Haiti | Six months after earthquake, rehabilitation needs persist
In its ongoing support of Haiti earthquake survivors, Humanity & Inclusion works to fill the rehabilitation gap in affected communities.
Read moreNepal | Prabin fitted with artificial limb after overcoming fear
Prabin, 5, lives in southeastern Nepal with his parents. He was born without the lower part of his right leg.
“Because of the disability of our child we were worried about his future,” says Sunita, Prabin’s mother.
A community mobilizer from Community Based Rehabilitation-Biratnagar (CBRB), a local partner organization of Humanity & Inclusion, met Prabin and referred the family to seek services at a rehabilitation center.
At first, Prabin was hesitant to be fitted with an artificial limb. Specialists worked with the boy and his parents to better understand how the device would work, and how it would help him. A month later, he was eager to have a new leg.
“This was a wonderful change for our little boy, as he quickly accepted the prosthesis and began playing, running, and even jumping like any other child of his age,” Sunita explains.
Prabin attends school and loves to play with his toys.
Ambika Sharma, a specialist in artificial limbs and orthopedic braces at CBRB, worked with the family.
“Initially, it was challenging to fit Prabin with an artificial limb because he was not accepting,” Sharma says. “But his parents made it possible with their supervision and guidance. It was an amazing experience for us to see him happy with prosthesis.”
As Prabin gets older, he will need to be fitted with new devices.
“Growth is an important aspect of a child's life,” Sharma continues. “As their bodies change, prostheses have to be adapted or changed in the similar manner to accommodate them. Just as they outgrow shirts, pants, and shoes, they will outgrow their prostheses."
These rehabilitation services are supported by USAID.
Sierra Leone | Providing emergency care to severe burn survivors
In Sierra Leone, Humanity & Inclusion is helping survivors of a fuel tank explosion access specialized rehabilitation care.
On Nov. 5, 2021, the explosion of a fuel tanker in Freetown killed more than 100 people and injured another 100. Facing a fuel shortage in the country, people gathered around the wreckage, collecting gasoline that leaked from the truck – then it exploded.
Humanity & Inclusion set up an emergency response to assist people burned in the incident, as well as survivors experiencing psychological trauma. After identifying affected individuals, the organization helped them gain access to mental health and specialized physical therapy. Almost two months after the explosion, survivors share their stories of recovery.
Accessing care
Humanity & Inclusion visited 201 people impacted by the blast: 133 family members of people killed or reported missing, and 68 survivors of the incident.
Among them was Mohamed, who received rehabilitation care for severe burns.
“I got burnt on my left ankle. I didn’t know what to do after being injured and I was afraid that the police would come and take me if I went to the hospital,” he says. “So I went back home and tried to take care of it on my own.”
Mohamed lives 15 miles from the site of the explosion.
“I was home when the Humanity & Inclusion team located me,” he explains. “They advised me to go to the nearest hospital to avoid infection. I received a treatment, including physical therapy, which is helping me. I don’t know what would have happened if I hadn’t gone to the hospital, as I couldn’t walk without a crutch. Now I am getting better day by day.”
To help patients get to their medical appointments, Humanity & Inclusion provides reimbursements for transportation costs.
“I am receiving treatment at Rokupa Government Hospital, about 30 minutes away from where I live in Old Wharf,” explains Mariatu, who was also injured in the incident. “Considering my condition, it’s difficult for me to attend daily care, as I have no income. Humanity & Inclusion supports me with transportation fees. It is so far the best support that I’ve received. I am now getting better every day.”
Humanity & Inclusion also created and distributed 800 leaflets with information about burn care, burn prevention and first aid tips to explain the complications risk and the importance of follow-up care.
Burn care expertise
When caring for burn injuries, physical therapy is essential during acute care in the hospital and long after discharge to avoid secondary complications and long-term functional limitations, which may lead to disabilities. With support from Humanity & Inclusion, 44 survivors received physical therapy.
Humanity & Inclusion deployed a physical therapist specialized in burn care to provide capacity building support for rehabilitation workers at the National Rehabilitation Center. The National Rehabilitation Center also deployed one rehabilitation worker in a community center to ensure continuity of care after the patients are discharged from the hospital. At the emergency hospital, 17 nurses and nine physical therapists were trained in burn care and physical rehabilitation care for patients with burn injuries.
“We are grateful for the burn training we have received,” says Emily, who leads the rehabilitation team. “The training was short but our team acquired vast knowledge, which is going to help us in our practice.”
