REPORT OF THE 6 th CONGRESS OF THE AFRICAN FEDERATION … · REPORT OF THE 6 th CONGRESS OF THE AFRICAN FEDERATION OF OR-THOPAEDIC TECHNICIANS (FATO) « Ensuring access to appropriate

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REPORT OF THE 6th CONGRESS OF THE AFRICAN FEDERATION OF OR-THOPAEDIC TECHNICIANS (FATO) « Ensuring access to appropriate orthopaedic and re -

habilitation services - Right to quality of care»

ARUSHA (TANZANIA) 19 TO 24 SEPTEMBER 2011 NAURA SPRING HOTEL

THE REPORTER:

DR COULIBALY ABDOURAMANE

6th International

Congress Of FATO

ARUSHA TANZANIA

SEPTEMBER, 19–24, 2011

ENAM APDK

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EPORT OF THE 6th CONGRESS OF THE AFRICAN FEDERATION OF ORTHOPAEDIC TECHNICIANS (FATO)

INTRODUCTION

I) OPENNING CEREMONY

II) FIRST DAY

III) SECOND DAY

IV) THIRD DAY

V) FOURTH DAY

VI) FIFTH DAY

VII) OPEN PAPERS

VIII) THE CONGRESS « OFF »

CONCLUSION

INTRODUCTION After the concern about very specific topics such as polio, the sustainability of physical rehabilitation centres, etc., the idea of of finding adequate solutions to the problem of physical rehabilitation in a much more comprehensive way, is is taking shape with the 6th with the 6th Congress of the FATO (African Federation of Orthopaedic Technologists). The commitment of the World Health Organization (WHO) and World Bank in the support of the disabled persons as a factor for poverty reduction (supported by the United Nations Convention for the Rights of Persons with Disabilities (CRPD)) offers the possibility of a synergistic action in solving the problems related to physical rehabilitation. The survey that preceded this congress is an important database for the writing and / or updating of national plans for rehabilitation.

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I) The openning ceremony

On September 19th, 2011, from 9h 48, the Kilimandjaro conference room of the Naura Spring Hotel hosted the 6th congress of FATO on the theme: « Ensuring access to appropriate orthopaedic and rehabilitation services - Right to quality of care ».

Mr Masse NIANG, President of FATO briefly introduced the distinguished guests:

Mrs Marguerite PETRO-KONI-ZEZE, Central African Minister of Social Affair and Soli-darity,

Dr RUFARO Chatora, WHO Resident Representative in Tanzania,

Honourable Members of Parliament of Burkina Faso and Chad,

Mr Harod Shangali, president of the national Organizing Committee (NOC) and Direc-tor of the Tanzania Training Centre for Orthopaedic Technologists (TATCOT),

Professor Claude Lecoultre, President of the Board of the ICRC Special Funds for the Disabled,

Isabelle URSEAU from the new Federation of Handicap International and president of the scientific committee,

Hon. Minister Mme Paurina MUPARIWA, Minister of Labour and social services in Zimbabwe

And her Excellency, Hon. Deputy Minister Dr. Lucy Nkya the Minister of Health and Social Protection in Tanzania who chaired the ceremony.

Then followed the different speeches; Mr SHANGALI, after having welcomed every-one, expressed his joy for the honor that the FATO gave to his country by allowing it to host this congress. It Is a positive sign of the devotion of this structure to support the efforts of rehabilitation in order to reduce dependency and increase the level of services delivered to disabled people, said Shangali.

For Mr Masse NIANG who spoke next, succeeding to bring together 53 countries in-cluding 39 from Africa, 6 from Europe, 6 from Asia and 2 from America around the is-sue of rehabilitation of people with disabilities is something very positive, when 130 countries have already agreed on the United Nations Convention on the Rights of Per-sons with Disabilities. This will allow to think of the basis of the recommendations of WHO and the World Bank. The strategic position of Tanzania and Arusha as a place of resolution of many conflicts in Africa, must be a starting point for a new dynamic on the right to have access to quality rehabilitation for people with disabilities.


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According to Professor Lecoultre, this new factor that is the CRPD will boost the ac-tions of FSH through inclusive development because the structure she has the honor to lead decided to be more opened to physical rehabilitation structures that work with h e r . For Isabelle URSEAU, the sustainability of actions undertaken in the area of rehabilitation and social services may be secured through the Partnership FATO-Handicap International

As for Dr Rufaro, he noted the weakness in the implementation of the CRPD and WHO recommendations, despite the accession of many countries.

Before declaring the congress opened, Honourable Minister of Health and Social Wel-fare of Tanzania expressed her congratulations to the FATO and the CNAO, and en-couraged all professionals coming from various horizons to take this opportunity in or-der to bring good recommendations for a more dynamic rehabilitation sector.

