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 that can be managed in isolation by a single professional to assist the needs of a persons condition within a health service.  Depending on the individual needs of the person who visit a health service will determine the various inputs required throughout their treatment and rehabilitation e.g. assessment by doctors, radiologists, specialised doctors, physiotherapists (PT), occupational therapists (OT), psychologists, dieticians, and social workers etc. Additionally, other professionals outside of the healthcare team also play a role when we are thinking holistically about the individual and what they need to survive and thrive such as, including vocational training professionals, and education professionals, etc.

Therefore, as a rehabilitation professional, we need to be creative and open minded to work with different professionals, to contribute and fulfil the needs of the individual person in front of you who needs support. In specific contexts, like camps for displaced persons, it is vital that we work collaboratively with other professionals both within and outside the rehabilitation team, as needs are often complex with many factors that impact on the rehabilitation rehabilitation process if you do not consider these within your rehabilitation programme including issues such as limited access to food for family members, inadequate shelter, sanitation or potable water.

Thus, working with inter-professionals will help us to see the holistic situations of patient then see how each of profession could contribute and most importantly how much resources do we have in this camps context and who should to do what. To summarise, a person-centered approach is necessary, combining multidisciplinary skills in one common goal. The rehabilitation professional plays a central role, 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. Although it seems that working as a rehabilitation professional, we are very much focused on health services, in fact it is very helpful for you to aware of the social structure within camps so you understand who you should collaborate and who you should be aware of according to community norms, which may help you to improve the rehabilitation services uptake. It is also important to have an understanding of who the main authorities are in order to advise in relation to rules and regulations in the camps and what you should or should not do in their communities. Furthermore, in most camp contexts you will see many humanitarians organisations who are implementing a wide range programs with various contents e.g. health, food distribution, shelter establishment, water and sanitation, education, vocational training, protection, social services, and resettlement.

The purposes 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 consist of 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 quality of services for displaced persons in the camps as well as representing 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, so having an understanding of this is important so that rehabilitation professionals understand the link that your patients may need to access services from camp management. Moreover, this is the great opportunity that the system is already open for them to access so if in practice you patient have some challenges then they are eligible to raise their voice 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 you can see in more detail in the handbook or the guideline of this structure in terms of, which organization are implementing what activities and providing what services so that you can either contact them or advice your patient to access further support. The Rehabilitation Project is under the Health Sub-committee according to this structure and Disabilities Inclusion project is cross cutting project so include 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 context in the references resources of 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 capacity to contribute to fill the gaps. If following each part of health system we can see the role of rehabilitation professionals in camps setting s to include:

Health Promotion

• Provide education on physical activities to improve the 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 conduct 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 for all impairment of people in the community.

Treatment and Rehabilitation

This domain is the clinical part that you really need to work closely with inter-professional team and identify the needs with the team that will determine 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 give your Physiotherapy technique services in various stage for example:

Early Stage

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

Recovery Stage

Techniques of early stage with more advance 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 care givers to learn to do thing by themselves and the therapists step back to be the coacher rather the direct services provider
• Cross check all understanding and handling technique of patients and care givers are correct and safety
• Prepare all education tools, such as poster, handbook, and card for patient to follow at home
• Discuss with all relevant care givers and stakeholder 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 commitment of the patient and their support structures to improve their health conditions. As we know rehabilitation is often a long time process for a patient to see improvement, which in more complex conditions might take months or years to see progression. 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 is not only from the population, but can also come from within the health service itself. Therefore, having strategies to show the contricution that rehabilitation professionals can make it vital to increase awareness of what rehabilitation can contribute and the benefits of our interventions towards the population health’s.

Facilitation of Inter-professional Working in the Community Setting

There are different approaches and levels that community’s providers and the agencies will agree who will lead or facilitate the health services in this setting. The obvious example that we can focus on this is the case management team leader. This is the role of the focal person to facilitate the discussion among that relevant teams who contribute support. Most of the time if it is in the community’s hospital the focal person is most commonly a nurse and many times in the community level such as Community Based Rehabilitation (CBR) Projects , the social worker is case manager. In addition, physiotherapist is one member of inter-professional team so you may also be the focal person too. In either your roles as member of the team or the main facilitator of the team, you need to be prepare and proactive to provide information about your assessment and what contribution you should give to this person and the team. Think holistically and prepare yourself before the team updates session start so that all of patient, care givers and your concerns can be asked and put in place to find solution for next step. Effective Communication Techniques are needed in this role.

Keep in mind that as rehabilitation profession, you have a great and long time with patient during rehabilitation session so you tend to gain relationship with patient and care giver more than other inter-professional team members. Therefore, it is good if you can gather and catalyze important information to discuss with the team for the best beneficial rehabilitation outcomes for the patients.

Information and Communication Tools

The information and Communication Tools (ICT) play a very important role in the context of camps for displaced persons as the rehabilitation services are need a lot of application to ensure the patients and care giver are less dependent to health centre. The reasons are that the limited resources of rehabilitation centres, over case load, long distance for patient to come to the centre and care giver are not able to assist to them to come to centre too often too. Therefore to develop simple tools for rehabilitation homework or home exercise is crucial to support them. This is also is a good tool for other professionals to see what you have advice the patient to take care of themselves so the inter-professional members can either remind them for you or avoid any duplication plan which may make them confuse.

In addition, the way to use the tools to make sure patient and care giver understand correctly is very important. Giving demonstration and ask them you demonstrate back to you as two way communication is one of effective way of home exercise education. Besides, pictures are more effective tools that the text as it is 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 the outcomes

Follow Up Process and Monitoring the Outcomes

The follow up process and monitoring the rehabilitation outcomes is important process which is to see the progression of the patient, quality or your services and feedback tools to your stakeholders about patient situation. It is one challenge of working in the refugee context regarding to people movement and situation changes. However, it is always possible for the inter-professional team to find the 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 are ket with use of a wide range of tools to evaluate the person’s quality of life as well as community support level. All of this could be discussed with the communities and stakeholder 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 available in short and long questionnaire to apply to your work context to assess the situation of people with impairments in the communities that you have involved.