Building the proper layers of care with Rehabilitation Sciences

Farrukh_ChishtieIt is indeed sad that the currently estimated 10% of our population which is disabled, faces increasing challenges on a daily basis. They not only lack effective support on the medical front, but they also face numerous barriers to integration as fully functioning members of society.

A tragic day in this regard was October 8, 2005, where an earthquake inflicted an immense amount of disability in Northern Pakistan, with more than 75,000 injured. Working on this issue from day one, I was also quite ignorant of the issues faced by the disabled. Working with foreign experts and representatives of social organizations, I noted that they raised concerns at the lack of proper medical facilities and expertise across the country.  Of course, this not only affects those tragically injured by the earthquake, but also the existing disabled population that survives with little support.  All experts voiced their concern that the disabled face a race against time and the authorities need to shift their focus from mere application of surgical treatments towards comprehensive care strategies through proper rehabilitation sciences.  Thus, a key step towards making them productive members for the society is through a proper introduction and integration of missing rehabilitation sciences such as occupational and vocational therapy.

It was well observed that hospital care for the earthquake victims has been very poor. Hospitals in the past and till today have just not adopted modern methods of medicine, which indeed involves care beyond surgery. The current level of rehabilitation medicine can be gauged from the fact that we have scattered centers for rehabilitation, a tiny population of physiotherapists and a non-existent amount of vocational and occupational therapists. It should be clear that if we do not provide services beyond the hospital institutions, then how can we expect them to function in their homes and broader settings?

As an extreme example, early in the earthquake tragedy, in Rawalpindi hospitals alone, an estimated 500 victims were lying with little or no care for brain damage. Subh-e-Nau (SN), a NGO I am part of, was treating the survivors suffering from brain and spinal cord injuries in various hospitals of the twin cities. We were caring for about 50 such patients with a team of physicians, orthopedic surgeons, neurologists, occupational therapists and physiotherapists. In 2006, we introduced a Community Based Rehabilitation (CBR) program in rural Muzaffarabad. An outreach program here found that these clients need modern medical care including surgery, psychological support for their shocked state of mind, and other therapies such as occupational and vocational therapy to help them resume their lives. This is a long-term task, which may need decades.

Occupational therapy focuses on making people functional and able to carry out activities of daily living, is as essential as the initial medical treatment and surgery. Similarly, vocational therapy, which focuses on facilitating the person with a job they are suited for, is also crucial to prevent them from becoming beggars or a burden on their families.  We are able to meet some of these goals in continuing work with earthquake victims.  However, it is important to note that these challenges apply not only to this population. The entire pre-earthquake disabled population needlessly suffers, to this day, as a staggering number of obstacles and barriers prevent them from living to their full potential and being valued by society.

On a broader level, being disabled in Pakistan typically means being a source of shame, as from the start, parents or family members overprotect or hide them.  Disabled people are therefore blocked from reaching out to possibilities that can improve and maximize their potential. Here, parents need to be educated enough by the media or the school system to gain understanding.  People with disabilities also face negative behavior outside the home, which can be overwhelming. This can be overcome by providing accessibility,  including making better physical facilities like ramps and special lifts,  and using media for  education to increase tolerance for the disabled amongst the general public. In addition, access to information poses a great challenge for the disabled.  The job quota in our constitution is a mere two percent!  By contrast, South Korea has fully developed an anti-discrimination campaign and implemented related laws on a national scale. Following such examples, Pakistan must amend its constitution to address all such barriers.

In summary, a key lesson I can relay is that rehabilitation sciences is not limited to physiotherapy but encompasses multidisciplinary and interdisciplinary approaches designed according to every specific individual need. It is an essential step needed in relieving the plight of the disabled in the country. Alongside, the barriers that they face towards proper functional and social integration must be removed. The government should make more investment in introducing and building such proper layers of care. These services can redress existing gaps, towards improving the quality of life in our disabled population.


Dr. Farrukh Chishtie
Institute of Space Technology



  1. K I says

    I think in Pakistan there needs to be more work in changing the encapsulated mindsets of people that still associate mental illnesses with taboo. Once that is done, things will start to look up at the rehabilitation front

  2. Ali Butt says

    You and your organization have done impressive work. I just feel this area of public health (rehab) needs more attention from the public sector as well.

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