Spinalis in Botswana
Spinalis Botswana Spinal Cord Injury Rehabilitation Project was a three-year partnership between the Ministry of Health (MoH) in Botswana and the Spinalis Foundation in Sweden. The project was partly financed by Sida. The aim of the project was to build capacity for comprehensive spinal cord injury (SCI) rehabilitation within the Botswana public health care services.
Basic public health care is comparatively well developed in Botswana however, knowledge and resources for rehabilitation of persons with SCI are limited. Persons living with SCI in Botswana who are lacking insurance coverage, were unlikely to get proper rehabilitation or relevant technical aids. Persons with insurance coverage (mainly victims of road traffic crashes or private insurances) could get some rehabilitation in South Africa as well as be given basic technical aids. The MoH did acknowledge this situation and in 2009 Spinalis was asked to assist in setting up a SCI rehabilitation centre at the largest public referral hospital, Princess Marina Hospital (PMH) in Gaborone, the capital of Botswana.
The clinical phase of the project started in May 2010 and the unit were then located at the orthopaedic wards at the PMH. A limited number of local staff, one physiotherapist, one occupational therapist, one nurse and a part time medical doctor, was assigned to the project. The Swedish team consisted of one physiotherapist/project coordinator on site full time and one occupational therapist, one physiotherapist, one rehab coach, one nurse, two medical doctors and a project director on site for longer or shorter periods.
The challenges during the first year were tough and multiple. Patients were kept in their beds most of the time with no real understanding or structure of rehabilitation, basic care was insufficient, bedsores frequent and patients were often discharged without relevant technical aids.
Despite the challenges the project made fast progress thanks to the dedicated teams. Through support from the MoH and the PMH the local staff were successively reinforced, and in March of 2011, when the centre got its own premises it became fully staffed. Due to the largest public employee demonstration in the history of Botswana, the remodelling and renovation of the old isolation unit were delayed, but in July of 2011 the SCI rehab centre did open and rehab could be implemented in full scale.
Now when all staff involved in the care and rehabilitation of the patients were specially trained, rehabilitation were on-going 24/7, during morning routines, during meals, and in the evenings. The challenges were still considerable; the quality of care had to be further increased, staff training intensified, guidelines implemented and a sustainable supply chain for equipment, consumables and technical aids to be developed. Most important, the long-term resources for the centre within the Botswana public health care services had to be secured.
During 2013 the Swedish team were slowly phasing out and the project coordinator moved back to Sweden but maintained closed contact with the centre and commuted almost monthly. Running of the centre, duties as ordering technical aids and consumables were fully taken over by the local staff. The centre became an integrated part of the public health care system and the project was ended in January 2014.
Long-term support and follow-up are crucial to maintain quality of care, structure, and development. The Spinalis Foundation has supported the Spinalis Botswana SCI Rehab Centre beyond the three-year project period. After the termination if the project several visits and long-distance consultation has been on-going, last visit was by Katarzyna and Inka in March 2020. There are still challenges for the patients and staff in Botswana, with a lack of leadership, maintaining qualified staff and a high level of knowledge, continuity of delivery of technical aids and to get a rehab coach employed.
However, the majority of the staff are doing a fantastic work and if you sustain a SCI today, you have significantly better odds of receiving rehabilitation, returning to society, and surviving compared with prior to 2010.
The Swedish team in Botswana
Lisa Bergmark, Occupational therapists
Tobias Holmlund, Physiotherapist
Claes Hultling, MD
Göran Lagerström, Project leader
Gunnel Lif, Nurse
Inka Löfvenmark, Physiotherapist, project coordinator in Botswana
Erika Nilsson, Project coordinator in Stockholm
Katarzyna Trok, MD
Pelle Vesterlund, Rehab coach