Afghanistan | Amid uncertainty, teams provide rehabilitation, mental health support
Mohammad Rasool is base coordinator for Humanity & Inclusion in Afghanistan, managing our work in the Kandahar and Nimroz provinces. There, our teams are providing rehabilitation and psychosocial support. In this interview, Mohammad describes the situation on the ground.
Q: What is it like living in Afghanistan at the moment?
People are still struggling with poverty, displacement, drought, the risk from Improvised Explosive Devices (IEDs) and threat from ISIS. Additionally the country is facing a failing health system and the economy is also on the edge of collapse. So people are highly distressed as they don't know what will happen next in this highly unpredictable situation.
Daily, thousands of people are aiming to leave the country due to protection issues or to seek a better life out of the country. Everywhere in Afghanistan, there is food insecurity and there's a huge need for humanitarian assistance.
Q: What is the level of need for rehabilitation services in Afghanistan?
Even though the conflict is now over, I mean the big conflict between the previous government and the IEA, the battlefields and the districts are still highly contaminated with explosive remnants of war and IEDs. So, of course, the need for physical rehabilitation and risk education, and also for psychosocial support, remains high.
Q: Could you describe how Humanity & Inclusion's teams are supporting people in Afghanistan?
We have several approaches to reach people in need of services, especially rehabilitation, psychosocial support or skill development (which is for income-generating activities).
For instance, we provide support in the rehabilitation center where people are referred to us by other stakeholders including humanitarian partners. And we also have mobile teams. We go to the communities where we deliver the services directly to people. We also refer them for follow-up services to other partners and also to the rehabilitation center if they need further support.
Q: What is the level of injuries at the moment in Afghanistan?
In Kandahar, approximately one-fourth of the people we are seeing in our rehabilitation center are survivors of the conflict. Either they have acquired their injury in the recent conflict in the recent months, or they are the victims of the conflict in the previous years, but they didn't have the opportunity to access the center. We also see people who have injuries from road accidents as well as people who acquired a disability during birth.
Q: Are you able to share the story of a patient that particularly affected you?
I will share one of the story out of a thousand because in our center we are seeing 9,000 patients every year.
One of the people who was referred to us in the recent months was Anisa, an 8-year old girl from Zabul Province (pictured above). A mortar bomb hit her house while she was playing at home with her cousins. She was badly injured and she was taken to several hospitals to treat her.
Unfortunately, her left leg had to be amputated and then she was referred to the rehabilitation center in Kandahar, which is managed by Humanity & Inclusion. Our team at the rehabilitation center worked with her for several weeks to help her recover. She was happy that she could play again with her cousins or go to school.
Q: What are the major challenges you face at the moment?
Certainly, there have been some changes as the new government is not well established yet and the public service remain interrupted. So there are a lot of uncertainties and the new government is trying to introduce new guidelines procedures. Female staff who are working for the public sector, apart from the health sector, are still not able to attend work. We had some challenges related to access for our female staff to our community-based activities. We had a lot of interaction and intensive engagement with new authorities. Finally, we succeeded and access for our female staff was granted.
Q: What do you enjoy the most about your job?
I like visiting my team while they are delivering services to the people we support. I take the opportunity to directly hear from my team and their patients, listening to their feedback, suggestions and challenges that they face in the day to day activities.
Q: Do you have any message for our supporters here in the U.S.?
Of course, I have a message: The people of Afghanistan really need the support from the international community now more than ever. So please, please don't forget Afghanistan in this difficult time.
Rehabilitation | Going green with assistive devices
When creating artificial limbs and braces, Humanity & Inclusion uses alternative, innovative solutions to limit negative environmental impacts.
Artificial limbs and braces can be life changing for many people. They open the door to countless opportunities and contribute to the invaluable autonomy and independence of their users. However, making these devices often requires an incredible amount of energy and materials.
“To make an orthopedic device, we need a lot of plastic, metals, water, plaster, carbon, resin, and more,” says Abder Banoune, rehabilitation specialist for Humanity & Inclusion.
“It takes a lot of energy, and a lot of people to make one simple device,” Banoune continues. “Each one is custom-made for the user, and new ones must be made as people grow or their bodies change. For example, many adults change prosthetics every five years, but amputation is for life. So you can imagine how many devices one person would have in their closet after 40 or 60 years. Children need to change even more frequently (every six months or a year) since they grow more. This results in a lot of waste.”
