff.

  • In July 2001, the first Azeri Orthopaedic Technologists (Category II, ISPO) graduated. Seven students passed the upgrading exams from CPC to the internationally recognized ISPO category II level in the presence of governmental and ISPO observers. The course could become a model for other programmes, wherever conditions allow.

  • Teaching tools in the form of puppets were developed and produced for all ICRC projects.

  • A medical conference was organized on scoliosis with visiting specialists from the Rehabilitation Centre from Lyon, France.

  • In December 2001, the machines, equipment and stock was handed over to MOLASP and discussions were held about decentralizing the services by partly transferring the Darnagul centre from Baku to Ganja.

 
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Cambodia: Phnom Penh, Battambang, 1991-2001 
 

    

 Background     

Cambodia has a very high number of mine victims. In 1991, the ICRC signed an agreement with the Ministry of Social Affairs, Labour, Vocational Training and Youth Rehabilitation (MOSALVY) to assist the disabled population through a prosthetic/orthotic centre in Battambang and a national prosthetic/orthotic component production centre in Phnom Penh. Since, these two programmes contribute significantly to the overall national effort in the area of physical rehabilitation in terms of number of assisted patients and in contributing to a national treatment uniformity. In 2001, the Cambodian government undertook a quantitative/qualitative analysis of practically all orthopaedic services in the country, which showed impressive improvements in terms of available qualified manpower (36 graduated Cat II prosthetists and 24 graduated physiotherapists), production capacity (16 centre's), available orthotic services (10 centre's), active outreach programmes (8 centre's) and qualitative/quantitative service provision in the country. In 2001, the Battambang Centre became the first centre whose statutes were officially recognized by the Cambodian government and it was promoted to Regional Fitting Centre.

    

 Achievements 1991-2000  

Phnom Penh:

  • Prosthetic/orthotic components were manufactured for national use and delivered free of charge to centre's assisted by all organizations (Veterans Int ernational, Handicap International, the American Red Cross, the Cambodia Trust and the Cambodia School of Prosthetics/Orthotics, ICRC) to enable an average national production of some 5'000 prostheses, 2'000 orthoses and 8'000 walking aids.

  • Renovation work was carried out on the premises, equipment was installed and a local production line developed.

  • Continued training was provided for 28 technical staff.

  • Y2000: introduction of delivery of components in prosthetic TT and TF kits; export of components to projects in 5 other countries; achievement of a high degree of technical and managerial autonomy;

Battambang:

  • Physical rehabilitation services were provided for patients, who received 12'377 prostheses and 748 orthoses.

  • Construction work was carried out, new equipment was installed and a patient dormitory set up.

  • Continued training was provided for 26 technical staff.

  • Y2000: access to Along Veng with 316 additional amputees fitted; 25% decline in number of reported mine casualties compared to the previous year; 21 repair field trips with 730 repaired prostheses; preparation of centre's statutes for national recognition; return of all 6 graduated students from CSPO.

    

 Achievements 2001  

Phnom Penh:

  • Free delivery of prosthetic/orthotic components to 16 national fitting centre's for a total production of 4'500 pro stheses, 2'000 knee-ankle-foot orthoses and 8'500 walking aids. The manufacturing process was improved leading to shorter delivery times and reduced costs.

  • Collaboration with national authorities and other organizations through participation in the Physical Rehabilitation Committee (national standards), the Prosthetic/Orthotic Technical Subcommittee, the Centre's Comparative Study Work group and in the CSPO Board of Studies. The very first Prosthetic & Orthotic Congress was organized and a National Association of Prosthetists/Orthotists was established.

  • In July, the national factory manager attend the ISPO World Congress in Glasgow, sponsored by the ICRC..

Battambang:

  • Physical rehabilitation services were provided for patients, who received 1'080 prostheses and 617 orthoses (over 90% of the fitted amputees were mine victims). This included the fitting of 17 amputees for the Mine Advisory Group with special working prostheses. The Centre is a leading national production centre, fitting approximately a quarter of the yearly total fitted amputees in the country.

