Editorial

Introduction

This editorial is intended to highlight a perspective of sharing globally existing potentials in rehabilitation medicine through various international networks of communication. My understanding is that, as individuals or institutions, we need to become immersed in the world of international business, gaining a cultural, social and economical understanding and achieving a truly global perspective. Individuals and organized institutions have to value the struggle and efforts made in developing rehabilitation services as well as recognizing the importance of such services to the community and thereby develop a sense on the need of contributing through cooperation.

It is indeed inevitable in that there is no way in this world today that we can dissociate ourselves from the regional and international facets in our rather complex field as the world responds to more integrated systems of communication, trade and partnership. Professionals, institutions, organizations and industries engaged in our field, particularly those from facilities with ample resources and leading in advanced technology, should be seen to be developing into global professionals or experts as the job market in which they will compete is now increasingly an international one. The era of isolating ourselves within the same facility and geographical environment is long gone. We have to reform ourselves, the structures and the systems to learn to communicate in foreign languages, understand and appreciate other cultures, and work toward shared goals with counterparts from different backgrounds.

Growing need for internationalism

A WHO press release (No. 24, 3 December 2003) stated that about 600 million people in the world experience disabilities of various types and degrees. The day-to-day life of 25% of the world population is affected by disability which affects entire families and not just the involved individuals. About 80% of the world's disabled people live in developing countries; the majority of them are poor and cannot access basic services including rehabilitation facilities. The global disabled population is increasing as a result of population growth, medical advances that preserve and prolong life, malnutrition, chronic conditions, HIV/AIDS, road injuries and land mines. During civil conflict or other violent events, many die but the number of people disabled can create an even larger health burden.

The range and variety of orthopaedic problems encountered around the world is enormous. The regional differences show specific disease patterns, variations in access to medical care, and quality of available care and healthcare traditions which are deeply rooted in all cultures. It should also be noted that in many parts of the world, there is still a reliance on indigenous traditional practitioners who often take temporary precedence for the scientific management and presentation of care which leads to many difficulties and complications.

It is widely known that development in the 21st century will be knowledge-based and science-led, therefore the growth and output in terms of quantity and quality of technology in rehabilitation medicine and specifically in prosthetics and orthotics will be technology-driven. While there are a number of preconditions for national, regional and global economically competitive and sustainable development, the emergence and growth of prosthetics and orthotics training and service facilities devoted to research and technological innovation shall continue to be the foundation of modern knowledge economy in our field. The transfer of technologies to other countries, and in particular developing countries, has often being disappointing if not producing negative results. These results can only be avoided with an open-minded and scientific approach which, in most cases, is either not in place or rarely adopted. A vigorous and well-defined desire to embark on internationalism among our institutions, organizations and industries will result in the establishment of international cooperation with the objectives to:

Support and promote institutional, organizational or industrial competitiveness through strategic research partnership with collaborating partners by engaging the best professionals within and outside one's facility;

Address specific problems that the collaborating partners/countries face or that have a global character, on the basis of mutual interest and mutual benefit.

In particular an establishment of international cooperation will allow:

• Access to the best technological knowledge and skilled researchers worldwide, promotion of the exchange of scientific information with a view of easing access to advanced solutions to the benefit of the partner, exchanging technology, and ensuring synergy among the best researchers in the world for the benefit of all;

• Achieving a global consensus for appropriate technologies and standardization, particularly among the countries that lead technological advance, and setting the pace for the establishment of cooperation with a view to avoiding unnecessary difficulties of availability, accessibility, continuity of services and integration of global systems;

• Strengthening and adapting business cooperation between institutions, organizations, service facilities and industries that lead technological advances with collaborating partners with a view of developing systems and services that best fit with local markets and needs, and opening markets through the promotion of solutions developed in the cooperation;

• Embark and strengthen more on the ‘Evidence-based Practice’ through research with a particularly emphasis in developing countries, so as to gather quantitative data upon which we can base our decisions about what constitutes effective and efficient rehabilitation measures. This type of practice has to emerge as one of the prerequisites to encourage meaningful and relevant evidence about technology practiced. Research aimed at quantifying and qualifying the quality of rehabilitation services is becoming increasingly important in healthcare and equally so in our field as our clients are demanding greater ownership and control over decisions affecting their quality of life;

• Closing the ‘digital divide’ between the rich and poor countries. The focus of the cooperation programme should be seen to provide opportunities to increase the role of the major partners in supporting external and development policies as required to achieve the desired objective of the cooperation.

