Physiotherapy without borders

Joël Tabury
06 June 2019
Since 1991, the Belgian Association for the Promotion of Education and Training Abroad (APEFE) has backed the implementation of three physical medicine and rehabilitation (PM&R) development programmes in Benin (1991), Burundi (2008) and Burkina-Faso (2014). Three programmes supported by Belgian Development Cooperation.

Professor Jacques De Nayer, former Head of the PM&R Department at the St Luc university hospitals of UCL laid the foundation for the programme in 1987: “The faculty of medicine at Cotonou asked UCL to help it develop activities in the field of rehabilitation medicine, the poor relation of healthcare in Africa. This was how I was appointed to monitor and foster this programme. For nearly 25 years, I have visited Benin and Burkina Faso twice a year to follow the progress this programme which has grown year on year, well beyond what we envisaged at the start. I was able to use the patient work by Olivier Jadin, a physiotherapist from UCL, who was and still is in the field, as a basis for the construction of all these activities. I have therefore witnessed the creation of the very first generation of Beninese and African doctors and physiotherapists, whose training I have followed.”

PM&R requirements are essential for many people in Africa. The range of health issues to be cared for is quite broad. This could mean rehabilitation after a road traffic accident, a sporting injury or even as a result of armed conflicts. Chronic respiratory diseases and acute pains must also be treated, along with the after-effects of strokes related to high blood pressure, a real 21st-century plague in Africa. And even various rheumatic diseases and urinary incontinence which, like other ailments, are pathologies that need to be treated using medical skills which are sorely lacking.

Continuing education session for Burundi's physiotherapists

Physiotherapy, the poor relation of healthcare in Africa

Most of the time, the capacities of the African countries in this field have proved to be very poor. Few care facilities, few trained professionals and few or no training centres. Such is the observation.

More traditional practices resulting from ancient knowledge exist, which are passed on between healers. In many situations that relate more to internal medicine or care of injuries (fever, pain, infections, digestion, wounds, etc.) the benefits of these techniques are not to be underestimated. However, in most cases of physical disability or incapacity (the after-effects of a stroke, cerebral palsy, after-effects of injuries, urinary incontinence, bad back, etc.) traditional medicine is relatively powerless and the physiotherapy techniques of modern medicine prove to be essential, as highlighted by Dr Germain Houngbedji, teacher at the Graduate School for Physiotherapy in Cotonou: “In some areas of Africa, there is a tradition of healers known for healing fractures, sprains and injuries in general. This is the case in my native region of Savè in the south-central area of Benin. However, I must state that despite all their skill, for most people with physical disabilities and incapacities, the response of traditional medicine is limited, because it looks much more at caring for injuries and diseases than rehabilitating their after-effects, which is our job.”

Rehabilitation of the back by a Beninese physiotherapist trained in Benin

Nearly 300 trained physiotherapist

Supported by Belgian Development Cooperation, APEFE, UCL and WBI therefore spearhead programmes in these three countries (Benin, Burundi and Burkina Faso) that are structured around a broadly identical strategy.

The first step is to form a quality human resources hub, comprised of physiotherapists, doctors specialising in PM&R and prosthetists and orthotists. This enables the creation of a “national PM&R reference centre” in one of the country’s teaching hospitals, facilitated by this initial hub of well-trained human resources. Once operational, this centre is used to train other professionals through a university school of physiotherapy. The reference centre then becomes a central training location for the school.

A hemiplegic patient in rehabilitation in the reference center of Bujumbura

The practitioners trained in such a centre can then gradually establish a network of physiotherapy and PM&R services in hospitals and healthcare centres throughout the country. The entire process is obviously supervised by the ministries of health of the countries in question. In every country where the programme is developed, the administrative services are specifically responsible for planning and supporting the development of PM&R in their own country.

Today, there are already 300 trained physiotherapists thanks to this programme and nearly one hundred are currently in training. This means in particular that the number of people treated by such PM&R specialists can be estimated at over 80,000 people per year, which is approximately 60,000 in Benin, 15,000 in Burundi and 5,000 in Burkina Faso.

Improved access to care for the poorest populations

Obviously, access to such healthcare is not yet possible for everyone in countries that do not have a healthcare reimbursement system similar to ours. However, improvements are being seen, as explained by Dr Lamine Mariko, a doctor who specialises in health mutuals for the Burkina Faso-based NGO, ASMADE: “In Burkina Faso, as elsewhere in Africa, people are unfamiliar with rehabilitation care, and where it does exist, it is often costly because it benefits from very few subsidy schemes. However, such treatments are increasingly in demand from African governments and populations who are learning about their usefulness. In order to start addressing this, with APEFE and “Solidarité Socialiste”, we have started an experiment to reimburse PM&R treatments (physiotherapist and PM&R medical consultation) by the health mutuals in the municipality of Ouagadougou. This is a first in Sub-Saharan Africa. If the experiment is conclusive, it could gradually be extended to more mutuals in a growing portion of the country.”

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