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Physical Medicine and Rehabilitation(MPR),known as the abbreviation

MPR, is a medical specialty intended to provide people with disabilities
with better living comfort.
MPR is based on rehabilitation and rehabilitation, managed by a
multidisciplinary team. The treatment is physiomotor but also social
and psychological.
The MPR aims to restore the physical abilities of the
patient,while reinserting him into society.

Certified orthoprosthetists
training on physiotherapy techniques
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SUMMARY

INTRODUCTION 1
THE CENTER ______________________________________2
SERVICES ______________________________________3
EQUIPMENTORTHOPEDIC ______________________________4-------
THE ORTHOPEDIC EQUIPMENT MANUFACTURING PROCESS 5
CARE OFPATIENTS ___________________________________6------
THE CAOR IN A FEWFIGURES __________________________7------
USEFUL INFORMATION_____________________________________ 8
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 INTRODUCTION
Worldwide, more than a billion people live with some form of disability, and nearly 200 million have severe
functional difficulties (1). According to the WHO, disability is perceived as an inability. It defines disability as
"a disadvantage resulting for an individual from an impairment or disability which limits the individual
concerned in performing a role which is normal for him or her, taking into account age, gender and socio-
cultural factors which prevent him or her from performing that role". The United Nations Convention on the
Rights of Persons with Disabilities specifies that people with disabilities are those who have long-term
physical, mental, intellectual or sensory impairments, the interaction of which prevents them from fulfilling
their potential. World Disability Report published by the WHO and the World Bank with various barriers can
hinder their full and effective participation in society on an equal basis with others. In Djibouti, as in many
other countries, people with disabilities are often discriminated against and marginalized, and do not always
have access to the services they need to live independently and participate fully and effectively in society on
an equal footing with others.
Image by a view at the top of the centercaor / Image of Balbala hospital known as Cheikho
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 THE
CENTER
Aware of the costs incurred by its operations, the
Context of creation of the CAOR center
government some time later called onan international
NGO called "international handicap" in the year 2000.
The Djiboutian civil war began in 1990, around fifteen
After two longyears of the mission of the “disability”
years after independence, and ended in 1994.
NGO International" comes to an end and a new
orthopedic fitting and rehabilitation center haswas
This civil war created violent ethnic clashes between two
created in2016. with the support of cooperation
majority communities in Djibouti; causing deaths and
German.
several injuries. After this war, the government found
itself in the need to equip the war wounded in order to
fully reintegrate them into society.

This being said, the government finds itself unable to

carry out medical evacuation operations because the
country did not have any orthopedic fitting and
rehabilitation center. 8
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The center Orthopedic Appliances and of In the long term, the main objective of the project is to
Rehabilitation (CAOR) was inaugurated in Djibouti in make the Orthopedic Apparatus and Rehabilitation Center
March 2016 within the Balbala hospital" saidCheiko" (CAOR) technically and financially autonomous, to
speaks Ministry delaHealthavec develop its status as a regional leader for prosthetics and
financial and technical support for orthotics services for disabled people and consolidate the
cooperationGerman and the NGO Johanniter. Since CAOR structure for its long-term establishment.
hercreation, the project enjoyed great
success with the population and especially with
peopledisabled requiring equipment
orthopedic.

The goal of the project was to allow people with physical

disabilities to access orthopedic fitting services and
functional rehabilitation. At the end of the project which
was closed, the takeover of the center took place with a
tripartite partnership (ANPH-CNSS-Balbala Hospital).

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Image of a technician fitting a child Image of an Indian prosthetist and a Djiboutian prosthetist who
collaborates in the manufacture of prostheses.

Image of certified physiotherapists

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Establishment of a tripartite partnership
(ANPH-CNSS-Hôpital de Balbala)
In January 2019, the German NGO Johanniter completed its technical assistance, and since February 2019, the Agence
Nationale des Personnes Handicapées (ANPH), with financial support from CNSS, has taken over. It is responsible for
the technical and financial assistance, supervision and training of the orthopedic technicians by recruiting Johanniter's
international technical expert. The Balbala hospital provides the CAOR center with qualified human resources, namely
ortho-prosthetic technicians and other technical staff. Starting in 2019, the ANPH has implemented a series of training
courses based on physiotherapy techniques for amputees. 4 orthoprosthetists and 9 physiotherapists from Balbala and
Peltier hospitals.

