Rehabilitation services in Haiti were much neglected during all time and services were unknown for more than 90% of the population. On 12 January 2010, Haiti was hit by an earthquake ever experienced in its history, which devastated much of the capital and south, caused more than 300 thousand death and more than 280 thousand injured. It was at this time that the government and people began to notice the lack of rehabilitation services and its importance in the country. Thus there has been a change in mentality turned to advocacy, campaign of non-discrimination of persons with disabilities, accessibility and development of new rehabilitation center. Before the earthquake there were only less than 5 physiotherapists across the country. The purpose of this presentation is to provide information on rehabilitation services before the earthquake and post-earthquake, efforts in the field, perspectives and challenges, the process and methodology of work of physiotherapists in developing countries contributing for a better understanding of global health to interesting candidates for volunteer work aboard and so we will present the effort the Haitian Foundation of Rehabilitation (FONHARE) is doing to enhance rehab services in Haiti to met the need of the most vulnerable individuals.
Prior to the January 2010 earthquake, rehabilitation services in Haiti were scarce . For a population in which one in six households included a person with a disability, most of these services were provided through non-governmental organizations (NGOs) and religious institutions. After the earthquake, the need for rehabilitation became even more evident due to the increased number of Haitians with permanent impairments; an estimated 300,000 Haitians were injured by the earthquake, including between 2000 and 4000 new amputees.
As a result, rehabilitation services were extremely overstretched due to an imbalance “between the needs for rehabilitation and the capacity of the country to supply these services from financial and human resource capacity” p.1617].
Since 2010, there have been significant changes in the rehabilitation sector in Haiti. Some Haitian physical therapists (PTs), who had left the country to receive their professional training, returned. As a result, the number of PTs was estimated to have increased from 12 in 2009 to 30 in 2015 . As part of the international and national response to the earthquake, many rehabilitation projects were established with the goal of providing assistance to persons with newly acquired injuries and individuals with preexisting disabilities. Since that time, the NGO sector has progressively transitioned from a disaster relief model to development-oriented aid activities .
Haitian rehabilitation sector has been the possibility of training rehabilitation providers in Haiti. Due to the absence of university-based rehabilitation education programs in their own country, until very recently Haitians had to travel to the Dominican Republic, Cuba, Brazil, or the USA to complete a bachelor’s or master’s degree in physical or occupational therapy . Similar to initiatives in other low and middle-income countries local and international NGOs implemented programs in Haiti to train rehabilitation technicians (RTs)1 as a means of addressing the lack of rehabilitation providers. Despite diversity in the duration and curricular content of these mid-level programs, graduates were all trained to work under the supervision of a PT, occupational therapist (OT), physician or, in some circumstances, a nurse.
, the first program was held in Port-au-Prince (West department) between 2001 and 2007 and was organized by the Healing Hands for Haiti Foundation in collaboration with Health Volunteers Overseas .The second program was organized jointly by Health Volunteers Overseas and the Albert Schweitzer Hospital at Deschapelles.
Component 1: survey
We conducted a survey with recent graduates in order to access descriptive information about their employment situation and professional practice profiles. We developed a French-language questionnaire based on a review of the literature, the research team’s experiences in rehabilitation capacity building projects, and discussion with instructors in an RT training program in Haiti. Two Haitian and two expatriate rehabilitation professionals involved in the training of RTs in Haiti, as well as one of the coauthors who is a Haitian PT (DC), reviewed the provisional version and proposed revisions to increase comprehensibility and relevance for the Haitian context. The survey was administered in 2014 to RTs who had graduated prior to 2014. In 2015, it was administered to two additional cohorts of graduates from training programs that were completed in the intervening year. In 2014, we used a 49-item version of the questionnaire. After analysis of the data, and in consultation with six Haitian rehabilitation professionals, we made additional refinements in 2015. As well as small edits to increase the clarity of several questions, we removed five questions that were judged to be less relevant, resulting in a 44-item questionnaire.
Survey data collection
Coordinators of the three training programs provided us with the graduates’ contact information. Recruitment was initiated in June 2014 and May 2015 by sending emails to all 96 graduates from training programs run by Handicap International (22 RT graduates in 2014, 29 in 2015), Loma Linda University (16 graduates in 2014, 12 in 2015), and Health Volunteers Overseas (14 graduates between 2009 and 2011). We invited graduates to complete an online questionnaire via Internet links to the web- based open-source software LimeSurvey and we sent a reminder email one week later.
In keeping with the convergent mixed methods design of this project, we present related elements of our qualitative and quantitative analysis in an alternating manner and based on a chronological perspective from motivations for becoming an RT to future career plans. In presenting the qualitative results, selected verbatim quotes from the interviewees are used to illustrate aspects of the analysis. Interview quotes were translated from French into English; back translation was used to verify that the meaning of the quotes was preserved during translation.
The availability of paid employment for RTs was a source of concern for RTs who participated in the interviews. When questionnaire results are compared between 2014 and 2015, it appears that RTs who graduated in 2015 had more difficulty to find employment in the months following their graduation. One possible explanation is that the job market for RTs is becoming increasingly saturated, even though the need for rehabilitation services in Haiti has not decreased. Hence, it could be hypothesized that the lack of awareness of the RT profession within Haitian society, lack of regulatory structures for rehabilitation professions (e.g., standards and policies), and scarcity of funding for rehabilitation services, may hinder the availability of RT positions in the health system.
This study provides insight into the experiences of RTs who graduated from three training programs in Haiti, and how the rehabilitation sector is evolving. Currently, NGOs play a central role in both training RTs and employing them upon graduation. This reliance on the contribution of NGOs raises concerns related to sustainability and the possibility of expanding rehabilitation services. Unequal distribution of RTs across the country also suggests important geographical variation in access to services. The types of patients treated by RTs appear to have changed over the past decade, with more RTs reporting that they treat amputees as part of their clinical work.
The RT training programs represent an important mechanism to enhance rehabilitation human resources in Haiti. However, challenges remain, including achieving official recognition of the RT training and the availability of RT jobs, especially in the public sector.
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