Against all odds: a qualitative study of rehabilitation of persons with spinal cord injury in Afghanistan.

Abstract

Cross-sectional, survey. To describe the challenges in rehabilitating patients with spinal cord injury in the orthopaedic centres of the International Committee of the Red Cross in Afghanistan. Afghanistan (Kabul, Herat, Mazar-i-Sharif, Jalalabad, Gulbahar), April 2012. Semi-structured interviews were conducted with managers and professional staff of ICRC and other concerned organizations/institutions (Ministries, hospitals, non-governmental organizations), and with people with SCI and their families. Quantitative data were extracted from routine statistics. A reported annual incidence of roughly 21 SCI cases per million in Afghanistan could be established for the year 2011. Acts of violence were the most frequent cause, followed by spinal tuberculosis. Despite very elementary prehospital and hospital care, SCI individuals are rehabilitated within the limits set by available technology and socio-economic factors. Support to community reintegration is effective for the ones living within a radius determined by distance and security. Rehabilitation of SCI patients would be ineffective without covering at least part of the services usually provided during the phases of acute hospital care and community reintegration. The question of whether services currently provided by foreign-based or funded organizations can be extended into a potential postconflict period, and by whom, remains open.