In February 2020, ANPH recruited a senior technician to strengthen the services of the CAOR department.
As part of the care provided to children and adults with amputations, physical impairments or multiple disabilities at the
CAOR, ANPH has set up a care mechanism to facilitate access to physical medicine and rehabilitation, as well as to
ensure the integration and rehabilitation of disabled people by providing adapted wheelchairs (FRA).
Since the introduction of the care mechanism, ANPH's Social Integration and Rehabilitation Department has been
coordinating with the CAOR center, in consultation.
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Image on the care, guidance and services of disabled people by social workers from the ANPH and the CAOR
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The technical platform

The center has a technical platform which is made up

of:
Casting room
Workshops with equipment and machines for
manufacturing
Assembly room for all types of prostheses and
orthotics,
Repairs of various orthopedic devices Cast rooms,
Workshop for thermoforming plastics and
resin lamination;
Walking and fitting room for prostheses and orthotics;

Image of the technical platform and the different

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machines available at the CAOR center
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The center team

The center team is multidisciplinary and is made up of:

A coordinator;
Technical Manager;
Three Orthoprosthetic technicians; A A
Technical Assistant;
Technical assistant.
A Maintenance Technician.;An
administrative and reception assistant.

Image of the Orthopedic Appliance Center teamand

Rehabilitation (CAOR) in action 13
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 THE SERVICES
With this mechanism of support and provision of
equipment, the CAOR has been able to take care of
children and young adults with multiple disabilities since
June 2020.
With the ANPH and more particularly the
Managementof Social Integration and Rehabilitation of
the ANPH, free consultations could be provided and
ensured by the senior technician in order to determine the
possible conditions for appropriate care.
The Orthopedic and Orthopedic Device Center
Consultations, advice and recommendations forall
orthopedic and orthopedic devices
mobility problems
(wheelchairs); Arrangement and adjustment of adapted
wheelchairs;
Manufacture of prostheses, orthotics in resin and
polypropylene for
lower and upper limbs;
Training and rehabilitation for walking with a
prosthesis;
Rigid thoracolumbar support and correction corsets;
Large step splints (GAM); Plantar
supports,
Orthopedic appliance repairs;

rehabilitation offers the following services:

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Image on the different orthopedic devices at the CAOR center
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 ORTHOPEDIC DEVICES
At the orthopedic and rehabilitation center, there are
two types of devices:

1. The big device (prosthesis)

A prosthesis is a device that replaces an absent limb.

The device allows the patient to regain independence
and use an amputated limb again. The large
equipment is manufactured in our workshops from a
mold made on the patient.
Image on orthopedic prosthetic devices from the Caor center
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 2. The small device (orthosis)

An orthosis is a device that corrects or helps a deficient

limb.
These include leg orthoses such as elevators, hand
splints, large walking devices, corrective orthoses for
potty training, etc.

Image on orthopedic devices orthotics from the caor center

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Image on the manufacturing process of orthopedic devices
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CARE OFPATIENTS
The support at CAOR is different depending on the
problem you are facing.

Thus, two care pathways exist.

Care of children and adult amputees

Support for children with multiple disabilities

Image of the care and rehabilitation of disabled

patients
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Care of children and adult amputees

First, it involves recording the files of children and adults who are amputees and have physical deformities.
Then, direct child amputees to the Orthopedic Apparatus and Rehabilitation Center (CAOR) by informing their parents of
the steps to take.

Cases where parents have the CNSS card or card: Children and adults benefit from the device depending on their level of
amputation.

Cases where the parents do not have the CNSS Card or Card: ANPH grants a consultation voucher upon presentation
of a quote for the orthopedic device provided by the CAOR. Children and adults benefit from the device depending on
their amputation level.

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Support for children with multiple disabilities

Firstly, it involves recording the files of children with multiple disabilities and cerebral palsy (CP).
Then, direct IMC children to the Orthopedic Apparatus and Rehabilitation Center (CAOR) in
informing their parents what to do. The medical files of the children to be consulted are sent via email to the CAOR manager
before 24 hours from the consultation.

Implementation of an on-site consultation and by appointment for children with multiple disabilities (IMC) (4
children /weeks). Prescribe an Adapted Wheelchair (FRA) if the child's condition requires an FRA or a wheelchair
Standard (FRS). In the presence of ANPH social workers: Children benefit from an Adapted Wheelchair (FRA) or a Standard
Wheelchair (FRS).

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An orthoprosthetist placing a BMI child on an
adapted wheelchair

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The CAOR in figures....

Since the creation of the center, nearly 2,754

people have been fitted with devices (small and
large devices)
24 consultations per week
150 children with IMC were able to benefit from a
free consultation

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USEFUL INFORMATION

The CAOR center is located in the Balbala hospital “called

Cheiko”.
For any consultation, the disabled person
can go directly to the CAOR with their CNSS universal
insurance card (PASS or AMO) or the ANPH CMI card.

If the disabled person does not have one of these cards,

they must go to the CAOR to get a quote for the
equipment. Then, you must present this quote to the ANPH
to benefit from
a consultation voucher for treatmentcharge. Image by a view at the top of the CAOR center
and
at the entrance to Cheikho hospital
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 National Agency for Disabled People

CAOR
Orthopedic Equipment and Rehabilitation Center

For more information:

- call 1519
- check out the websitewww.anph.dj
- meet at the ANPH (boulaos site)