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Rehabilitation Rights: The Never-Ending Fight for Restoring Meaning and Purpose, Through True Holistic Management

By Ashley Scott
on April 3, 2023

In South Africa, we recently celebrated Human Rights Day where we reflect on how far we have come as a country in terms of our human rights since the Sharpeville Massacre during the Apartheid Era. This day prompted me to reflect on which human rights are close to my heart and whether these are being enacted and what work still needs to be done.

It is no surprise that the first right that I reflected on, is access to health care, specifically rehabilitation. I am passionate about this topic, because it is something this is passively classed a luxury that only those who can afford it can benefit from and is a crucial aspect in restoring and maintaining dignity.

As with the majority of literature around rehabilitation, academics and society concur that rehabilitation is a crucial healthcare service. The World Health Organization (2019) has noted that rehabilitation is not a luxury and is important in a world that is experiencing growing levels of multi-morbidity, chronic disease and disability. Accordingly, the organization considers access to rehabilitation as a part of the Sustainable Development Goals (SDGs), first of all under SDG3 (Good health and wellbeing), but the issue is obviously also relevant to SDG 1 (Eradicate Poverty), SDG 4 (Education), 8 (Decent work and economic growth) and 10 (Reduce inequalities). There are multitudes of academic papers that indicate that the benefits of rehabilitation are unquestionable. However, this is where the disconnect occurs: if rehabilitation is so obviously a healthcare right, why are so few people receiving it?

I like to think that I would have enjoyed being an old, Greek philosopher like Aristotle or Socrates, answering big questions while sitting under an olive tree, but my pondering moments tend to come as I am falling asleep. After reflecting on rehabilitation during the day, as I was falling asleep, I started thinking about health and rehabilitation and a question came to me: how do we know that someone has moved from being unhealthy to healthy and where is the line? Secondly, how does this play out on a day to day basis for a person who is ill? These specific questions were swirling around my mind, as I think that they both play a pertinent role in the accessibility of rehabilitation.

If we look at a generic example of a patient seeking healthcare, this scenario is simple. Signs and symptoms are provided, physical examination done, diagnosis made and treatment provided. Dependent on who your healthcare provider is, and their approach to healthcare, this may differ. A clinician who uses a biomedical approach to care will provide a very different treatment and possibly a different outcome to a clinician who practices a biopsychosocial approach.

Unfortunately, the “biopsychosocial model” and “holistic medical management” tend to be categorised with ethics, data protection and compliance in terms of healthcare professionals’ interests and tend to only be studied for Continuous Professional Development points. The Biopsychosocial Model promotes the understanding of a patient’s psychological and social status as well as their illness in order for health to be holistically managed. My suspicion is that this is where the line becomes blurred, because the psychological and social aspects of health are at times not within the scope of all healthcare professionals, and tend to be ignored by our more biomedically inclined colleagues. I saw this situation playing out several times: a patient comes in who has suffered a Stroke with a dense hemiplegia. The doctor controls their blood pressure and tells them that their symptoms will improve but this will happen slowly so they can be discharged home but must swing by rehab on the way out for a wheelchair. The patient was healthy right? “Their BP was controlled. Pain is being managed. Can’t fix the hemiplegia with medication- just gotta wait it out.”

The problem is that although the patient is symptomatically managed and in this case no longer deemed as acutely ill, he/she is not yet healthy. All of the gooey psychological and social sides of the patient’s health are central to getting them back to their optimal level of health.

“Optimal level of health.” Another broad and vague term prancing along the line of health and wellbeing, which generally describes living your best life. Rehabilitation views your “best life” in terms of function and how you are able to carry out your daily roles, routines and habits after you have been affected by an illness, impairment and disability. Medicine adds years to life; rehabilitation adds life to years. As such, rehabilitation is impossible without considering the social and psychological (as well as biomedical) aspects of the patients’ lives that they are returning to. Rehabilitating a confident, optimistic, wealthy investment fund manager back to work after a stroke will look completely different to rehabilitating an elderly lady with no family who suffers from depression and will be moving to a state retirement village after her stroke. The detail behind their life story and personal factors dictates the goals that need to be achieved and the obstacles that need to be overcome to be able to function at their optimal level of wellbeing. Rehabilitation can be viewed as the pair of prescription glasses that provide clarity to the “health line”, differentiating ill health from wellness and wellbeing, and the most efficient route to cross the health line.

The injustice of not having access to rehabilitation is not only devastating in the personal effect that it has on the patient’s life, but also on the community around them, that will need to cope with a sudden loss of a productive and meaningful community member. The South African term “Ubuntu”, describes the effect of an illness or disability in the community best- “I am, because we are”. Take, for example, a patient with a stroke who used to be the breadwinner, and now his wife is going to have to look after him at home which means that she can’t work either, which means that their children cannot afford to go to school, reinforcing the poverty cycle of the community through stunting opportunity. The likelihood is that they are accessing state health services, where rehabilitation professionals are few and far between or the benefits of rehabilitation are unknown so the referral is never made.

Practical ways to promote holistic management

In short, my suggestions to all healthcare professionals regarding the right to accessing healthcare, and specifically rehabilitation, are simple:

  1. Don’t be scared of empathy for your patients- lean into it and use it to strengthen the biopsychosocial approach to care. There has historically been a bad reputation for healthcare professionals who care “too much” for their patients. As long as you are setting boundaries for your own mental health, your patient’s medical care may improve with increased empathy. The healthcare professionals that I have always admired, always spent time with the person, not the illness. 
  2. Medically stabilising a patient does not automatically imply health.
  3. Refer to rehab (Physical Therapy, Occupational Therapy, Speech Therapy, Psychology etc), refer sooner rather than later and when in doubt- ask. I have had my fair share of seemingly peculiar referrals as an Occupational Therapist however, we are more often than not, able to assist and make the transition over the line from illness to health, a bit smoother with a generally quicker and better outcome.

My last plea is to the funders and policy makers: please consider rehabilitation programs when deciding on where to donate and when building policies. Rehabilitation is almost always over-looked for funding, resulting in a larger population of people who are surviving their illnesses, but not living healthy and functional lives. Help people to survive after they have survived; provide the colour back into their days after illness and fully experience their fundamental human right to true health.

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