This OVERVIEW of Rehabilitation in Nigeria was done by Dr Francis Ohanyido as part of MPH Behavioural Class Assignment in Ahmadu Bello University Department of Community Medicine, June 20, 2005.

REHABILITATION:

Identification of those in need of rehabilitation in Nigeria.

Methods of Implementing Rehabilitation in Nigeria

Ohanyido Francis O.

MPH  class

ohanyido@ohanyido.cjb.net/20/06/2005

REHABILITATION

Introduction

Rehabilitation maybe defined as the combined and co-ordinated use of medical, social, educational and vocational measures for training, retraining the individual to the highest possible level of functional ability- WHO (1969) technical report serial no 419. It includes all measures aimed at reducing the impact of disabling and handicapping conditions and at enabling the disabled and the handicapped people to achieve social integration.

Social integration has been defined as the active participation of disabled and handicapped people in the mainstream of community life. Rehabilitation medicine has been ever developing and is cardinally multi-disciplinary with diverse groups like; physiotherapy, occupational therapy, speech therapy, audiology, psychology education, social work, vocational guidance and placement services.

There are four (4) types of approach to rehabilitation medicine: -

 1. Medical rehabilitation          -  Restoration of function

 2. Vocational rehabilitation            -  Restoration of livelihood

 3. Social rehabilitation           -  Restoration of family relationship

 4. Psychological Rehabilitation  -    Restoration of Personal dignity and confidence.

Rehabilitation may be a process predicated on the need to return as close as normal to an original acceptable level of existence, within the cardinal attributes of the United Nations charter of human rights. Lt also follows from the “theory of Hierarchy of Needs” postulated by the psychologist, Abraham Maslow that people have a variety of different needs whether in the pre-, intra- or post- rehabilitative phase of existence.

In most cases of rehabilitation, the purpose is not only to meet up with his perceived needs, but also his positive desires which will enhance his quality of life. In most cases, it will be obvious that the structured concept of Maslow’s Hierarchy of Needs is distorted. An effective rehabilitative process is usually associated with what is known as “Hawthorne Effect” i.e. there is a tendency for persons on rehabilitation to do well when they feel they are receiving special attention for their innate positive desires.

Based on the behavioural concepts relating to illness and the sick role expounded by Edward Suthermann and Parson, may also say that from the point of social medicine, that every sick person needs some modicum of rehabilitation due to the disruption of his level of habilitation.

The foregoing definition has led this author to propose the flow chart below in other to illustrate the interrelated concepts of Habilitation (wellness, able to cope, within social niche), Dehabilitation (dysfunctional, disrupted, disorganized habilitation), and Rehabilitation (reintegration, restoration to habilitation). >See diagram below:

FIG. 1.  OHANYIDO’S H-D-R FLOW CHART

(HABILITATION - DEHABILITATION  - REHABILITATION)                 

              ߬Disruptive /Dehabilitative processes

             ߬Rehabilitative /Re-integrative processes

o       Medical

o       Vocational

o       Social

o       Psychological

 (OUTCOME= 2⁰ Habilitation)

Global Picture

The concept of rehabilitation is as old as man itself and has been practiced in all forms by all cultures in all ramification and spheres of human endeavours. Infact the idea runs through all the charters of the United Nations whether at National or individual levels. For example     

WHO DECLARATION OF COOPERATION 
 Mental Health of Refugees, displaced AND OTHER populations AFFECTED BY CONFLICT AND POST-CONFLICT SITUATIONS (2002) in its 20^th and last article says” Governmental and non-governmental funding sources, United Nations agencies, international organizations must ensure equity in the allocation of financial resources for mental health care and psychosocial rehabilitation of refugees, displaced and other populations affected by conflict.”

Rehabilitative medicine probably came of age probably due to the rather unique needs of Leprosy control and Rehabilitative interventions around the world. All rehabilitative programmes revolve around six cardinal principles and they are as follows;

_ The holistic principle

_ The participatory principle

_ Sustainability

_ Integration

_ Gender sensitivity

_ Sensitivity to special needs

The Nigerian Picture

    Rehabilitation is practiced in Nigeria as everywhere else.