II) Summary of Day 1

Physical and functional rehabilitation in Africa

This first day has shown the level of rehabilitation in each country through the results of the survey led by FATO and the presentations per country. Four major challenges become important further to this analysis:

1) Lack of basic infrastructures as well as their equipment,

2) Lack of rehabilitation professionals,

3) Low level of existing professionals’ training,

4) The cost and the quality of the material used.

To this is opposed the precariousness of the living conditions of people with disabili-ties, target population of rehabilitation, thus limiting their access to basic services. This situation should lead us to bear the thoughts towards new approaches that of a sectoral vision rather than that of services. For, this will have the advantage of creat-ing a synergy of actions for a more positive dynamic in the search for sustainable solu-tions. We must therefore commit ourselves toward a comprehensive development of physical medicine and rehabilitation that takes into account all sectors and all stake-holders through sharing of skills.


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Legislations and policies

WHO estimates that 42% of countries have no rehabilitation policy, 50% have no leg-islation and 40% have no program and in addition, most of these countries come from the African continent. Legislation and policy of the countries do not provide real practical solutions to the is-sue, although many countries have made the effort to acquire them and even if inter-national organizations provide sufficient expertise at this level through recommenda-tions and conventions. Only half of the countries covered by the survey conducted by the FATO has a mini-mum of legal basis for activities for people with disabilities. In addition, international documents from the surveys and recommendations or organizations such as WHO, ILO, ARI) provides sufficient guidelines for use in the countries. But difficulties lie es-pecially in implementation, with a weak political will to accompany them.

The lack of reliable statistical data on the target population prevents a better under-standing of all the contours of the great problems of disability in the countries. Rehabilitation professionals such as physiotherapists, rehabilitation doctors, orthopae-dic technologists, speech therapists, etc. must come together in national, regional and sub-regional, networks, to better share experiences and pool energies in solving their problems.

Club foot: treatment, training and service

The Session 5 allowed participants to share the experience of certain countries on a disease: Clubfoot, which, by early care may prevent progression to situations of dis-ability. Clubfoot, disabling pathology, in full resurgence in Africa has focused the attention of delegates especially in terms of case management that seems to give a good place to Ponseti method, although a comparative study of the assistive device of clubfoot points out the other methods with best results.

Would it not be wiser to carry out a scientific study on the causes of clubfoot in Africa seeing the extent that take this pathology?


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Wheeled mobility devices, service delivery and trai ning The second session focused on the promotion of mobility of persons with disabilities through wheeled assistive technology. Constituting an important factor in improving the quality of life of people with disabilities, the development of rolling technical aids more suitable to the socio-economic and environmental context is more than neces-sary. WHO and many NGOs have experienced actions in this area, but the will and commitment are limited to certain regions of the continent. This promotion will not find its effectiveness in regional and sub-regional gatherings that will make of these relationships a lower risk of obstruction to mobility. The effect of head posture in some children with disabilities has been shown and this can improve significantly the quality of life of these children. In response to this situation, the importance of mobility must remain a priority. The production of wheeled assistive devices must take into account the socio-economic and environmental context of our countries as recommended by WHO guidelines. Many NGOs have developed programs in this area, but these programs do not yet cover all regions of the continent. The grouping of countries into sectors, regions and sub regions can help reduce the risk of obstruction and disparity in mobility by minimizing certain cost of manufacture. The WHO guidelines for manual wheelchair services in low income areas constitute a reference document in the production of Wheeled mobility devices .

III) Summary of Day 2

The needs versus the Capacities When the session shows the need for rehabilitation versus the capacity, we notice that they are enormous and can’t be properly assessed given the lack of reliable statistics on the target population and on their needs, the lack of the professional sector, the ex-cessive poverty of the target population and the lack or weakness of national policies and strategies. According to WHO, over one billion people with disabilities live in the world and 200 million are in need of rehabilitation services. In addition, In addition, the growth rate of aging and chronic health problems do adds to the situation of disability. Governments should not see rehabilitation services as expenditures but as investments because of its impact on the living condition of people with disabilities. States which shall establish the institutional framework play their role poorly despite the support of international institutions and NGOs working in the field. Can the project of the African Commission on Human Rights on the African Charter for the rights of people with disabilities positively impact all the failures?


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IV) Summary of Day 3

Strategy and National policies

Given all the above it is surprising that the national strategic plans exist only in 14 of the 27 who participated in the survey conducted by the FATO. If concerns remain very sectorial, the problem of disability will continue to face difficul-ties. We must thus take into account the achievements to develop the rehabilitation sector as a whole.

So reflections must move into action of advocacy with governments, community groups that offer more opportunity for success through the exchange of experiences so that they commit themselves, with the support of development partners, on reduc-tion of poverty among disabled people. This poverty reduction must be achieved through the development of multisectoral actions in order to solve the problems of the target population.

V) Summary of Day 4

CBR

For WHO, it is a strategy of rehabilitation, equalization of opportunities, poverty reduc-tion and social integration of People with Disabilities.

