Developing rehabiliation care

Birth of the program 

MSF's medical and operational departments and the MSF Foundation made the same observation over a number of years concerning the lack of rehabilitation care in the organization's fields of intervention, apart from trauma care projects, an area in which MSF has historically operated. A consensus emerged on the sometimes tragic consequences of this lack of specific care in our fields. All the parties involved therefore naturally converged around a common desire to develop the provision of rehabilitation care for patients.  

The first step consisted in concretely identifying the rehabilitation needs that were not being met. To do this, it was essential to work with the operational teams in our fields of intervention. That is why the MSF Foundation’s teams specializing in rehabilitation conducted an extensive survey among MSF field workers end 2022. This survey made it possible to map the needs, capacities and wishes of the fields in order to explore the role of rehabilitation in our missions.  

In 2023, analysis of the results of this survey and regular and repeated discussions with the field teams led to the defining of new areas of intervention and needs:  

Among these areas of intervention, three sectors have been prioritized with MSF’s operational and medical departments to start the implementation of this new project:  

1. Women’s health in the areas of: cervical cancer, gynecology/maternity and sexual violence  
2. Pediatrics: care for developmental disorders in cases of malnutrition and neuro-pediatric rehabilitation for children with diagnosed pathologies
3. Burns: burn rehabilitation practices 

Implementation methodology.  

The MSF Foundation has identified experts in each of these specific areas. These experts will help to implement the projects and will intervene to assist in clinical practice and patient monitoring, develop standard procedures and training, select the necessary hardware and take part in potential research projects.  

The three pilot projects in 2023  

The pilot projects set up by the MSF Foundation with the MSF teams, particularly the medical and operational departments, will be able to be taken up at the local level after a period of implementation and transition.  

1.The Haydan Project in Yemen - Pediatrics - Malnutrition 

This project concerns neuromotor development in pediatrics. Lucile Saint-Louis, a specialist in pediatric rehabilitation, was identified and recruited by the MSF Foundation and went to Haydan from September to December 2023.  

In this project, a physiotherapist present in 2022 raised awareness regarding management of neuromotor development in children and then drew up an inventory of problems linked to malnutrition. Lucile’s aim, basing herself in particular on this inventory which is still very valuable today, was to start the implementation of the pediatric rehabilitation part of the program with the MSF project teams, who had requested this intervention during the preliminary study.  

Lucile Saint-Louis was able to explore and analyze every element during her time in Haydan and engaged in discussions with the teams to find an effective setup for the rapid implementation of these new practices.  

The main child’s motor skills, which develop in the first year of life, constitute an essential basis for the rest of the child’s development. Work on these motor skills is part of a multidisciplinary approach to child care that takes into account the environment and emotions as well as motor ability. Lucile Saint-Louis began training physiotherapists, doctors and nurses in these practices. The introduction of these motor skills sessions for very young children will allow child care to begin at an earlier age. The healthcare teams will thus have the means to work in a multidisciplinary way on the overall health of children in Haydan. Due to the vulnerable environment in which they live (a country at war) and widespread malnutrition, many of these children present developmental delays that could irreparably affect their overall development. 

2. The project in Jahun, Nigeria. Women’s health 

This project concerns management of vesicovaginal fistulas and postpartum care as a whole in the maternity hospital supported by MSF in Jahun, Nigeria.  

Elizabeth Braga, a new women’s health rehabilitation specialist identified and recruited by the MSF Foundation, went to Jahun in September and October 2023. She was able to draw up an assessment of rehabilitation needs in the project and evaluate the potential for implementing new rehabilitation practices, particularly perineal rehabilitation and postpartum and fistula care for the women concerned.   

The majority of the women who arrive at our MSF project in Jahun face long and difficult deliveries, with these complications resulting in the development of obstetric fistulas (perforations that frequently occurs between the bladder and the vagina). In functional terms, fistulas cause involuntary discharge and urinary incontinence. Their treatment often relies solely on surgery.  

However, physiotherapy plays a major part in the treatment of these conditions. Its main role is perioperative. By acting directly on the pelvic floor (which is a group of muscles that needs to be re-educated and rehabilitated), it helps to ensure the best possible conditions for these women and thus plays a big part in improving the results of the operation.  

This project to develop new physiotherapy practices is not limited to the pelvic floor. The teams are now working on all needs and assisting patients whose general condition has deteriorated and been affected by the associated complications. 

Without physiotherapy at this stage of care, the effects on these women’s lives are often dramatic, both in terms of their social environment (stigmatization and abandonment) and in physical terms (complications and severe deterioration of their general condition). In the first half of 2024, Elizabeth Braga is expected to return to Jahun to train the Minister of Health teams in rehabilitation practices. 

3.The project in Atmeh, Syria. Burns  

This project concerns all rehabilitation practices for both acute and chronic burns.  

Elise Tauveron, a physiotherapist specializing in burns, is the expert identified and recruited to explore and implement burn scar rehabilitation practices in the MSF project in Atmeh. She brings to the development of this project all the experience and expertise that she previously contributed to the 3D printed compression mask project deployed in Haiti, Jordan and Gaza (link). 

The MSF project in Atmeh, Syria, has been providing care to burn patients since 2013. With its 22 hospital beds and three outpatient facilities for the whole region, this project’s need for rehabilitation is substantial. Unfortunately, from 2014 to 2022, the international teams were unable to go to the site in person, leaving the teams there isolated and without any real specific training. This was despite the fact that care for burn patients, both in general and in rehabilitation, requires a very high level of technical expertise and specific and unique training. In 2023, the on-site rehabilitation team was strengthened, the number of physiotherapists being increased from 3 to 8. It is in the training of these teams in this very specific type of care that the MSF Foundation intervenes. Elise Tauveron, accompanied by Sajdy Molla, Regional Focal Point for the 3D program, visited the project first of all to assess the training needs. Based on this assessment, they were able during a second visit to conduct a first week of training sessions, focusing in particular on the basics of care for burn patients in rehabilitation. This initial training will be followed by support and additional distance learning. Future visits are planned to improve the team’s knowledge and practice. These visits will also make it possible to evaluate the potential for setting up an additional project for compression masks for burn victims, as the teams were able to do in Haiti