IDENTIFYING THOSE IN NEED OF REHABILITATION IN NIGERIA

For the purpose of appreciating the great ambit of the rehabilitative process in Nigeria, the processes can be viewed from five areas of Relatedness. These areas of relatedness are by no means exhaustive, but purely for explanatory and system diagnostics purposes. It must also be noted that some of these categories overlap each other, for example bombasts which comes under crisis/trauma   trauma group has a high medical relatedness.

1.  Social- Related Situations

o       Street Beggars

o       “Area Boys”

o       Prisoners

o       Prostitutes/Commercial Sex Workers

o       Substance Abuse Addicts

2.  Age-Related Situations

o       Old- Geriatric, War Veterans (Legionnaires)

o       Retired Non-geriatric

o       Young         -Child Labour, Child abuse, child trafficking, street      urchins/beggars, child combatants /soldiers, orphans, polio handicapped

3.  Trauma/Crisis-Related Situations

o       War destitute/ refugees/ victims of landmines

o       Sporadic disasters- Munitions bombasts, Fire, Ethno-religious clashes, Floods etc

o       Torture/rape

o       Civilian firearm injuries 

o       Large scale accidents- Munitions bombasts, Fire, Floods etc

4.  Culture –Related Situations

o       Female Genital Mutilation

o       Widow Rights

o       Slaves / caste system

5.  Medical –Related Situations

o       Vesico-vaginal fistula

o       Cardio-vascular accidents / stroke

o       Occupational accidents

o       Leprosy

o       Acid attack and sever burns deformities

Social- Related Situations

Street Beggars (Mendicants)

This group of people is a heterogeneous group ranging from young to old, women and men, singular or in group with varying ranges of deformities that led them to the begging profession. There are occasionally healthy individuals who beg for a living. In the far North, this is common due to the engendering atmosphere. Recently, there has been an increasing trend of begging among destitute pensionable old men alongside the influx of illegal aliens from impoverished and war –thorn area like Chad and Niger. Some of these aliens have been utilized in distabilising Nigeria in the past for example one may recall the Maitatsine religious crisis in Kano.

Presently both the Lagos and Kano state governments who have seen the bulk of these influxes have been making efforts at rehabilitation. In Tekunle, in the outskirts of Lagos, there is a state of the art vocational facility with choice areas of learning, which is nearing completion. The idea is to first take a census of these mendicants and then group them for the sake of the programme that also takes into cognizance their individual handicaps.

The Rehabilitation of “Area Boys”

LAGOSIANS presently have every reason to be happy. Indeed many of them recently heaved a sigh of relief with reports that the Lagos State government has concluded plans to put an end to the menace or nightmare called "area boys" in the state. This is one group in need of rehabilitation can be said to be purely a homegrown ‘Lagos phenomenon’. For the past few years, especially since the commencement of the present civilian administrative dispensation, Nigerians and foreigners alike who live, work or do business in Lagos, particularly in the Lagos Island part of the state have had to contend with the menace of these miscreants who delighted in terrorising law-abiding citizens. With little or no intervention from law enforcement agencies or protection from the state government Lagosians were virtually left at the mercy of these unscrupulous undesirable elements who behaved as if they were on a vengeful mission against society.

For instance, shoppers and motorists in Central Lagos usually receive a raw deal in the hands of these miscreants who use every guise to extort money from those going about their lawful businesses. Businessmen and women operating in the area are coerced or blackmailed into paying them protection money, same as those who come to buy goods. Partially exempted from this extortion racket are banks and other big time corporate organisations, which took steps to secure their business premises with Police protection. So, business operators who are not big or influential enough to arrange or organise their own Police protection had no choice but to succumb to the blackmail of the area boys by paying their illegally imposed sundry levies.