Seven (7) WHO booklets deal with the various CBR modules including:

1-health

2- education

3-les moyens de subsistance,

4-livelihoods,

5- social

6- additional booklet

7-introduction module


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The objective of WHO and the World Bank is getting a society for all in the expectation of the millennium objectives. In the framework of the e-learning WHO has developed 9 (nine) online training modules that can be accessible to all target groups involved in CBR.

The experience of Tanzania shows a program that integrates the country's health sys-tem, but wh ich does not cover yet the whole count ry. Tanzania, through CCBRT develops CBR in two programs, the first one takes into ac-count health and education, while the second considers the other elements of the ma-trix.

Côte d'Ivoire has presented a project that is currently in search of funding.

VI) Summary of Day 5

Professional development and recognition

The Schools of Lomé (TOGO) and Moshi (Tanzania) are the two biggest names in Af-rica, dividing Africa into two strategic areas.. However many countries are trying to de-velop training at national level with the support of various partners including FATO, for-eign universities, ISPO. The training of specialist doctors as it remains a very frag-mented especially when it concerns rehabilitation specialist; only Cote d’Ivoire is well positioned in this field.

In the training of CBR agents, Benin and Tanzania appear to have made giant steps. ICRC has just initiated another type of training in physiotherapy area, it is assistant physiotherapists.

The e-Learning, method of outline training is taking gradually its place in the develop-ment of human resources. This type of training exists only in Tanzania and focuses only on corsets.

Training is a problem that is acute in many countries. Each country must work according to its needs and national recognition is very important before the in-tervention of international recognition.


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VII) Open papers

Cerebral palsy Presentations on this topic have shown the specificity of the management of cerebral palsy where spasticity and orthopedic deformities constitute major problems, and the sitting installation of the patients in adapted seats is the basis of the fight against defor-mations. Other papers such as the difficulties of early fitting of lower limb agenesis in children, the triad need -demand-response in assistive device, defective stumps, manufacture of tibial socket, standards in rehabilitation the thorny problem of scientific publications pre-sented by Professor MIJIYAWA were the topics of lively discussions. NB: It should be noted that the 6th congress of the FATO has been reinforced with its workshops for target groups with scientific, technical and strategic themes that have led to reports that the operation is today a mission to continue. Similarly, for personal initiatives, meetings with corporations were run by professional managers or fitting centers in Africa and to launch the first milestones of the pooling of forces as recommended by the conclusion of the President of FATO. It is obvious then, that the wealth of this Congress deserves a much deeper reflection on how the means and the conditions for continuation of the mission undertaken in the whole FATO area and with partners.

VIII) Congress « off »

Visit to TATCOT, On Thursday, September 22, 2011 all delegates were able to discover the prestigious Tanzanian Training Centre for Orthopaedic Technologists (TATCOT) which is in Moshi. This visit allowed knowing all the departments of the school (P&O, physiotherapist, wheelchair technician...) And the remarkable cinematic room that allows recording lower limbs movement of a patient. Meeting with Proteor In the evening of the same day, this French company shared with the participants it’s vision of rehabilitation of disabled persons based on multi-disciplinarity and enhance-ment of business in different countries. The theme of the "Statute of the P&O Technolo-gist" was developed by Michel Pierron, President and CEO of PROTEOR and former president of the French Union of Orthopaedic Technologists (UFOP).


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The Exhibition Several companies have their image associated with the exhibition organized during this meeting of rehabilitation professionals They are:

- Proteor

- Mobility india

- Handicap International

- Cr Equipments SA

- ENAM

- Christopher Blind Mission (CBM)

- International Committee of Red Cross(ICRC)

- Tavan Sazan from Iran

- Jos America

- ORFIT

- APDK

- Limb International


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RECOMMANDATIONS

The President of the FATO formulated two main recommendations. The FATO thanked and congratulates the 29 countries that have realized their in-quiries and encourages the remaining countries to start the process so that to work in conformity with the aimed objectives. RECOMMANDATION 1 The FATO encourages all the state members to write their national action plans they have not already not done so or to update existing national plans of rehabilita-tion. RECOMMANDATION 2 The survey A committee to follow-up is established to make sure of the validation of the data sent by 29 countries and make sure of their authorization before any publication Faced with this turn of events, we must inevitably direct energies on the setting up of sustainable solutions through the development of program and consistent policy for the welfare of disabled people. Rendez-vous is thus taken for the next congress in 2013.

Made in Arusha, 24 September 2011 Dr COULIBALY Abdouramane


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REPORT OF THE 6 th CONGRESS OF THE AFRICAN FEDERATION … · REPORT OF THE 6 th CONGRESS OF THE AFRICAN FEDERATION OF OR-THOPAEDIC TECHNICIANS (FATO) « Ensuring access to appropriate