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Synopsis of Physiotherapy in Owamboland Namibia So
Synopsis of Physiotherapy in Owamboland Namibia So
statement by H o u d e (1977) probably puts the whole subject Harcus, A. W.. Smith. R. and Whittle, B. in: Pain — New
into perspective: “ at present we have no better measure of Perspectives in Measurem ent a n d Managem ent. Churchill
pain than the patient’s own report ol its presence a nd severity Livingstone. Edinburgh, pp. 27-33.
in his own word s.” Huskisson. E. C. (1974). Measurem ent of pain. Lancet, 2,
1 127-1131.
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Downie, W. W., L eath am , P. A., Rhind. V. M. el al (1978). and Managem ent. Churchill Livingstone. Edinburgh, pp
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378-381. Rosen. M. (1977). The m easurement of pain. Eds. Harcus, A.
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SUMMARY O PSOM M IN G
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
A resume o f the author’s experience as the sole physiotherapist ’n Oorsig van die skryw er se ondervinding as die enigste
at the O shakati S ta te H ospital situated d o se to the Angolan fisioterapeut b y die O shakati Staatsliospitaal naby die
border in Owamboland, Namibia, is given. The conditions seen Angolese grens in Owamboland, word gegee. Die toestande
over a one-year period and appropriate treatm ent, are gesien gedurende ’n periode van een ja a r en toepaslike
described, emphasising the shortcom ings and problem s facing behandeling word b e s k r y f m et klem op die tekortkom inge en
a physiotherapist in a rural hospital situated in a bush-war probleme wat 'n fisioterapeut in 'n plattelandse hospitaal in ’n
area. Particular em phasis is placed on those patients with bosoorlogsarea in die gesig staar. Pasiente m et ortopediese,
orthopaedic, neurological and burn injuries, as well as those neurologiese en brandwond beserings, asook diegene wat
requiring chest physiotherapy. borskas fisioterapie benodig, word beklemtoon.
cause of hemiplegia. In most cases, the upper limb was found (kraals). Early skin grafting was performed a n d the limb
to be more severely affected than the lower limb, resulting in splinted to prevent c ontracture formation. Early removal of
a poo rer prognosis. Physiotherapy in the initial flaccid stage the dressing was carried o ut ( 3 - 5 days following graft).
consisted of correct positioning of the patient in bed and Physiotherapy com m enced at this stage. This consisted of
passive movements to prevent contractures. This was active exercises as well as gentle passive stretching to
followed by exercising the patient through the stages of the m aintain the fullest range of movement possible. Because of
normal developm ental sequence. S ta n d in g a n d walkingwere the absence o f a physiotherapist in the preceding four
first performed in the parallel bars. Use was sometimes made m onths, some patients had already developed severe
of a plaster-of-paris back slab to su p p o rt the affected lower contractures. In these cases physiotherapy consisted o f serial
limb. Once the patient was mobile (usually with the aid o f a splinting, passive stretching and active exercises to decrease
stick) in-patient m anagem ent ceased and the patient was the contractures. In those patients in whom physiotherapy
discharged. (The d e m a n d for beds necessitated an early proved ineffective, surgery was carried out. O f the remaining
discharge). Because of the difficulty of out-patient follow- one-third o f the burn injuries, the majority resulted from
up, the patient usually received' little or no further motor-vehicle or land-mine accidents. Most o f these were
managem ent a n d therefore the best possible result was often high percentage surface area burns with the lungs also being
not achieved. involved. In these patients, despite intensive chest
physiotherapy, mortality was high.
Paraplegia
In most cases trau m a was the cause of paraplegia. Because C H E S T PH Y SIO TH ER A PY
|of the lack of facilities and the inability o f families to care for
patients at home, they faced the grim reality of being The spectrum of chest physiotherapy seen was similar to
confined to the hospital on a perm anent basis. These patients that o f any general hospital and contributed to 30% o f the
were acc om m od a te d in a special ward of their own with d e p artm e n t’s workload. Medical chest conditions most
specially trained sisters. Following diagnosis, the patients com m only seen were p neu m onia (childhood a n d adult),
were put on a p rog ram m e o f strict bed rest with turningevery p u lm o n a ry tu b erc u lo sis an d lung abscess. Chest
two hours to prevent bed sores, a n d passive movements to physiotherapy was also carried out post-operatively, usually
prevent contractures. Once the condition stabilised, they post-abdominal surgery.
were mobilised in a wheelchair a nd taught to manage all T herapy was conventional, consisting of breathing
activities o f daily living. A special rehabilitation program m e exercises, postural d rain age with vibration, percussion and
consisting of standin g and walking (with aid o f calipers and coughing, and, where necessary, intermittent positive
crutches), passive movements a n d sport was designed and pressure ventilation using the Bird Respirator.
carried out. The services of an occupational therapist would
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)