But the good news at the moment is that the Lagos State government has at last resolved to put the reign of terror by these area boys to an end. But while they will no longer be allowed to terrorise and harm innocent citizens, the government of Bola Ahmed Tinubu is presently putting in place a socio-economic programme to rehabilitate these miscreants. The programme encapsulates the setting up of a skills acquisition centre meant for the social miscreants and lay-about youths in the state, located at Tekunle Island (Ila-Oko), near Ise, Lekki Peninsula area. The program is supposed to have taken off in the first quarter of 2005. the centre would be ready for commissioning and become operational as soon as the new tools had been fully installed. The project, according to him has so far gulped N110 million and has attained 80 percent completion. The 4200 square metre centre, has facilities for training residents in fabrication, capentary, weaving, an agriculture component (involving snailry, poultry and fish production), detoxification centre, clinic, and residence for 200 along with a staff quarter and helipad. The pilot phase of the rehabilitation programme would exclude females and would be based on offering the youths an opportunity for change. The six months period of residence is expected not only lead to complete rehabilitation but also lead to the internationally recognised trade test certificate. The state envisioned a two-pronged plan for rehabilitation

Prisoners Rehabilitation

Many prison rehabilitation programs have been in existence since colonial period, which revolves around acquisition of vocational skills etc. One particular man has developed an introduced a unique rehabilitative method into Nigeria. Succeeding where human rights organizations have for the most part failed, Emmanuel Ache's (Nigeria 1995) project focuses on several key issues to facilitate the release and rehabilitation of prisoners from Nigeria's over-crowded prisons.

The New Idea In superficial continuity with traditional norms, Nigerian prisons operate with a strong belief in punishing and humiliating lawbreakers. To put it mildly, rehabilitation has not been a priority of the under-funded, poorly run and dramatically overcrowded penal system. For years, human rights advocates have confronted the system with its sins to little avail. Now Emmanuel Ache is demonstrating notable success with a more conciliatory approach that provides desperately needed services to prisoners in a way that eases the burdens of prison officials. The intention is to insinuate world-class criminal rehabilitation practices into Nigeria's criminal justice and penal systems. He puts it rather differently when he is pitching his program to prison officials. Having figured out that prison officials also pay a heavy price for the mal-administration and chronic shortages of every kind that characterize Nigerian prisons, Emmanuel's first step is to offer to handle some of the administration for them. Accordingly, the project starts by arranging legal assistance, processing legal papers, providing transport to and from court, and putting prisoners in touch with family members. For the vast majority of Nigeria's prisoners, these mundane services arrive almost like a miracle.

Having established his credibility in this way with both officials and prisoners, Emmanuel moves on to provide education, training and counseling to prisoners to prepare them, vocationally and emotionally, for re-integration in society. For newly released prisoners he offers a range of services, beginning with emergency medical care and proper food for that significant number of prisoners who are near death from malnutrition and disease upon release. When they are stronger, he makes certain they have money for transportation to go home to their families. The program however goes beyond these simple if desperately important intermediary forms of assistance to newly released inmates. Emmanuel has established the first halfway house and vocational training program in Nigeria to give released prisoners a chance to develop marketable skills. The halfway house operates through partnerships with a number of employers who will get to know an inmate through contract work and, if satisfied, may eventually provide a full-time job. Now having a demonstrable impact in the country's main prisons in Lagos State, Emmanuel is planning the extension of his work to the country's other prison systems.

The Problem :At every point, Nigeria's prisons are a national scandal. Large numbers of prisoners are denied due process of law after arrest and held illegally, some for years, merely for want of simple administration or logistics, for example unprocessed or "lost" legal papers, lack of transport to bring them to court for arraignment, absence of legal assistance. Even when a friend or relative hires a vehicle to bring a prisoner to court, taxi drivers often refuse to carry them when, not infrequently, they are found to be in near-death condition.

The medium security prisons around the country, which house the poor an as they are called, "anonymous" prisoners, have the worst conditions, housing more than twice the number of inmates than beds available. Often, their own families and loved ones do not know where the prisoners are. If they do know, they are powerless to help because of poverty or lack of information about how they might help. Many inmates don't know why they have been imprisoned or how they can get out. They are unaware of their rights to legal advice and to minimum nutritional requirements. Some think about little else but their plight; despairing, they become unruly and hardened.

