Rakotonirainy Renaud, Helen N. Locke, Ramaswamy Hariharan, M. Anne Chamberlain, Rory J. O’Connor
Rehabilitation Medicine, Hôpital Joseph Ravoahangy Andrianavalona, Madagascar
DOI: 10.2340/16501977-2323

Rehabilitation for people with spinal cord injury in many low- and middle-income countries is not avail-able or is in the early stages of development. However, rehabilitation is recognized as crucial in order to optimize functional recovery and outcomes for patients with spinal cord injury. With an increasing incidence of spinal cord injury, the unmet need for rehabilitation is huge. This report describes the early development of a specialist rehabilitation service for spinal cord injury in Madagascar, one of the poorest countries in the world. The sustained input to an expanding rehabilitation team has led to reductions in avoidable complications. The input of the rehabilitation team has been welcomed by the neurosurgery department, which has recognized fewer delays in patients undergoing surgical treatments. Cost, lack of resources and trained staff, and poor understanding of disability continue to provide challenges. However, the development of the rehabilitation service using low technology, but with a high level of knowledge and systematic management, is a source of considerable pride. This development in Madagascar can be regarded as a model for spinal cord injury rehabilitation in other low-resource settings.

Injury to the spinal cord can be life-changing and often leads to long-term disability. It is well recognised that specialist rehabilitation services are crucial in helping people who have suffered spinal cord injury to regain as much independence as possible, allowing them to participate in everyday activities, while reducing the risks of complications. However, in many poorer countries these services are not available or are in an early stage of development. As the number of people suffering spinal cord injury continues to increase, there is an even greater need for specialist rehabilitation services. This report aims to describe the development of the first ever specialist rehabilitation service for spinal cord injuries in Madagascar, one of the poorest countries in the world. This service has led to a reduction in the number of complications following the initial injury, meaning patients can undergo surgery earlier. Cost, lack of resources and trained staff, and poor understanding of disability continue to provide challenges. However, the development of this service despite the ongoing challenges is a source of considerable pride. It is hoped that this will be used as a model for spinal cord injury rehabilitation in other similar settings.