  • In July, a national technician attended the ISPO World Congress in Glasgow, sponsored by the ICRC.

During the year, 18 repair field trips were organized, enabling the repair of 1002 prostheses and improvements in the identification -and referral process of patients to Battambang.

In November, the first National Continuing Education Course was hosted in Battambang, organized together with the CSPO. It focussed on the fabrication of interchangeable trans-radial prosthetic sockets and different methods to define the knee axis for KAFO's.

 
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Democratic Republic of the Congo: Kinshasa, 1998–2001  
 

    

 Background  

The complex political emergency in the Democratic Republic of the Congo has had a devastating effect on public services. The three existing physical rehabilitation centre's in Kinshasa are thus facing enormous difficulties. Presently, the National Red Cross Society's centre in Kinshasa is the only centre in the capital to provide prosthetic services in significant numbers, following some building modifications, material assistance and training of national staff. Efforts are focussing on improving the accessability of the centre, especially for the war disabled, and on improving the quality of the patient services. In 1999, 500 amputees were registered at the centre.

    

 Achievements 1998–2000     

  • Physical rehabilitation services were provided for patients, who received 563 prostheses and 22 orthoses.

  • The premises were renovated and new equipment was installed.

  • Continued training was provid ed for technical staff.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 236 prostheses and 22 orthoses.

  • In order to identify the most sustainable long term solution, the organization of the patient services, the employment status of the national employees and the quality of the provided appliances were thorough discussed between the partners.

 
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Ethiopia: Addis Ababa, Mekele, Harar, Desse, 1979–1995 and 2000-2001  
 

    

 Background  

Since 1979, the ICRC has helped set up and provided assistance for prosthetic/orthotic centres in Debre Zeit, Addis Ababa, Harar and Mekele. The assistance programme ended in 1995 with the stabilization of the social and political situation, although monitoring of the centres continued. The centres also still received some assistance from the ICRC’s Special Fund for the Disabled, which maintained its presence in Addis Ababa with a regional prosthetic/orthotic training centre, including material assistance and technical follow-up visits to assiste d centre's. Following the outbreak of war in 1998 between Ethiopia and Eritrea, facilities were overwhelmed by patients requiring health services, including physical rehabilitation. As a result, the ICRC resumed its assistance programme for the prosthetic/orthotic centres. By employing a Patient Services Support System, the ICRC partially subsidizes running costs while the centres retain managerial and operational control. The costs for services provided to patients, such as the provision of orthopaedic appliances, physiotherapy, transportation, accommodation and food, are partly reimbursed by the ICRC, which monitors the quality of those services.

    

 Achievements 1979-1995; 2000  

  • Physical rehabilitation services were provided for patients, who received 8'618 prostheses (amputees) and 3'856 orthoses (other beneficiaries).

  • Two training courses were provided and 28 technicians graduated , recognized by the national authorities.

  • The premises were renovated and new equipment was installed.

  • Continued training was provided for technical staff

  • Y2000: signing of 4 agreements with authorities to assist prosthetic/orthotic centre's in Mekelle (Feb.), Addis Ababa (May), Bahr Dar (May) and Harar (Dec. ); scaling down of local component production and introduction of CRE-components.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 1'902 prosthe ses and 1'498 orthoses (38% of the fitted amputees were mine victims). This represented a 50% increase in assisted patients compared to the previous year. A total of 40 technical visits to the 4 centre's were realized, to provide on the job training and to monitor the quality of the patient services.

  • 2 national technicians were sponsored to start a 3-years course in prosthetics/orthotics TATCOT, Tanzania..

 
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Georgia: Tbilisi, Gagra, 1995-2001  
 

    

 Background  

Owing to a lack of financial investment, the absence of in-depth reforms and proper training for medical staff, the health-care system has been rapidly disintegrating. In co-operation with the local authorities, the ICRC has provided assistance for the disabled through two prosthetic/orthotic centres in Tbilisi and Gagra, Abkhazia, since 1995. These are the only centres available to treat those in need of physical rehabilitation. Given the financial difficulties faced by the partner and the patients, their running costs are largely subsidized by the ICRC.