Those prisoners who are released receive nothing from the prison authorities. If they must travel many miles to reach their homes, they may either beg or steal from the public for their fares. Some have been known to be re-arrested and returned to prison for stealing car fare on the same day they are released.

Despite best efforts by prisoner rights advocates, there is virtually no independent monitoring of prison conditions. Lawyers are rarely allowed entry into these facilities, and have had little impact on the conditions when they do. Both prison and court officials tend to perceive the lawyers as confrontational, and meet efforts unsympathetically.

The Strategy

In this context, to attempt to introduce meaningful rehabilitation is not unlike cleaning the fabled Aegean stables.

Emmanuel has tackled the problem by breaking it down into manageable tasks, beginning with the administrative and resource constraints hindering arraignment for new detainees. With the full cooperation from the prison authorities, who also suffer from the ill-consequences of chaotic administration, Emmanuel's organization facilitates the preparation of the paperwork for arraignment and provides a bus for transport to court for the preliminary hearing, at which they accompany the prisoner. The transport and accompaniment service has, by itself, precipitated the release of many prisoners against whom the state had no real case. Where appropriate they contact legal aid organizations, intermediate with the lawyers, and contact the prisoners’ families to ensure that they know where and how they are and what their needs may be. Between mid-1995, when the program began, and early 1997, Emmanuel's efforts resulted in the release of 1,416 prisoners.

These activities generate tremendous good will among prisoners and prison officials alike and create a climate in which Emmanuel's organization can take the next step of introducing vocational education and counseling (for re-integration into society). Specific job skills are taught, often linked to contract work for businesses that could provide employment upon release. "Re-integration" sessions include video films to stimulate prisoner discussion on moral issues and role-playing. Noting that exchange and learning among prisoners is natural and continuous, he uses prisoners as teachers in his programs whenever possible. This strategy contributes to the sense of dignity of both the "teachers" and those they educate.

Upon their release, the ex-prisoners are often sick, malnourished and barely clothed. Emmanuel's organization provides emergency medical care, wholesome food, clothes and, when they are stronger, he makes certain they have money for transportation to go home to their families. The project goes beyond these simple if desperately important forms of relief to newly released inmates. He has established the first prisoners' "half-way house" in Nigeria to help in the process of giving released prisoners marketable skills. The halfway house provides temporary accommodation, vocational training and certification, introductions to formal employment through apprenticeships, and counseling through the difficult transition back into society. Looking forward, he believes that the project needs to develop specialized expertise to address common inmate problems such as drug and alcohol dependency and related psychological problems.

Emmanuel calls his organization the Good Shepherd Half-Way Home Community and Rehabilitation Project and runs it with a diverse range of volunteers who specialize in different activities. A team of ten volunteers in Lagos, for example, visits the families of inmates to prepare them to receive their sons after release from prison. Three of the volunteers are themselves ex-inmates who now work with him full time sharing in his abstemious life and helping to free others. Two are university graduates who were previously arrested by the police on minor charges.

The initial efforts in Nigeria's first city, Lagos, has been successful, the plan is to replicate his program throughout the Lagos State system and spread it nationwide over the next five years.

Age- Related Situations

. Rehabilitation of Child  beggars/Child Labor victims in Nigeria

In 1998, the International Labor Organization (ILO) estimated that 24.6 percent of children between the ages of 10 and 14 in Nigeria were working. In 1994, the United Nations Children’s Fund (UNICEF) reported that approximately 24 percent (12 million) of all children under the age of 16 worked.

