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 Program Resume - The Leonard Cheshire Centre Programmes In Azerbaijan (LCC)

 Duration: 31.12.1995 - present
 Location: Baku
 Sectors: Health

The Leonard Cheshire Centre of Conflict Recovery is part of the much wider Leonard Cheshire organisation, which operates over 130 residential homes and services in the UK and in 51 countries world-wide, to support and empower people with disabilities. It

THE LEONARD CHESHIRE CENTRE
PROGRAMMES IN AZERBAIJAN

by Caroline Kennedy
Coordinator LCC Overseas Programmes

BACKGROUND:

The Leonard Cheshire Centre of Conflict Recovery (LCC) is part of the much wider Leonard Cheshire organisation. Leonard Cheshire operates over 130 residential homes and services throughout the UK and supports over 200 homes and services in 55 countries world-wide, aiding and empowering people with disabilities.

LCC is an academic, medical and surgical centre, set up within the Department of Surgery at University College London (UCL), to support the health and rehabilitation of victims of conflict or disaster, with a particular emphasis in the post-conflict, post-disaster phase. This requires the deployment of relevant skilled personnel, including surgeons of all disciplines, anaesthetists, physiotherapists, dentists, occupational therapists, psychiatrists, nurse practitioners and health visitors, at the invitation of the local government, to observe, teach and train within the local hospitals, communities and refugee camps.

Following an invitation by the Azerbaijan Health and Social Assistance Ministries in 1996, LCC embarked on its first overseas mission. The task was to study the provision of local healthcare and rehabilitation services to the 800,000 refugee and IDP population following the end of hostilities between Azerbaijan and its neighbour, Armenia, and its independence from the former Soviet Union.

Another aspect of LCCs task was to establish academic relations with local doctors and surgeons at Bakus major teaching hospitals and to find out how these hospitals continue to operate without vital equipment, poor facilities and a severe lack of funds within the local healthcare system.

The first in-depth health assessments undertaken by LCCs medical personnel took place, in May and August 1997, within the refugee camps of Saatli and Sabirabad run by the IFRC (International Federation of the Red Cross and Red Crescent Societies). Although the camp clinics, which offer basic primary medicine, were found to be well run by caring local IFRC medical staff and the refugees and IDPs, in general, were mainly in good health, there were several cases who were in critical need of urgent medical or surgical attention.

One case, in particular, a nine year old boy, with severe 2nd degree burns to 60% of the left anterior, distal and posterior lower limb was found to be receiving no medical treatment at all. His mother was pouring boiled water on the suppurating wounds and picking off the necrosed flesh twice a day. His family was unable to raise the funds required for an operation and extensive skin grafts but it was obvious that, without vital surgical intervention, the boy would die of septacaemia or hypothermia. With the help of Save the Children U.S.A., who generously provided the ambulance, LCC medical personnel transported this child to the Institute of Trauma and Orthopaedy in Baku, where they managed to convince Professor Agshin Bagirov, the senior orthopaedic consultant, to waive his professional fees. LCC agreed to pay for medicines, dressings, food and transportation.

THE FAST TRACK PROGRAMME:

This was how the Leonard Cheshire Centre Fast Track programme was born. Soon, with the approval of the Deputy Prime Minister and the Minister of Health and the unstinting efforts of Professor Bagirov and his colleagues at the Institute, other hospitals and their staff became involved. Currently the Fast Track Programme is operating within three participating hospitals:

  • The Institute of Trauma and Orthopaedy
  • The Republic University Teaching Hospital
  • The Nagiyev (First Aid) Hospital, Paediatric Department.

To date the Fast Track Programme has treated or operated on 67 refugee patients, mainly children, and has a waiting list of some 35 further patients.

LCC has recently been invited by Umcor (United Methodist Committee on Relief) to extend the Fast Track Programme to their camps at Imisli and Sabirabad.