Two main activities are carried out at the centres: treatment for the physically disabled (amputees and others) and a training programme lasting several years for technical staff.

    

 Achievements 1995-2000  

  • Physical rehabilitation services were provided for patients, who received 3'197 prostheses (amputees) and 1'147 orthoses (other beneficiaries).

  • The premises were renovated, new equipment was installed and a patient dormitory was set up.

  • Continued training was provided for 25 technical staff.

  • Y2000: an outreach program was started in Gali. Eight Tbilissi and 6 Gagra technicians obtained the Certificate of Professional Competence (CPC) after a 2 years formal training. Two visits by external consultants, mainly for training purpose. The Tbilissi National Director attended a 4 weeks physical rehabilitation course in The Netherlands. Submission of a 5 years retroactive activity report to the governmental authorities for discussion about the future. Hand over of technical and management responsibilities to the local partner in Gagra.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 463 prostheses and 612 orthoses (21% of the fitted amputees were mine victims).

  • In Tbilissi, 5 technicians passed the international recognized ISPO Cat II level after a 3 years formal training in prosthetics/orthotics. The co urse and the final exams were assessed by 2 ISPO consultants. The graduates are recognized by the Georgian authorities.

  • The Gagra centre continued to function satisfactorily, with complete te chnical and managerial autonomy, assisted by monthly visits from an ICRC-specialist. Discussions with the authorities about the functioning and future status of the Tbilissi prosthetic/orthotic centre continued.

 
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Iraq: Baghdad (MOH), Baghdad (MOD), Basra, Najef, Mosul, Arbil, 1993-2001 
 

    

 Background     

Unlike the majority of ICRC-assisted countries, in the past Iraq was a wealthy nation with a well-funded health-care system that included prosthetic/orthotic services. A decade of sanctions has had severe consequences for the public services, including those for the physically disabled. The ICRC’s programme in the country, begun in 1993, aims to provide the technology necessary to continue providing prosthetic care. It supports six prosthetic/orthotic centres (two in Baghdad and one each in Basra, Najef, Mosul and Arbil) and the Baghdad Prosthetic/Orthotic School. These projects involve agreements with five different partners. The ICRC also supervises a local component production facility.

    

 Achievements 1993-1999  

  • Physical rehabilitation services were provided for patients, who received 13'402 prostheses (amputees) and 7'857 orthoses (other beneficiaries).

  • The premises were renovated and new equipment was installed.

  • Continued training was provided for 150 technical staff

    

 Achievements 2000  

  • Physical rehabilitation services were provided for patients, who received 2,303 prostheses and 814 orthoses (51% of the fitted amputees were mine victims). In 2000 the government managed to import some prosthetic/orthotic components from Europe under the oil-for-food programme. These are being used in a number of centres in addition to the ICRC’s polypropylene components (criteria for use are being developed). However, time-consuming government import procedures make it difficult to ensure a reliable supply.

  • Physiotherapy facilities and gait-training areas were set up or upgraded in all assisted centres with a view to improving the quality of the clinical services provided. A travelling physiotherapist visited all the centres to provide follow-up training and organizational advice. A physiotherapy handbook, including basic treatment guidelines for projects, was compiled.

  • Four national seminars were conducted jointly with the Ministry of Higher Education. These dealt with physiotherapy for lower-limb prostheses, partial foot prostheses, Symes prostheses and cast-taking and fitting techniques for short stumps. A meeting for the directors of all the prosthetic/orthotic centres was organized to allow for an exchange information and discussion of quality control.

  • Two expatriate positions were taken over by local staff and two local staff were sent abroad to attend a one-week congress on physical rehabilitation.

  • A constructive relationship could be built up with a number of newly appointed contacts at the MOH. The Under-Secretary of Health visited one of the assisted centres in Baghdad and a Steering Group for Prosthetic/Orthotic Services was set up to establish quality guidelines and address other issues.