Child labor is found predominately in the informal sector. In rural areas, children are found working in agriculture and on family farms. They are seldom employed by state-owned commercial agriculture plantations, which are responsible for much of the agricultural production for export. In cottage industries and mechanical workshops, children work as apprentices in various crafts or trades such as weaving, tailoring, catering, hairdressing, and auto repair. In urban areas and towns children work on the streets as vendors, car washers, scavengers, beggars, head-load carriers, feet-washers and bus conductors. In 1996, the Child Welfare League reported that in Lagos alone there were 100,000 boys and girls living and working on the streets. In northern Nigeria, children, known as the almajirai, survive on the street by begging. Children in prostitution and trafficking of children are reported in Nigeria. According to a 1998 report by the International Labor Organization (ILO), the incidence of child prostitution has been growing. A separate report revealed that 19 percent of the school children and 40 percent of the street children surveyed had been trafficked, and nearly all of the trafficked children were economically active. Trafficked children are employed in agriculture and herding, and as domestic servants, sex workers, drug peddlers, hawkers, petty traders, beggars, car washers, and bus conductors.

Child traffickers take advantage of a cultural tradition of “fostering,” where a poor, usually rural family sends a child to live and work with a family in an urban area for educational and employment purposes. Often, children in these situations do not receive any formal education. Instead, they are forced to serve as domestic servants, become street hawkers, or engage in other activities, and many of them are vulnerable to physical and sexual abuse by their guardians. There are also credible reports that poor families sell their daughters into marriage under the guise of fostering as a means of supplementing their income.

Nigeria is a source, destination, and country of transit for trafficking of children. Children are trafficked to and from Cameroon, Gabon, Benin, Equatorial Guinea, Togo and other West African countries to work in agricultural enterprises, as domestic servants, or as prostitutes. Trafficking of children has been particularly pronounced in eastern Nigeria and in some southern states. There are also reports of trafficking of children to non-African countries, such as to the United States and Europe.

2. Children’s Participation in School

Recent primary school attendance rates are unavailable for Nigeria. While enrollment rates indicate a level of commitment to education, they do not always reflect a child’s participation in school. Gross primary school enrollment has declined in Nigeria from approximately 86.2 percent in 1993 to 70.3 percent in 1996. Dropout rates for both males and females in primary school remained high, around 10 to 15 percent between 1990 and 1994 for each level of education. Only 64 percent of the students in primary school completed grade five, and only 43.5 percent continued on to junior secondary school. School quality has reportedly deteriorated in Nigeria, and recent school reforms have been slow to take effect. Teachers are not well trained and are poorly paid, making them less motivated and contributing to poor or irregular school attendance among children. A bias frequently exists against girls’ education, particularly in rural and northern areas of Nigeria. Only 42 percent of rural girls are enrolled in school compared with 72 percent of urban girls. In the north, girls are often withdrawn from school and placed into early marriages, domestic and agricultural labor, or commercial activities such as trading and street vending. In addition, there are reports that school-based gangs target girls, raping or killing them as part of gang activity.

3. Child Labor Law and Enforcement

The Labor Act of 1974 prohibits the employment of children under the age of 15 in commerce and industry and restricts labor performed by children to home-based agricultural or domestic work. The Labor Act of 1974 stipulates that children may not be employed in agricultural or domestic work for more than eight hours per day, and that children under the age of 12 cannot be required to lift or carry loads that are likely to harm their physical development. The Labor Act of 1974 also prohibits forced labor.

The Ministry of Labor and Productivity’s Inspections Department is responsible for enforcing legal provisions relating to conditions of work and protection of workers. There are, however, fewer than 50 inspectors for the entire country, making it difficult for them to fulfill these responsibilities. Moreover, the Ministry conducts inspections only in the formal business sector, although most child labor occurs in the country’s informal sector.

4. Addressing Child Labor and Promoting Schooling

a. Child Labor Initiatives

On August 8, 2000, the Government of Nigeria signed a Memorandum of Understanding with the ILO, becoming a member of the ILO’s International Program on the Elimination of Child Labor (ILO-IPEC). As part of efforts to address child labor in the country, the Government of Nigeria and IPEC, with funding support of the U.S. Department of Labor (USDOL), have launched a country program and established a National Steering Committee that includes representatives from the government, labor, industry, and nongovernmental organizations (NGOs). The steering committee is responsible for developing and overseeing implementation of a national plan of action on child labor. In addition, Nigeria has carried out a national child labor survey with technical support from ILO-IPEC’s Statistical Information and Monitoring Program on Child Labor (SIMPOC) and funding from USDOL.