LCC believes the appeal of the Fast Track Programme is:

  • that no other organisation is providing similar emergency medical and surgical treatment.
  • due to the generous spirit of local medical staff in participating hospitals, the costs are kept very low. Thus more patients are able to receive treatment.
  • local doctors and surgeons are able use their skills to operate on their own people.
  • patients, particularly children, suffer less stress and trauma receiving operations within their own hospitals in their own country, thereby reducing the length of the recovery period.
  • visiting UK medical personnel are able to work alongside local medical personnel and provide academic support, surgical and physiotherapy training skills when invited.
  • the contribution of local surgeons and hospitals to the Fast Track Programme will be generously acknowledged in academic papers, articles and book chapters published by LCC and University College London.

DRAMA THERAPY PROGRAMME:

Following a successful collaborative two week experimental programme at Echo Camp in April 1998, the Central School of Speech and Drama and LCC have forged long term links. The School has written two field units into their Drama Education Degree Courses which will require 3rd year students to participate, on an annual basis, in LCC projects overseas in the Spring and Summer terms. Both units this year will take place in Azerbaijan.

The first unit, The Professional Settings Unit, which will take place in April 1999, will focus on creating a drama production with refugee children to be presented to the local community. Under the guidance of Central School students, the children will not only take on all the roles themselves but will be encouraged to suggest the subject matter, help write the script, create the music and make the scenery and costumes.

In the second unit, The Collaboration and Application Unit, which will take place in June 1999, the Central School team will take a subject, such as the local attitude towards children with disabilities, and, in a sensitive manner, create a drama around the preselected subject before leaving the UK. The team will then take this production to the chosen country and give performances in front of local communities and in institutions, such as schools, hospitals and orphanages.

PHYSIOTHERAPY TRAINING PROGRAMME:

In response to an invitation by the Institute of Trauma and Orthopaedy and the Physiotherapy Hospital in Baku, the UCL Head of Physiotherapy Services visited Azerbaijan in 1998 to assess the need for physiotherapy skills for post-operative patients both within the hospitals and the refugee camps. The resulting report found that, although the standard of orthopaedic surgery being performed was high, no post-operative physiotherapy was being provided for patients. Consequently there was found to be a high incidence of reduced mobility and unnecessary disability among these patients. A programme of physiotherapy training for medical personnel within the two hospitals was drawn up and agreed.

Commencing in May 1999 two LCC / UCL physios will visit Baku every two months to start demonstrating and teaching their skills to medical staff at the two hospitals. It is hoped to extend this programme, initially to Fast Track patients in the camps, by demonstrating to the patients families the long-term benefits of limb manipulation and by giving simple instructions on muscle strengthening exercises which can help prevent future disability.

ACADEMIC MEDICAL EXCHANGE:

LCC and UCL Hospital have been collaborating with the Institute of Trauma and Orthopaedy since 1996. Secondments of junior medical personnel have been attached to the Institutes Department of Orthopaedics on a regular basis. The aim of these secondments is to widen awareness among hospital trainees of the problems faced by their peers in overseas teaching hospitals suffering in a post-conflict environment. In the longer term, it is hoped to implement links between the two hospitals leading to further secondments and reciprocal visits.

Senior academic and clinical staff have also visited the Institute during these secondments, including burns consultants, orthopaedic consultants, anaesthetists and trauma surgeons. Some have been invited to observe clinical and operational procedures carried out at the Institute. Others have been invited to operate as part of the Institutes surgical team. These visits have resulted in links being forged at a senior clinical and academic level and have helped to provide guidance for deployed junior trainees in instituting research and audit projects. Over the longer term, combined international projects are envisaged between the UK and Azerbaijan. For example, methods and approaches to fracture management are radically different in both countries suggesting the value of a comparative prospective trial.

Reciprocal visits by senior Azeri medical personnel to the UK have also taken place. At the invitation of LCC, Professor Agshin Bagirov, senior orthopaedic and trauma consultant at the Institute, visited UCL Hospital and other UK hospitals in 1997. In February 1999 Professor Qafarov, senior consultant in burns and plastic surgery at the Institute has been invited to the UK by UCL and Stoke Mandeville Hospitals. His colleague, Dr. Kerimov, consultant in Paediatric Orthopaedics will visit the UK in June to attend the 2nd Trauma Care Conference to be held, this year, in Bournemouth.



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