Facilitation of Inter-professional Working in Camps for Displaced Persons

Original Editor - Pasala Maneewong and Patrick Le Folcalvez

Top Contributors - Naomi O'Reilly, Kim Jackson, Ewa Jaraczewska and Rishika Babburu  

Introduction

There is no single treatment or rehabilitation programme within a health service that can be managed in isolation by a single professional to assist with needs of the person's specific condition. The specific needs of a person who visits a health service will determine the various inputs that would be required throughout their treatment and rehabilitation e.g. assessment by doctors, radiologists, specialised doctors, physiotherapists (PT), occupational therapists (OT), psychologists, dieticians, and social workers. Additionally, other professionals outside of the healthcare team also play a role in meeting this person's needs to survive and thrive, including vocational training professionals and education professionals.

As rehabilitation professionals, we need to be creative and open-minded to work with other specialists to contribute and fulfil the needs of the individual person seeking support. In specific contexts, like camps for displaced persons, it is vital that we work collaboratively with other professionals. The needs of displaced person are often complex with many factors which, if not addressed, can negatively impact the rehabilitation process. They may include limited access to food for family members, inadequate shelter, sanitation or potable water.

Working with inter-professionals will help to built a holistic approach to meet the patient's needs, where each profession contribute and where all available resources are well utilised. To summarise, a person-centred approach is necessary, combining multidisciplinary skills with one common goal. The rehabilitation professional plays a central role, in linking medical and social stakeholders.

Understanding Camp Management Structure

In the complexity of the camp context for displaced persons, there are many different structures that you should be aware of. It seems that working as rehabilitation professionals, we are very much focused on health services. In fact, it is very helpful to be aware of the social structure within camps to understand who you should collaborate with and what role they play, which may help you to improve the rehabilitation services uptake. It is also important to have an understanding of who is the main authority within the camp to ask for advise about rules and regulations in the camps and what you should or should not do in its communities. Furthermore, in most camp contexts you will have many humanitarian organisations that are implementing a wide range of programs with various contents e.g. health, food distribution, shelter establishment, water and sanitation, education, vocational training, protection, social services, and resettlement.

The purpose of camp management is to make sure that services and protection provided are in line with national and international laws, guidelines and agreed standards. International Guidelines and Standards, such as the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response, outline the minimum humanitarian standards in four technical areas: Water Supply, Sanitation and Hygiene Promotion, Food Security and Nutrition. Another example is the Inter-Agency Network for Education in Emergencies (INEE), which is the standard for humanitarian actors to coordinate the quality of education prior to, during and after agencies. They also include ethical considerations for working with displaced persons.

Example of Camp Management in Thailand Myanmar Displaced Persons Camps

The Committee for Coordination of Services to Displaced Persons in Thailand (CCSDPT) was developed by the humanitarian agencies working within 9 Displaced Persons Camps along the Thailand / Myanmar border. It was formed and aims to be a forum for members to communicate and coordinate between them to ensure the quality of services for displaced persons in the camps and to represent the membership’s interest to the Royal Thai Government, International Organisations and Embassies.

The camp management is one sector of the CCSDPT, which functions to facilitate the displaced communities' experience in their camp management as an accountable, inclusive and capacitated self-governance system that adheres to humanitarian principles. It ensures access to justice and involves them in planning for solutions. One of the strategies is to promote the rights of persons with specific needs and under-represented groups, ensuring their equitable access to services, including justice. The mapping services document outlines what is always available and facilitates links to agencies that support specific roles. Being aware of this document is important so that rehabilitation professionals understand the links that allow the patients to access services from camp management. Moreover, there is a great opportunity for the rehabilitation professionals to use the system if they need to raise their concerns about patients or contact relevant actors.

Fig 1. CCSDPT Coordination Structure

There are different sectors that the CCSDPT members are divided into, to support specialised or responsive approaches to the needs of the displaced communities. You may see the overall services for the camps, which are available in greater detail in the handbook. The graph provides guideline of the camp structure on which organisations are implementing what activities and providing what services so that you can either contact them or advise your patient to access further support. The Rehabilitation Project is under the Health Sub-committee according to this structure and the Disabilities Inclusion project is a cross-cutting project that includes involvement across a number of sectors. This coordination structure is similar in other Displaced Person Camps settings all around the world so you can explore further in other contexts in the references resources on this page.

Roles of Rehabilitation Professionals with Camps Setting

Rehabilitation professionals have various roles within the health services system, including promotion, prevention, treatment, and rehabilitation. Therefore, you should analyse the needs of the camp context that you are going to work in, the local and available resources and your organization's capacity to contribute to filling the gaps.

The role of rehabilitation professionals in camps settings include:

Health Promotion

• Provide education on physical activities to improve strength, cardiovascular health, psychological health and well-being. Although often these activities are not seen as a priority within the context of camps for many displaced persons as the focus tends to be on their basic needs such as food, safety and security of family members according to the context.

Prevention

• Health Education
• Awareness rising for particular health conditions such as nutrition programs.