Nigeria is also active in an ILO-IPEC regional project, funded by USDOL, to combat trafficking of children for labor exploitation in West and Central Africa. The first phase of the project involved an assessment of the trafficking problem in nine African countries, including Nigeria, and workshops at the national and regional level to review country-level findings. A national plan of action to combat trafficking in Nigeria has been developed by the Federal Ministry of Women Affairs and Youth Development with support from ILO-IPEC and the UNICEF. In July 2001, a second phase of the project began focusing on direct action to assist children who are victims of trafficking, raising awareness, strengthening local capacity to address the problem, and enhancing regional cooperation to address trafficking.

UNICEF has established a series of programs for street children in Nigeria and launched a collaborative project with ILO-IPEC specifically aiding the almajirai children. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) funded a study on street children in 1995, which was implemented by the Child Life Line, a local NGO. The Child Life Line opened centers to rehabilitate street children in Lagos based upon its findings, and in 1999, hosted a workshop to help other NGOs set up effective street children focused programs. Many other NGOs, such as the Child Project, Galilee Foundation, Kingi Kids, the Friends of the Disabled, and the Samaritans are also involved in efforts to rescue and rehabilitate street children.

b. Educational Alternatives

In September 1999, the president of Nigeria launched the new Universal Basic Education plan that requires the first nine years of schooling to be free and compulsory. The plan aims to improve the relevance, efficiency, and quality of schools and to create programs to address the basic education needs of nomadic and out-of-school children, youth and adults. In its 2000 budget, the Government of Nigeria budgeted 46 billion naira (US$460 million) to support this plan.

The Federal Ministry of Women Affairs and Social Welfare has worked in collaboration with UNICEF and the Centre for Non-Formal Education and Training (CENFET) on a non-formal education curriculum for girls, children without access to school, and school dropouts, particularly those from Koranic schools where girls account for 60 percent of all dropouts. These efforts have contributed to an increase in enrollment, particularly among girls, and enhanced opportunities for non-formal and nomadic education. In a pilot project in Sokoto state in Northern Nigeria, enrollment in basic education rose from 914 pupils in 1996 to 115,525 pupils in 2000, of which 73,291 had passed their exams. The project recorded a less than 0.2 percent dropout rate, with fewer girls dropping out than boys.

Trauma- Related Situations

Rehabilitation of Trauma Victims

Trauma is accidental and non-accidental injuries inflicted on a person. Injured patients constitute a notable proportion of people treated as emergencies in orthodox medical institutions and non-orthodox health clinics in Nigeria. Trauma and infection are the very common causes of premature deaths in Nigeria. Infection has been and is still being tackled on all fronts; but injuries from road accidents, sporadic disasters and civilian firearms remain neglected. 

Causes and Types of Trauma in Nigeria 

The leading cause of fatal injuries in Nigeria is road traffic accidents followed by sporadic disasters and civilian gunshot injuries. 

Road accidents (RTA); Drivers are responsible for over 50% of road traffic accidents and pedestrians constitute a significant proportion of the casualties. The peak incidence of injured pedestrians occurs in children within 6 and 12 years of age2. Alcohol and drug ingestion by public vehicle drivers adversely influence their behaviour behind the steering wheel.

Sporadic disasters; A disaster is an incidence resulting in mass human casualties and destruction of properties, which overwhelm the emergency medical resources, and other capabilities of the community. Sporadic disasters are no longer sporadic in Nigeria, for the occurrence has been on the increase. The most common are fire disasters involving markets, petroleum pipeline leakages and burning of tall sensitive government buildings. Explosions occur from petroleum pipeline leakages, adulterated kerosene and neglected military bombs. Other sporadic disasters resulting in mass casualties are stampeding mobs, plane crashes, ferry disaster, religious and tribal violence and inter boundary conflicts. Mass injury also occurs from violent protesters, riots and police anti-demonstration violence. 