Humanity & Inclusion is committed to making quality rehabilitation care accessible to people all around the world, while remaining conscious of its ecological impact. Low-income countries, where Humanity & Inclusion primarily operates, are disproportionately affected by the negative consequences of waste, climate change and environmental neglect, all of which magnify humanitarian needs. As part of Humanity & Inclusion’s commitment to the communities it serves and to their environments, the organization takes a three-prong approach to limit waste and energy use in creating assistive devices: reuse, reduce, recycle.
Reuse
After seeing old assistive devices going to waste, Humanity & Inclusion’s Rehabilitation Director Isabelle Urseau had the idea to reuse second-hand artificial limbs and braces. Banoune has seen the same thing.
“When I was working in Africa, the centers all had huge piles and containers full of destroyed or rusted devices that could not be re-used,” Banoune explains. “They are just dumped in the backyard where they would stay forever.”
In Lyon, France, Humanity & Inclusion operates a second-hand prosthetics workshop called “La Poudrette.” It’s run by retired prosthetics and orthotics professionals. The workshop receives used devices and dismantles them, conserving all of the re-usable components that can help construct new devices.
“About 50-60% of the device can be re-used,” Banoune explains. “Sometimes, if you need to repair a device, you only need one part. Instead of buying new components or having to make an entirely new prosthetic, we can still use the parts that are good quality from the old ones.”
La Poudrette has grown significantly since its creation and is now dismantling as many as 1,500 prosthetics each year, with plans to double or triple their actions in the near future.
Reduce
In 2016, Humanity & Inclusion became the first NGO to use 3D printing to make braces in low-resource settings. In Uganda, the organization uses the innovative technology in refugee camps to scan individuals in need of orthopedic devices, and send the digital files off to be 3D printed in a separate location, without the recipient needing to travel to a rehabilitation center. By doing so, Humanity & Inclusion can reach more people in isolated areas while using less energy and fewer materials than the traditional method of making these devices.
When making devices the traditional way, a cast of the body is first made out of plaster, which is difficult to recycle. Plastic is then heated to 392 degrees Fahrenheit to be shaped onto the plaster cast, before later adding components such as metal joints, foam, resin laminate and others. The process requires thousands of gallons of fuel, a powerful generator, and a large center to house the equipment.
“3D printing is a unique approach to making orthopedic devices without needing huge equipment, lots of energy, or a lot of materials,” Banoune says. “It’s all virtual, so instead of using plaster, we can just scan the limbs. We don’t need a huge space and the printer only uses a small amount of energy—about three or four times less than the traditional method. In the future, I think we can power them by solar panels, which would not be possible traditionally. It’s ecological, and it is inexpensive.”
Recycle
Though 3D printing is emerging as a possible solution, plaster-based creation is still the norm for most devices. The plaster required to make artificial limbs and braces is often shipped internationally and can only be used once before being thrown in the trash. Gypsum, from which plaster is made, makes up 400,000 tons of waste worldwide. Humanity & Inclusion alone creates 5 to 10 tons of gypsum waste per year through prosthetic creation, and is determined to find a solution.
Humanity & Inclusion has partnered with the National Institute of Applied Sciences, an engineering school in France, to conduct research to solve this problem. A program at the institute is performing experiments and studying efficient ways to re-use and recycle the plaster needed for the prosthetics process.
Another research program is looking at ways to locally source and recycle materials such as plastic bottles or vegetable fibers to create the filament used in 3D printing.
“It’s important to find adapted, local solutions,” explains Magdalena Szynkowska, Humanity & Inclusion’s Innovation Development Officer. “Every context might have different materials available, different vegetable fibers, and variety of types of plastic used in plastic bottles, so there may not be one single answer. It is complicated work, but I am confident that we will find solutions.”
GREEN Initiative: Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.
Haiti | Teams distribute hygiene kits in earthquake's aftermath
Four months after a 7.2-magnitude earthquake struck Haiti, Humanity & Inclusion's emergency response continues with the distribution of hygiene kits to people with disabilities.
Read moreSierra Leone | After explosion in Freetown, survivors need aid
At least 144 people were killed after a fuel tanker exploded in Freetown, the capital of Sierra Leone, on Nov. 5. After assessing needs in the field, Humanity & Inclusion is moving on to the next stage of its response: assisting victims.
Humanity & Inclusion teams were working in Freetown when the explosion occurred and immediately began evaluating needs in the community. The victims include especially at-risk groups such as children, aging people and people with chronic diseases.