 
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Myanmar: Yangon (2x), Mandalay, Pyin Oo Lwin, Yenanthar , Hpa An, 1986-1995 and 1999-2001 
 

    

 Background     

There are many mine victims and other amputees in Myanmar. A national survey has not yet been performed; conservative estimates put their number at 6,000. The majority live in border areas and most cannot afford to travel to existing workshops. The ICRC started its physical rehabilitation assistance programme in Myanmar in 1986, together with the Ministry of Health (MOH). The following year it began its co-operation with the Ministry of Defence (MOD). In 1990, a Joint Programme was set up with the Myanmar Red Cross Society (MRCS) to register and provide transportation for patients. In 1995, the ICR C withdrew its full-time staff but kept on monitoring the situation through periodic technical follow-up visits from Cambodia. The fitting of amputees continued through the Joint Programme, but on a smaller scale. Under the programme, the MRCS identifies registers   and refers amputees while the ICRC funds transportation, lodging and food for them during the time needed for fitting. The ICRC resumed its assistance programme with a full-time expatriate prosthetist in June 1999 so as to increase the quality of care and the number of patients being treated. The ICRC remains the only assistance organization directly involved in physical rehabilitation programs with the authorities. Appliances made with ICRC assistance represent 80% of the total national production.

    

 Achievements 1986-1995 and 1999-2000  

  • Physical rehabilitation services were provided for patients, who received 11'418 prostheses and 2,624 orthoses.

  • The premises were renovated, new equipment was installed and a patient dormitory was set up.

  • Continued training was provided for technical staff.

  • Y2000: sponsorship of training for 4 students to CSPO School in Cambodia; 2 trainees followed a 1 month training course in Addis Ababa, Ethiopia; construction of gait-training area; set-up of local elbow crutch production.

    

 Achievements 2001  

  • Physical rehabilitation services and prosthetic/orthotic appliances were provided for 2'139 amputees (72% of whom were mine victims) and 95 other disabled

(orthoses).

  • Closer technical support of the 5 existing centre's was made possible by raising the expatriate personnel from 1 to 4 specialists by the end of the year.

This also enabled to start preparing an additional prosthetic/orthotic centre close to the mine-affected area in Hpa-Ana and to increase the assistance to the Pyin Oo Lwin Centre.

  • Eight prosthetic refreshment courses were organized for 4 centre's.

  • Four additional students were selected and sent to CSPO School in Cambodia, raising the total number of ICRC sponsored students to seven. One student had to stop his studies.

  • A start was made to review the scope and the functioning of the Joint Programme; recommendations are expected next year.

 
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Sri Lanka: Jaffna , 1999-2001 
 

    

 Background  

The long-standing conflict in Sri Lanka has left many people disabled, most of them mine victims. In 1998 the ICRC carried out an assessment of needs and the following year it started up an assistance programme for the Friends in Need Society Centre in Jaffna, the only existing prosthetic/orthotic facility on the peninsula. Delays in the supply of materials due to the security situation hampered the initial stages of the programme. In spite of the necessity of moving the location of the prosthetic centre twice in the past, progress has been made in providing better patient care and in introducing polypropylene technology as an alternative to the tradionally used aluminium technology.

    

 Achievements 1999-2000  

  • Physical rehabilitation services were provided for patients, who received 348 prostheses and 38 orthoses.

  • The premises were renovated and new equipment installed.

  • Continued training was provided for technical staff.

  • Y2000: interruptions of the production and twice a relocation of the centre due to the changing security situation; assignment and training of 2 separate staff working with polypropylene technology.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 257 prostheses and 47 orthoses (51% of the fitted amputees were mine victims). Continuous flow of patients with few disruptions, compared to the previous year. Half of the prostheses are made with the traditional aluminium technology; the other half with polypropylene.

  • Two technicians received a 1 month training in Addis Ababa, Ethiopia. Continued on the job training in polypropylene technology for 2 prosthetic and 2 orthotic technic ians.