Natural disasters such as earthquakes, tornadoes, hurricanes, mudslides, and erupting volcanoes are rarely heard of in Nigeria. Limited flood disaster occurs occasionally. Nigeria has not yet put in place systems to handle effectively, any form of disasters, be it natural or acquired. Nigeria has been free of war disasters since the cessation of Nigeria- Biafra hostilities in 1970.

Civilian firearm injuries 

Blunt trauma is the major etiology of injuries in Nigeria; though penetrating gunshot wounds have significantly increased. . Prior to the Nigeria-Biafra civil war, civilian gunshot injuries were rare and caused by hunting mishaps from (locally made) Dane guns. Gunshot firearm injuries increased dramatically in the late 1970’s and in the 1980’s with the advent of armed robbery attacks in car snatching and in homes.

Other causes Industrial mishaps, domestic burns, acid attack, and glass accidents, penetrating stab wounds from knives and daggers, falls and assaults, also cause intentional, and unintentional, trauma. 

Clinical Presentation of Trauma 

Injured patients present to hospital in a variety of ways; blunt or penetrating injuries (often abdominal or thoracic); contusions, lacerations or avulsions superficial or flaps; soft tissue injuries - major or minor; bone fractures closed or open; crush injuries to hands and limbs. These injuries occur in isolation or in multiples (poly-trauma). The multiplicity of organs injured normally increases the severity of the injury. Yet, a single injury, e.g. to the head, can be fatal. 

Management 

There are three major peaks of incidence of death in relation to the time of injury. Injury deaths in the immediate phase that are not preventable, unless detection is immediate and therapy immediately administered, are responsible for about 50% of total injury deaths. The second peak of deaths (30%) occurs within a few hours and is due to the effects of hemorrhage and shock. The third peak of 20% of deaths is seen a longer time after injury. The latter deaths are due to sepsis (systemic inflammatory response) associated with adult respiratory distress syndrome (ARDS) or multiple organ failure (MOF). These complications are not fully understood and patients who have received “excellent” medical and surgical therapy may die. In more than 30% of bacteraemic patients dying of sepsis or MOF, no septic focus could be identified either clinically or at autopsy5. 

Pre-hospital Emergency Service (PHES) in Nigeria 

Effective pre-hospital emergency service is required to reduce the death toll in the immediate and acute phase of injury. Controlled PHES has not been established in Nigeria, for there is no basic ambulance service in any city, town or village. In a study of pre-hospital and emergency department care in Lagos, only 6% of injured patients were conveyed in ambulance to hospitals and health centres and 94% were transported in public vehicles and private cars. Information mismanagement was primarily responsible for the loss of over 1000 fleeing victims who perished in a swamp 4 kilometers away from the site of the explosions in the bomb blasts. Rapid response disaster management teams must be in place and constantly ready to go into action whenever disaster occurs. These teams would include, medical, police, Federal road safety corps, firefighters, military and voluntary organizations e.g. the Red Cross. Basic and advanced trauma care systems with organized PHES and regional trauma care systems should already be in operation for the disaster management effort to be successful. . 

Hospital Care and Trauma Systems 

On arrival in the hospital, injured patients receive treatment in the casualty or accident and emergency department and are admitted for definitive care depending on the severity of injury.

Control and prevention of Injuries

 Injury prevention is the goal of trauma care. In the Nigeria situation, it would involve avoiding potential road accidents, sporadic disasters e.g. petroleum pipeline leakage explosions in which mass incineration of Nigerians occurred. Civilian firearm injuries should also be prevented; and possession of handguns by Nigeria citizens should not be encouraged. 

Rehabilitation 

The success of treatment of the injured patient is measured by how quickly he returns to a productive life. Hence rehabilitation should be built into the management of the injured from the outset. After surgical operations, injured patients invariably need rehabilitation from several units including physiotherapy, occupational therapy, medical psychology, social work and dietetics. This may extend into months and years and counseling should commence before and continued after surgical procedures. Rehabilitation is an area where much research is desirable and funding sought. The scope of rehabilitation depends on the nature of injury and resultant impairment. For example Loss of limb in industrial hazard may necessitate vocational and psychosocial rehabilitation. In some cases use of wheel chair may be necessary.

