The development of a spinal injuries unit in Armenia

The challenge of spinal cord injury care in the developing world

Great strides have been made in reducing morbidity and mortality following spinal cord injury (SCI), and improving long-term health and community participation; however, this progress has not been uniform across the globe. This review highlights differences in global epidemiology of SCI and the ongoing challenges in meeting the needs of individuals with SCI in the developing world, including post-disaster. Significant disparities persist, with life expectancies of 2 years or less not uncommon for persons living with paraplegia in many developing countries. The international community has an important role in improving access to appropriate care following SCI worldwide.

Preparedness for medical rehabilitation of casualties in disaster situations

Natural and man-made disasters produce large numbers of severely and multiply injured casualties, many of whom survive with severe impairments that require comprehensive and protracted rehabilitation (brain and spinal cord damage, peripheral nerve injuries, amputations). In a disaster situation, even adequately developed rehabilitation services are unable to provide care to the large number of casualties, without advance planning and preparation. Such planning has to consider expansion of available rehabilitation institutions and conversion of other facilities into settings for rehabilitation, and integrating all into a rehabilitation referral system consisting of levels of care. It should further consider strengthening community service for the provision of continuity of rehabilitation care and the preparation of guidelines for adequate management of various categories of disablements at various levels. The paper offers guidance to those in disaster-prone areas, or in anticipation of a disaster, who might wish to undertake the planning, as well as to those who need to organize available services or to set up new ones, once the disaster has occurred.

Trauma system development in Armenia

A medical partnership program between Boston University School of Medicine and the the Emergency Hospital, of Yerevan, Armenia, has been developed to improve the care of the injured in that city. The Emergency Hospital, a trauma center, was site-visited by experts from a Level I trauma center who evaluated prehospital and hospital-based emergency and trauma services and made system-wide recommendations. Recognizing local limitations, the hospital was found to have the leadership commitment, staff complement, and basic infrastructure to meet the American College of Surgeons' criteria for Level II trauma centers. The goal of integration of the academic, clinical, and research roles of a medical center consistent with Level I-type trauma centers was formulated. After 36 months, several issues raised in the assessment are being addressed notwithstanding political and economic turbulence. The Emergency Hospital has established an accredited residency program in emergency medicine; implemented programs for postgraduate medical education of its staff; begun to develop medical information systems; expanded the scope of its activities to other institutions; and restructured the emergency admissions area. Management systems remain largely undeveloped as the discipline lacks recognition as an analytic tool for institutional improvement.

CONCLUSIONS

The use of existing published resources for assessment and improvement of health services in dissimilar health-care systems has been validated as a systematic approach. For system advances to be well-founded, a combination of education, management, and clinical approaches needs to be addressed. Of these, our experience is that management issues are the most resistant to change.