Wider cooperation between professional associations and experts

As the application of clinical skills and technology practiced throughout the world varies extensively, establishing globalized international cooperation will have a substantial impact on the quality of service we are providing in terms of quality assurance through application of international accreditation procedures and the spread of global quality standards and, in turn, elevate the quality of life of our consumer society worldwide.

The long-term strategy should be aimed at sensitizing and promoting prosthetics and orthotics facilities through institutions which have excelled in research and development to interact and develop the profession and individual professionals around the world.

Establishment of such networks is one of the most effective ways of mobilizing socio-economic, scientific and technical resources to address common regional challenges such as professional development, technology transfer, adaptation and development within the given local conditions.

In most of the Eastern Europe, Asia, Africa and Latin America, the service infrastructures are not yet sound and therefore, there is still a great struggle against other local political and socio-economic barriers to establish and elevate rehabilitation services. A need of international cooperation is inevitable as my former President, the late Julius Kambarage Nyerere; once said: ‘In the world of boxing, you cannot put a heavyweight and a featherweight in the same ring. This will be a murder. You have to support the weak until he/she is able to compete and then you can sit at the same table and talk about globalization’.

All of this depends solely on the level of qualification of professionals engaged in the field and therefore training and education becomes inevitable and a prerequisite in achieving these developments. ISPO has been actively involved in promoting and supporting education and training, particularly in prosthetics and orthotics through collaborating with other non-government and government organizations. There has been an increasing number of new programmes and schools within or attached to universities, ministries, organizations or associations which have established collaborative and consultative status with ISPO. There have been consultation meetings with schools in developing and industrialized countries: In March 2002 in El Salvador and April 2004 in Dortmund, Germany, and most recently in March 2007 in France. The aim of these meetings was to set up a link for cooperation between themselves and ISPO as well as making known the education and training modules available around the world. The other activities which have been carried out by ISPO which promote and advocate internationalism include:

▪ Advisory role on curriculum development and course structures of Distance Learning and E-Learning;

▪ Development of training guidelines and professional profiles for the different categories of personnel;

▪ Consultation and support through a teachers' exchange programme, external lecturers/instructors and examiners;

▪ WHO consultation on issues related to education, training, service, guidelines in developing countries amongst others;

▪ Evaluation of programmes wishing to be accorded international accreditation;

▪ Consensus conferences on amputation, poliomyelitis, cerebral palsy and stroke and their treatment as well as rehabilitation solutions appropriate to local conditions and running courses based on the consensus conferences;

▪ Field trials and mechanical testing of locally-made components and devices;

▪Sponsorship support of students enrolled in different prosthetics/orthotics and wheelchair courses.

Recently (early April 2006) ISPO in consultation with LWVF-USAID, WHO and other organizations/institutions organized a consensus conference on ‘Lower limb orthotics technology for developing countries’ to gather expert views on their respective experiences of the different technological approaches as well as the feedback and opinions of the users. The consensus reached in that conference did outline recommendations and guidelines of the appropriate technological approach of lower limb orthotics application for different pathologies in developing countries.

The presentations made on the need of establishing appropriate wheelchair training, production and distribution of wheelchair services (during the ISPO World Congress in Hong Kong) has provoked a consciousness of the deficiency of such services required for people with physical disabilities in developing countries. Appropriate wheelchairs technology for developing countries was either given very low priority or taken for granted in that any design of wheelchairs was seen to be appropriate for anyone in need, regardless of the cause or severity of disability.

Another consensus conference on ‘Wheelchairs for developing countries’ was held in November 2006 in Bangalore, India, in which a consensus was reached on the guidelines for service provision, acceptable quality and standards, distribution, financing, and finally establishment of such facilities in developing countries. These are other initiatives which were made to promote cooperation through consultations and using the available potentials of experts to improve the quality of life of physically disabled people throughout the world. Your individual contributions are greatly needed as we continue to develop close ties between ourselves and our institutions.

Many of these activities to a great extent have improved the quality of training, services provided and finally the quality of life of persons with physical disabilities. This achievement has been made through the Society's status of collaboration with other organizations such as World Health Organization (WHO); International Committee of the Red Cross (ICRC); Handicap International (HI); World Rehabilitation Fund (WRF); International Commission for Technology and Accessibility (ICTA); World Orthopaedic Concern (WOC); Leahy War Victims Fund of USAID, INTERBOR, Bundesinnung Verband (BIV); and German Agency for Technical Cooperation (GTZ), to mention a few.

At this juncture, I would therefore wish to invite the members who are representing either their institutions or individual professionals to embark and extend their support in establishing or joining efforts in the ongoing cooperation activities. You have a lot to offer to contribute to the development of this profession around the world.

Harold G. Shangali

President, ISPO

1st May 2007