An NGO, Impact for Change has been organising psychosocial rehabilitation for children of Lagos cantonment explosion children, including those of Oke-oba fire disaster to help them through the trauma.

Medical- Related Situations

Socio-Economic Rehabilitation of Leprosy Victims in Nigeria

Social and economic rehabilitation of people affected by leprosy is a major priority of International Leprosy Eradication Program (ILEP ) and its member associations. Social and economic rehabilitation (SER) programmes for people affected by leprosy exist in many countries around the world including Nigeria. They differ in content and in context. While poverty is a common factor, they face different challenges and opportunities. Can standard guidelines be of help? We have sought to identify the broad principles and approaches that have been found to work in existing successful SER programmes. These guidelines provide individuals and organisations with the information and tools they need to ensure project activities are appropriate and of real benefit to those in need. The guidelines provide sensible help and ideas for those starting a new project as well as for those already involved in SER activities. We believe that the guidelines will prove to be practical and effective, since the contents have been distilled from the contributions and experience of those actively involved in the field.

Leprosy control programmes are increasingly recognising the importance of SER as a vital aspect of leprosy work. There is now the opportunity to develop new areas of expertise based on the compassion for individuals, which has marked leprosy services in the past. New skills are needed, new approaches have to be tried, and new alliances have to be made. It is important to seize the opportunity and adopt innovative approaches, which benefit those in need and enhance their dignity.

It is important to reflect on the experience of others before applying their conclusions in a new situation. These guidelines bring together a wealth of experience in one document. They will generate new ideas, encourage new approaches and promote the sharing of information among all those involved in the field. May they also serve as a source of personal encouragement to all those seeking to bring an Improved quality of life to people whose lives have been affected by leprosy. The developments that led to the current interest in the rehabilitation of people affected by leprosy. There is now a clearer understanding of priorities and of appropriate ways to respond; three general principles are identified.

The context for the work is the broader impact of leprosy. The focus must be upon the concerns of people affected by leprosy and their families and communities. The various approaches adopted by current programmes are used to demonstrate operational principles recognised as important in rehabilitation. Issues that need to be considered when developing strategic aims and objectives are identified. Caused by leprosy. To a greater or lesser extent they have experienced the stigma associated with the disease for centuries, the fearful attempts at concealment, the trauma of increasing impairment. Although many people are resilient enough to cope with the effects of leprosy, others need help if they are to resume their previous way of life. These individuals are the focus of SER programmes. The scope of the rehabilitation process is now better understood. The approach to SER should therefore be based on three principles:

1. A recognition of the broad impact of leprosy on the individual; in other words, its physical, psychological, social and economic effects.

2. Responsiveness to the concerns of individuals affected by leprosy. This requires an approach that restores dignity and self-respect; in other words, participation and empowerment.

3. Sensitivity to the concerns of the families and communities affected by leprosy. Members of the family and the community have an important role to play in rehabilitation.

Conclusion

From the fore going, it can be seen that Rehabilitation encompasses all facets of man’s endeavours and many problems plaguing Nigeria require some level of identification and rehabilitation of those directly or indirectly affected.The width of this overview on rehabilitation can not be totally trashed in this small overview , rather this should serve as a gateway to peek at the vista.

REFERENCES

1.     WHO (1969) technical report serial no 419

2.     Map of Nigeria- courtesy Source: Central Intelligence Agency (CIA)   | Date: 01 May 2003

3.     ILEP ;G U I D E L I N E S F O R T H E S O C I A L A N D E C O N O M I C R E H A B I L I T A T I O N O F P E O P L E A F F E C T E D B Y L E P R O S Y

4.     www.dol.gov/ilab/ Child Labor in Nigeria

5.     Child Welfare League of Nigeria, Alternative Report on the Implementation of CRC, submission to the CRC, September-October 1996 [hereinafter Alternative Report ], as cited in The Worst Forms of Child Labor: Country- Wise Data October 2000 (New Delhi: The Global March Against Child Labour, 2000).

6.     http://www.thisdayonline.com/news/20040926news22.html