  • Limited material assistance was provided to the prosthetic/orthotiuc centre in the Vanni to enable the fitting of patients with prostheses, using the traditional technology.

  • Dissemination of the rehabilitation activities through a press conference, open house and presentations.

 
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Sudan: Khartoum 1990-1996 and 1999-2001 
 

    

 Background  

In 1999, the ICRC resumed its assistance to the governmentprosthetic/orthotic centre in Khartoum which had been supported from 1990 untill 1996. During the interval of two and a half years, the centre received periodic follow-up visits from the Special Fund for the Disabled programme. These visits demonstrated the need for a full-time ICRC involvement in the centre to offset a rapid deterioration in the quality of patient care, prosthetic fitting and orthopaedic components. One of the main reasons for the deterioration was the departure of nearly half of the ICRC-trained technicians, who found more attractive employment in the Gulf states. Apart from that, the building and the layout of the different sections were in need of improvement.

    

 Achievements 1990-1996 and 1999-2000  

  • Physical rehabilitation services were provided for patients, who received 4'925 prostheses and 1'485 orthoses.

  • The premises were renovated and new equipment installed.

  • Continued training was provided for 43 technical staff.

  • Y2000: increase in treated patients with prostheses and orthoses due to completed renovation (April) and introduction of incentive system; start of treating patients from Wau in Khartoum; organization of training courses (2x10 days) for Juba centre; signing of a new 3-years agreement (April).

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 839 prostheses and 603 orthoses. A stricter check-out quality control system was introduced which resulted in important improvements for the patients.

  • Accessibility was improved by transporting 15 patients from Wau and 2 from Malakal to Khartoum for treatment and assessing and preparing 4 locations for future peripheral satellite centre's (.......). Prosthetic manufacturing equipment was provided to the NAD-Juba centre (NAD=Norwegian Association for the Disabled)

  • The Patient Management System was introduced in Khartoum for better follow-up of patients and appliances.

  • Equipment was provided to start local crutch production using recycled polypropylene.

  • On the job training continued for all Khartoum staff in prosthetics, orthotics and physiotherapy; organization of a 6 months intensive training for technicians coming from Nyala; provision of training sessions (3x10 days) in orthotics and prosthetics in the NAD-Juba centre.

  • Good collaboration exists with the national authorities, symbolized by the award of the esteemed Order of the 2 Nile's to an ICRC prosthetist.

 
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Kenya: Lokichokio, 1992-2001 
 

    

 Background     

Amputees and other disabled people from the rebel-held areas in southern Sudan have been undergoing physical rehabilitation since 1992 at the ICRC’s hospital in Lopiding across the Kenyan border in Lokichokio. As it mainly serves patients from across the border, the centre is fully run and managed by the ICRC.

    

 Achievements 1992-2000  

  • Physical rehabilitation services were provided for patients, who received 2'455 prostheses for (amputees) and 1'417 orthoses (other beneficiaries). New premises were built and equipment installed.

  • Cont inued training of eight technical staff

  • Y2000: Total production was lower because the Ebol a virus outbreak in North Uganda, resulting in travel restrictions; 2 technicians followed a training in Addis Ababa; 4 technicians from South Sudan received training in prosthetic repairs , plus the required equipment; continuation of weekly 2-hours training sessions for national staff.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 365 prostheses and 174 orthoses (25% of the fitted amputees were mine victims). Though the production was slightly higher compared to last year, the rainy season and the limited number of flight destinations hampered a even greater increase. A new program for poliomyelitis was started for 35 patients originating from the Yirol area. Provision of 23 tricycles, produced by the Physically Disabled of Kenya.

  • An agreement was made between Kangemi Orthopaedic centre and the ICRC to better organize the patient flow from the refugee camp in Kakuma.

  • Local crutches are produced using recycled polypropylene.