Focusing on rehabilitation and psychosocial support, Humanity & Inclusion will work in partnership with other organizations and the Freetown city authorities over the coming days to provide support to:
- 200 injured survivors of the explosion
- Relatives of the 144 people who have died
- 1,172 indirectly affected members of the community
- 50 health professionals
Rehabilitation and psychosocial support
In addition to emergency medical care, victims of the explosion will need long-term rehabilitation and psychosocial support.
Hundreds of people were injured in the explosion, many with severe burns. Burn victims risk developing joint contractures and difficulties with movement, and require special rehabilitation care. Unfortunately, physical therapists in Sierra Leone do not have expertise in caring for serious burn victims. Humanity & Inclusion plans to develop targeted rehabilitation activities so patients can get the care they need.
When people experience a traumatic event on this scale, victims and their families need help to overcome their pain and the impact of the accident.
“We plan to assist victims affected directly and indirectly by the disaster,” says Pauline Ducos, Humanity & Inclusion’s director in Sierra Leone. “Psychosocial support and rehabilitation care are among our main priorities. Humanity & Inclusion will help victims overcome the disaster and build their resilience. Social workers from our partner organization will reach out to each victim and their family, listen to them and refer them to specialized services, if necessary.”
Humanity & Inclusion’s emergency response includes:
- Rehabilitation care for burn victims: physical therapy sessions; patient follow-up; covering transportation costs
- Psychosocial activities: individual and group support; paying wages of psychosocial staff members
- Training health staff
Vietnam | OpenTeleRehab software reduces barriers to rehabilitation
Humanity & Inclusion’s Telerehabilitation Project Manager, Martin Jacobs, answers common questions about a new telerehabilitation software developed by the organization and being launched in Vietnam.
Q: What inspired Humanity & Inclusion to develop OpenTeleRehab?
OpenTeleRehab was inspired by the need to improve access to rehabilitation services in communities and strengthen discharge procedures. Many people have the mindset that there are rehabilitation professionals just around the corner at any given time, and that these services are easy to access. We need to realize that the context is different in different countries. People often need to travel to receive care. It’s costly for them to spend the money to travel, to pay for their consultation, and they miss out on earning income while they’re away from work.
The software aims to avoid multiple trips back and forth, increase our capacity to provide services over a distance, and increase the ability to follow-up with patients. We have seen how useful telerehabilitation can be in situations like the Covid-19 pandemic, where physical services are closed, or in emergency settings where rehabilitation needs surge and hospitals must quickly discharge patients without a way to follow-up afterward. With OpenTeleRehab, access can be improved because it reduces some of the current barriers to rehabilitation services.
Q: How is telerehabilitation software different from simply watching online videos or using internet resources?
It is important to rely on the expertise of rehabilitation professionals, who are trained to design individual treatment plans for optimal functioning. This helps prevent the possibility of further damage, which could be caused by following inappropriate practices or advice we may find online. Following a treatment plan remotely does not mean you are on your own. With OpenTeleRehab, even while you are remote, you are getting individualized care that is designed and adapted for you by a professional. Plus, users receive regular follow-up from their providers. Humanity & Inclusion’s approach is not only to facilitate service delivery, but to provide quality services. Our ‘Do No Harm’ mandate would not be fully respected if we allowed people to self-provide rehabilitation services.
Q: How will people use the software?
In upper-low and middle-income countries, actually a large portion of the population has access to smartphones. For example, I was surprised to see how many people in rural parts of Vietnam actually have smartphones and how common internet connection is. In some countries, this may be less true, but we can rely on hybrid approaches where we have tablets in local health community centers or schools, for example. This means people will not need to have a device at home, and rehabilitation professionals will not have to travel all the way to the community.
OpenTeleRehab is specifically designed to use very little data and allow access to content even when offline, so it is ideal for low-connectivity settings or contexts where internet may come and go. Reports show that internet access is increasing every year, so it will become even more relevant for more regions over time.
Q: What inclusive considerations were taken in designing the software?
OpenTeleRehab is patient-centered and has been designed for a wide range of users. The patient mobile app is really simple to use. Users will land on a homepage and it will immediately tell them what to do. There is also a child-friendly version, made specifically for younger users. We followed web content accessibility guidelines to ensure that the software is accessible to users of differing abilities, and we selected what we believed were the most relevant accessibility features for users. One of these is the ability to read the exercises aloud, for users with low vision.
We have also designed OpenTeleRehab to be culturally appropriate. After monitoring other software in various countries, we found that the illustrations were rarely appropriate or representative of the users. Our illustrations are gender-balanced, mostly age-neutral (with the exception of infants), and wearing loose-fitted, full coverage clothing.