One Step at a Time: Providing Hope Through Rehabilitation

In a disaster or emergency, saving a life is only the first step in a survivor’s journey to recovery. Lifechanging injuries such as severe burns or loss of limbs, or acute or chronic illnesses can alter a person’s day-to-day living, leaving them unable to do many activities they once enjoyed.

Rehabilitation is an important component of universal health coverage and is defined by the World Health Organization (WHO) as a process which “helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family.”

At its core, rehabilitation focuses on the person and their individual needs. Through person-centred interventions including provision of assistive products, functional retraining, and prosthetics, rehabilitation works alongside a person and their family to maximize their opportunities to lead a fulfilling life after sustaining major injuries or when coping with the impact of other health conditions. From learning to write again to being able to hold their loved ones, rehabilitation prioritises activities that bring happiness and comfort for the individual, as well as their families and communities.

WHO estimates there are 2.4 billion people around the world who are living with a health condition that would benefit from rehabilitation. In many cases, this need goes unmet, particularly in countries and contexts where resources and existing health infrastructure are strained. In low- and middle-income countries, for example, more than half of people who require rehabilitation do not receive it.

Photo: WHO/Nare Shahinyan

Rehabilitation in Emergencies

In the aftermath of a disaster or during conflict, there is invariably a surge in the number of people in need of rehabilitation.

Enter UK-Med’s Rehabilitation Team – a highly specialised component of the wider Health Department. Among them is Dr. April Gamble, UK-Med’s Senior Health Advisor for Rehabilitation. April recently deployed to Armenia, where they provided rehabilitation support in the aftermath of an explosion at a fuel depot on 25 September which killed over 200 people and left nearly 200 more with severe burns.

“Rehabilitation is an essential component in the care for burn survivors and should start immediately,” they said. “One primary aim of early burn rehabilitation is to work alongside the person and their family to maintain a person’s ability to use and move the affected areas of their body.”

“Rehabilitation aims to promote burn healing, prevent health complications, and ultimately maximize the person’s ability to participate in the activities that bring meaning and joy to their lives.”
Dr. April Gamble provided rehabilitation care for survivors of the fuel depot explosion in Karabakh region. Photo: WHO/Nare Shahinyan.

April was part of a multidisciplinary team providing care for people at Mikaelyan Hospital in Yerevan, where many survivors of the explosion were admitted. Joining April was one surgeon, two nurses, an anaesthesiologist, and the UK-Med Team Lead.

Armenia has a National Burns Hospital with significant skills and experience in providing high-quality care to burn survivors. However, immediately after the explosion, this facility and the healthcare system quickly became overwhelmed with the demand for specialist care, leading the Armenian government to request urgent Emergency Medical Team (EMT) assistance from the World Health Organization.

In turn, WHO called on the global pool of verified Emergency Medical Teams (EMT) to mobilise their staff. According to WHO’s rigorous standards for EMTs, rehabilitation is considered a desirable component. UK-Med is leading the way for promoting the role of rehabilitation in EMTs by making rehabilitation a required element of all their Type 1 (outpatient emergency care) EMTs and by delivering the only WHO-verified Rehabilitation Specialized Care Team as part of the UK EMT.

UK-Med specialists comprised the UK Emergency Medical Team (EMT) which deployed to Armenia. Photo: WHO/Spartak Avetisyan.

UK-Med showed their commitment to rehabilitation, by responding to the call from WHO as the UK EMT, with a surgical and rehabilitation team arriving in Armenia in early October to support the treatment of burn survivors.

“This small surgical and rehab team arrived in Yerevan, and coordinated closely with the Armenian Ministry of Health, other EMTs, and local and partners to provide surgical and rehabilitation treatment for the survivors of the blast,” explained Lizzi Marmont, Team Lead for UK-Med’s response.

Meaningful Gains

Central to this response was ensuring that burns survivors could regain their mobility and independence, particularly as many of them had suffered severe burns to both of their hands. Matilda Willow, a Specialist Burns Nurse with the UK-EMT and who worked alongside Armenian healthcare staff at Mikaelyan Medical Centre, said:

Looking towards recovery, the way that hands heal affects how people live – whether they can handle cutlery or learn to write again. One young man told us his first priority was to get back on his phone as soon as possible! Bandaging each finger separately enables people to start rehabilitation and regain their independence sooner. We passed these skills on to the local team so that they could continue after we left”. 

Matilda Willow is a Specialist Burns Nurse. Prior to deploying to Armenia, she had previously worked with UK-Med in Ukraine.

These small but meaningful milestones in a person’s recovery can have a huge impact on their emotional wellbeing, as the UK EMT witnessed in Armenia.

“One of the joys of offering early rehabilitation with burn survivors is seeing the immediate and meaningful gains that people make.” – Dr April Gamble, Senior Health Advisor for Rehabilitation

“For example, one young man in the intensive care unit with severe burns and a leg fracture, initially had very limited active movement of his arms and legs,” said April. “During the rehabilitation sessions, he progressed to being able to sit up without support, use his hands in basic self-care tasks like opening a water bottle, chatting to his friends on his phone, and being able to walk with the support of a walking frame.”

With the help of Dr. April Gamble, one survivor re-learns how to open a water bottle after sustaining severe burns to both of his hands.

In its holistic approach, rehabilitation goes beyond the confines of the patient-caregiver relationship to facilitate the active involvement of a person’s family.

“Many of the burn survivors and their families learned from the rehabilitation teams, how to position and actively move the areas affected by the burns to prevent them from developing disabling stiffness and contractures. The active movement and positioning necessary to promote recovery and prevent disability is often very painful and difficult,” they said.

“But the people and their families were committed to performing these activities as they understood it would support them to participate fully in life activities – many could see how these activities would help them return to playing football, working in their jobs in offices, farms, and the military, and enjoying walks with their family and friends in the many beautiful parks in Armenia.”

The Next Step

To strengthen the availability of rehabilitation services for the burn survivors beyond the team’s deployment to Armenia, the Armenian Ministry of Health invited the UK-Med specialists to deliver a Training of Trainers course focused on burns rehabilitation. This was delivered jointly with WHO Armenia and Samaritan’s Purse EMT.

The training UK-Med staff provided for Armenian health workers will strengthen their ability to provide much needed rehabilitation services. Photo: WHO/Nare Shahinyan.

“The training provided me with valuable knowledge and new skills for working with burn patients,” said one participant, “I especially liked the training model, where theoretical knowledge was applied in practical exercises, including simulations”.

The three-day course was delivered for over 26 participants from 9 medical and rehabilitation centres across Armenia. It was the first time in an EMT response, that a multi-agency capacity-building activity was delivered within a national health strategy and for healthcare providers from across the country.

Photo: WHO/Nare Shahinyan

“Conducting such course is crucial, as there is significant demand for relevant specialists, and we anticipate having well-informed and compassionate rehabilitation professionals,” said one Armenian clinician.

The training course sought to equip participants with the knowledge and skills to provide burn rehabilitation services and to train local healthcare staff in essential burn rehabilitation. This will help facilitate the next step in each survivor’s journey to recovery, ensuring that healthcare staff will be better prepared to provide rehabilitation services into the future.