  • Two technicians followed a one-month prosthetic training course in Addis Ababa. On the job training focussed mainly on orthotics. Four technicians from South Sudan received a training in prosthetic repairs plus the required equipment. Two students from the Kenyata Medical Training College followed a 4-months practical training, following which one remained as permanent employee.

  • The Patient Management System was introduced for better follow-up of patients and appliances.

 
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Tajikistan: Dushanbe, 1997-2001 
 

    

 Background  

Following the breaking apart of the USSR, the existing prosthetic workshops in Dushanbe and Khojent were deprived of the materials and financial means they required to go on functioning. Initial surveys conducted by the ICRC in 1997 revealed substantial unmet needs (concerning an estimated 3,000 amputees, including 500 war-wounded). A tripartite agreement was signed in March 1998 between the Ministry of Social Protection (MSP), the Red Crescent Society of Tajikistan (RCST) and the ICRC to assist the main prosthetic orthotic centre in Dushanbe. There are also 3 centre's in the provinces (Kuliab, Khorog, Khojent) with very limited capacity. As with similar projects, the long-term aims are twofold: to provide correct fitting of prostheses for all amputees so as to facilitate their reintegration into normal life and to ensure the future autonomy of the centre under the management of the local authorities. The project was delegated to the Canadian Red Cross.

    

 Achievements 1997-1999  

  • Physical rehabilitation services were provided for patients, who received 597 prostheses.

  • Training workshops focusing on dissemination and the registration of amputees were organized together with the RCST.

  • The premises were renovated, new equipment was installed and a patient dormitory was set up.

  • Continued training was provided for technical staff.

  • Y2000: 6 orthopaedic seminars with the RCST and the MSP were organized; in total 728 amputees were registered; physiotherapy facilities were developed and a training course given; technicians from 3 peripheral centre's were trained in repairing polypropylene prostheses.

    

 Achievements 2001     

  • Physical rehabilitation services were provided for patients, who received 444 prostheses (12% were mine victims). A total of 1261 amputees, including 249 war victims, are now registered in the newly installed Patient Management System (PMS).

  • Four regional orthopaedic seminars were organized with the RCST and the MSP.

  • Two technicians from the centre's in Kuliab and Khojent completed a 1 year training in repairs of polypropylene prostheses.

 
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Uganda: Fort Portal, Gulu, Mbarara, 1988-1990 and 1998-2001  
 

 Background  

Between 1988 and 1990, the Mulago centre in Kampala was supported by the ICRC. In consultation with the Ministry of Health (MOH), and following a survey at the end of 1997, the ICRC resumed its assistance programme in Uganda in the smaller MOH prosthetic/orthotic centre in Fort Portal in January 1998. An agreement was signed with the Ministry of Health in July 1998 to provide assistance for the disabled population of the western region, using appropriate technology. The first production started in August 1998. During 1999 and 2000, ICRC support was extended to other MOH prosthetic/orthotic centres in Gulu and Mbarara, providing training to national staff and required materials and equipment. By the end of 2001 the assistance programme was concluded, leaving sufficient raw materials in place to continue the fitting of patients for at least another year.

    

 Achievements 1988-1990 and 1998-2000     

  • Physical rehabilitation services were provided for patients, who received 564 prostheses and 642 orthoses.

  • The premises were renovated and new equipment installed. Patient dormitories were established.

  • Continued training was provided for 15 technical staff

  • Y2000: reduction of assisted patients due to Ebola virus; MOH organized a national orthopaedic seminar; initiation of polypropylene prosthetic production in Mbarare in March following training of Mbar are technicians in Fort Portall and on the spot.

    

 Achievements 2001  

  • Physical rehabilitation services were provided for patients, who received 235 prostheses and 163 orthoses (31% of the fitted amputees were mine victims).

  • Abolishment of the prevailing national " cost-sharing " policy in hospitals, complicating the already frail health services. No confirmation of the engagement sta tus of a number of national employees in the assisted centre's. Conclusion of the assistance programme at the end of the year.