Early Identification Activities

As we all know that early detection of all health issues is important for effective management and to access further treatment to ensure good outcomes and prognosis.  Some activities that have been conducted in camp contexts include;

• Early childhood development programs - detection of any sign of impairments in early childhood age and referral to proper services.
• FAST, facial droop, arm drop, speech disturbance and time, the way to identify the signs of stroke.
• Early detection of impairment of people in the community.

Treatment and Rehabilitation

In this clinical role, rehabilitation professionals need to work closely with the inter-professional team. The entire team will identify the patient's needs that will determine the treatment or rehabilitation process. The International Classification of Health and Disabilities Framework (ICF) is an effective tool for teams to work together throughout the rehabilitation process.

You can consider offering your physiotherapy services in various stages, including:

Early Stage

• Positioning
• Mobility
• Gentle Active Exercise
• Breathing exercises
• Early transfers with or without an assistant
• Developmental activities for for children
• Provision of assistive technology

Recovery Stage

Techniques of the early stage with more advanced techniques

• Active resisted exercises or strengthening programs
• Independent Transfers
• Independent Mobility
• Self-Stretching
• Provision of assistive technology

Prepare for Discharge Stage

• Take time for patients or their caregivers to learn to do things by themselves and the therapists step back to be the coacher rather than the direct services provider
• Cross check all understanding and handling techniques of patients and caregivers are correct and that safety
• Prepare all education tools, such as poster, handbook, and card for patient to follow at home
• Discuss with all relevant caregivers and stakeholders according to the patients' future plan e.g. continue education, willing to attend vocational training, etc.
• If possible, visit the patient’s home and environment to identify potential obstacles that request specific adaptations.

Value of Rehabilitation

Rehabilitation services require collaboration amongst all team members and the commitment of the patient and their support structures to improve their health conditions. As we know rehabilitation is often a long process towards the improvement, and more complex conditions might take months or years to show any progress. Moreover, rehabilitation and its role are not always well understood or valued in many countries so advocacy for rehabilitation services is often a huge part of the role. This lack of understanding of rehabilitation comes not only from the population but can be present within the health service itself. Therefore, having strategies to show the contribution of rehabilitation professionals is vital to increase awareness of what rehabilitation can achieve and the benefits of our interventions toward population health.

Facilitation of Inter-professional Working in the Community Setting

There are different approaches and levels that community providers and the agencies agree on regarding who will lead or facilitate the health services in this setting. One example is the case manager as a team leader. In the community’s hospital, the focal person is most likely a nurse. At the community level, such as Community Based Rehabilitation (CBR) Projects, the case manager is the social worker. In addition, a physiotherapist is one member of the inter-professional team so he or she may also be the focal person. In either role as a member of the team or the main facilitator of the team, you need to be prepared and proactive to provide information about your assessment and what contribution you should offer to this person and the team. Think holistically and prepare yourself before the team updates session start, so that all of the patient, caregivers and your own concerns can be asked and put in place to find the solution for the next step. Effective Communication Techniques are needed in this role.

Keep in mind that as a rehabilitation professional, you spend a long time with patients during their rehabilitation sessions so you tend to form a closer relationships with patients and caregivers than other inter-professional team members. Therefore, it is a good idea to gather and catalyse important information to discuss them with the team for the best outcomes for the patients.

Information and Communication Tools

Information and Communication Tools (ICT) play a very important role in the context of camps for displaced persons because the rehabilitation services need a lot of application to ensure the patients and caregivers are less dependent on the health centre. The ICT are needed due to:

• limited resources of rehabilitation centres
• cases overload
• long distance for patients to come to the centre
• caregivers are not able to assist them to come to the centre too often too.

To develop simple tools for rehabilitation homework or home exercise is crucial to support them. This is also a good tool for other professionals to see what you have advised the patient to take care of themselves so the inter-professional members can either remind them of you or avoid any duplication plan which may make them confused.

In addition, the way to use the tools to make sure patient and caregiver understand correctly is very important. Giving a demonstration and asking them to demonstrate back to you as two-way communication is one effective way of home exercise education. Besides, pictures are more effective tools than text as it is a visible clear demonstration. Adding some text is suggested, but too much text is less interesting and many refugees are not able to read and write. Follow-up process and monitoring of the outcomes

Follow Up Process and Monitoring the Outcomes

The follow-up process and monitoring of the rehabilitation outcomes are important, because they allow to:

• see the progression of the patient
• assess the quality of your services
• provide feedback tools to your stakeholders about the patient situation.

These processes are challenging to apply in the refugee context because of people's movement and changes in their social or housing situation. However, it is always possible for the inter-professional team to find a simple way to measure the outcomes of your treatment and rehabilitation. Functional Independence Measure (FIM), Barthel Index and other Outcome Measures are encouraged in the Refugee context to monitor the impact of your programs. Holistic approaches and long-term rehabilitation including Community Based Rehabilitation approaches use a wide range of tools to evaluate the person’s quality of life as well as a community support level. All of this could be discussed with the communities and stakeholders to find out the proper tools or questionnaire. Good examples of international tools include the Disability Measurement and Monitoring of the Washington Group Disability Questions , which is available in short and long questionnaires. It is used to assess the situation of people with impairments in the communities that you were involved.