 
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Annexes 
 

    

    

 
 

 Annexe 1  

    

 

  ICRC Physical Rehabilitation Programmes
  Geographical distribution, 2001 
 

    

    

    

    

   

    

    

    

    

 
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 Annexe 2  

 

  ICRC prosthetic/orthotic programmes
  Statistics for 2001 
 

 

 COUNTRIES  

 NEWLY REGISTERED AMPUTEES FITTED WITH PROSTHESES  

 NUMBER OF PROSTHESES MANUFACTURED  

 NUMBER OF PROSTHESES MANUFACTURED FOR MINE VICTIMS  

 NEWLY REGISTERED PATIENTS FITTED WITH ORTHOSES  

 NUMBER OF ORTHOSES MANUFACTURED  

 PAIRS OF CRUTCHES MANUFACTURED  

 WHEELCHAIRS  

 MANUFACTURED  

1

 AFGHANISTAN: Herat, Jalalabad, Kabul, Mazar-i-Sharif, Gulbar,faizabad  

1'176

3'985

3'029

3'536

6'305

5'713

731

2

 ANGOLA: Huambo, Kuito, Luanda  

1'067

1'953

1'578

20

28

3'454

106

3

 AZERBAIDJAN: Baku  

130

292

47

269

545

112

3

4

 CAMBODIA: Battambang, Phnom Penh  

330

1'080

1'024

327

617

2'073

166

5

 ETHIOPIA: Addis Ababa, Mekele, Dessie,harar  

698

1'902

726

1'061

1'498

2'505

54

6

 GEORGIA: Tbilissi. Gagra  

208

473

97

213

612

344

28

7

 IRAQ: Baghdad (4), Basra Najaf, Mosul, Erbil,  

964

2'301

1'168

488

814

518

5

8

 KENYA : Lokichokio  

128

365

91

112

174

718

23

9

 MYANMAR:Yangon (3) ,Mandalay, Pyinoolwin  

1'595

2'139

1'539

63

95

88

0

10

 R.D. CONGO: Kinshasa  

125

236

67

13

22

463

0

11

 SRI LANKA: Jaffna  

84

257

130

18

47

46

36

12

 SUDAN: Khartoum  

331

839

158

465

603

308

0

13

 TADJIKISTAN: Dushanbe  

360

444

53

0

0

288

11

14

 UGANDA: Fort Portal, Gulu, Mbara  

222

235

72

137

163

7

0

 

 TOTAL  

 7'418  

 16'501  

 9'779  

 6'722  

 11'523  

 16'637  

 1'163  

    

 Components delivered to non-ICRC projects  

 

 Feet  

 Knee joints  

 Alignment systems  

 Orthotic sidebars  

Afghanistan

0

170

280

0

Angola

0

379

1'086

0

Cambodia

0

1'062

3'837

1'471

Ethiopia

1'003

401

4'842

284

 Total  

 1'003  

 2'012  

 10'045  

 1'755  

    

    

 
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 Annexe 3  

    

 

ICRC-assisted Prosthetic Orthotic Centre's
  Staff 2001  
 

    

    

 

 Expatriate staff  

 National staff  

 

Programme

Prosthetist

Physiotherapist

 Total  

ISPO Cat I Prosthetists

ISPO Cat II Prosthetists

Technicians (with patient contact)

Benchworkers and other technical

Physio th erapy

Non-technical

 Total  

1

Afghanistan

2

3

 5  

 

 

34

22

44

179

 279  

2

Angola

4

0.5

 4.5  

 

 

25

41

15

74

 155  

3

Azerbaijan*

3

 

 3  

 

6

1

8

1

13

 29  

4

Cambodia*

4

 

 4  

 

8

2

38

6

20

 74  

5

DRCongo

 

1

 1  

 

 

5

 

0

5

 10  

6

Georgia*

2

 

 2  

 

5

5

13

1

4

 28  

7

Iraq

5

1

 6  

 

2

79

64

11

58

 214  

8

Kenya

1

 

 1  

 

2

4

1

2

0

 9  

9

Myanmar*

2

 

 2  

 

1

27

42

6

18

 94  

10

Ethiopia*

2

 

 2  

1

2

7

19

6

104

 139  

11

Tadjikistan

2

 

 2  

 

 

7

4

3

4

 18  

12

Sri Lanka

1

 

 1  

 

 

5

 

2

13

 20  

13

Sudan*

2

1

 3  

 

3

15

25

4

80

 127  

14

Uganda

2

 

 2  

1

3

6

5

1.5

2

 18.5  

15

Switzerland* HQ

2

1

 3  

 

 

 

 

 

 

 0  

 

 TOTAL  

34

7.5

 41.5  

2

32

222

196

102.5

574

 1'128.5  

 
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 Annexe 4  

 

Production statistics per country programme 1979 - 2001  
 

    

 

YEAR

COUNTRIES

NEWLY REGISTERED AMPUTEES FITTED WITH PROSTHESES

NUMBER OF PROSTHESES MANUFACTURED

NEWLY REGISTERED PATIENTS FITTED WITH ORTHOSES*

NUMBER OF ORTHOSES MANUFACTURED

PAIRS OF CRUTCHES

WHEELCHAIRS

 

 

 

 

 

 

 

 

 

 

 ONGOING PROJECTS 2001  

 

 

 

 

 

 

1

1987-01

AFGHANISTAN

20'958

39'020

17'397

28'412

78'476

6'702

2

1979-01

ANGOLA

15'880

24'224

122

180

25'322

162

3

1995-01

AZERBAIDJAN

1'453

2'481

496

903

3'309

3

4

1991-01

CAMBODIA

7'163

13'457

1'075

1'739

24'035

166

5

1995-01

GEORGIA

2'080

3'670

791

1'759

1'484

663

6

1979-95/01

ETHIOPIA

6'304

10'520

3'295

5'354

31'261

779

7

1995-01

IRAQ

11'841

15'703

5'748

8'670

2'261

141

8

1992-01

KENYA

1'613

2'820

1'399

1'591

5'745

608

9

1986-95/01

MYANMAR

7'061

13'557

1'622

2'719

12'046

0

10

1998-01

D.R. CONGO

659

799

37

44

639

0

11

1998-01

TADJIKISTAN

909

1'041

0

0

808

17

12

88-90/98-01

UGANDA

786

833

666

805

3'282

507

13

1999-01

SRI LANKA

260

605

49

85

222

119

14

84-96/99-01

SUDAN

5'256

8'191

1'950

2'601

6'905

1

 

 

 

 

 

 

 

 

 

 

 

 TOTAL  

 82'223  

 136'921  

 34'647  

 54'862  

 195'795  

 9'868  

 

 

 

 

 

 

 

 

 

 

 COMPLETED PROJECTS  

 

 

 

 

 

 

1

1889

CHAD

945

1'346

411

744

1'140

0

2

1897

COLOMBIA

1'049

1'081

1'731

1'863

0

0

3

1898

ERYTREA

1'421

1'421

54

54

487

0

4

1887

LEBANON

2'149

3'545

1'169

2'111

0

0

5

1886

MOZAMBIQUE

4'285

8'195

318

409

26'129

304

6

1891

NICARAGUA

1'709

2'901

4'677

8'032

417

0

7

1888

PAKISTAN OWS

5'345

8'065

0

0

0

0

8

1885

PAKISTAN PARA

0

0

3'020

5'132

2'482

3'210

9

1997

RWANDA

124

162

433

639

755

13

10

1888

SYRIA

983

1'341

27

41

0

0

'11

1893

VIETNAM

11'046

12'775

0

0

0

27

12

1895

ZIMBABWE

1'308

1'453

226

367

7'280

0

 

 

TOTAL

30'364

42'285

12'066

19'392

38'690

3'554

 

 

 

 

 

 

 

 

 

 

 TOTAL  

 

 112'587  

 179'206  

 46'713  

 74'254  

 234'485  

 13'422  

 
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 Annexe 5