This commentary is by Andrew J. Haig, MD. He is a Lifetime Professor Emeritus of Physical Medicine and Rehabilitation at the University of Michigan and has received numerous international awards, most recently his 2022 Distinguished Advocate Award from the American Academy of Physical Medicine and Rehabilitation. . He practices in Middlebury and Williston.
I’m a local rehab doctor here in Middlebury. Friday morning, I heard a woman I had never seen or heard.
Haben Girma was in Geneva, Switzerland at the time. She moderated the World Health Organization’s Global Report on Health Equity for Persons with Disabilities, which was released on Friday. Her troubles had to do with inequalities in health care for people with disabilities.
I was virtually there as president of the International Rehabilitation Forum. www.rehabforum.org, an organization that builds rehabilitation around the world. By the end of that meeting, I felt I had to take the message back to Vermont.
I will return to Mr. Gilma. Her doctor told her she couldn’t go to school. So, a few years after that bad medical advice, she graduated from her law school at Harvard. Brought from Geneva with a computer with a Braille interface, she eloquently stated the facts. 16 percent of her in the world, or 1.25 billion of her, have a significant disability. They are discriminated against, under-employed, with less social interaction and less access to basic services. be neglected.
Her colleague filled in the details. Not “those people” with disabilities. It is “we humans”. Whether it’s slam dunking a basketball or explaining the Goldman-Stapler-Katz equation, we’re powerless right now. Nearly everyone suffers a significant physical disability during their lifetime. However, a disability only matters if it interferes with a particular activity that the person wants or needs to do, or if other people determine that it is a disability.
The report also shows that every $1 spent on rehabilitation of disabled people brings $10 to society. Strong national and state medical rehabilitation is therefore a smart strategy. A World Health Organization report concludes that health care systems need to acquire specialists to deal with disability.
Here in Vermont, even with voice and braille computer interfaces, Gilma didn’t hear much about rehabilitation medicine. I have almost no special skills. UVM has 6 he to 4 specialists. Dartmouth has the same token number it has had for decades. There are only a handful of us in private schools.
So what happens when there are not enough rehab doctors?
People with disabilities due to spinal cord injury, brain injury, cancer, Covid, stroke, neurological disease, and other problems do not have trained professionals in rehabilitation. Your family doctor, surgeon, physical therapist, etc. will have no one to take care of your back pain, sports injury, or frailty in the elderly.
So they struggle with more surgeries, injections, and treatments, often to no avail, and sometimes with more complications. Requiring only one visit to a rehabilitator for patients referred for treatment reduced surgery rates by a third and saved millions of dollars.
An award-winning study published this summer found that states with fewer rehab doctors had more deaths from opioids.
We need to develop rehabilitation medicine specialists. Currently, UVM does not have any on-site trained doctors. Dartmouth is zero. UMass, Brown, and Yale — strange isolated academic monopolies in New England — have none.
As a matter of fact, doctors trained in my specialty in Vermont are virtually trained on my laptop computer in Ghana, Ethiopia, Cameroon and South Africa.
I am baffled that our small state medical center is finding funding to train spine surgeons, but not training doctors to prevent spine surgery. We train neurologists, but not doctors who treat the consequences of stroke. You can’t help someone with a disability get back to work.
We train general pediatricians, but the experts who ensure that children with cerebral palsy, spina bifida, and other disabilities grow up to become accountants, counselors, and even lawyers like Ms. Gilma. don’t train
But our medical students are passionate about rehabilitation. I’m going out for pizza this Saturday with six of her UVM and Dartmouth medical students who have been hired. Like other doctors I have helped before, these young doctors were “matched” to Miami or Des Moines, where they trained for four years, got married, were offered jobs, and helped people with disabilities in Vermont. I will never go back to take care of you.
It’s time for Dartmouth College and UVM to catch up with universities in these resource-poor countries. Not to mention almost every other state in America. They need to rebuild the financial, political and physical spaces where rehabilitation takes place within the institution. Then you need to recruit visionary young leaders with the skills to build.
They need money too. So they should ask him if OneCare really cares and ask the development office to seek grants, corporate sponsorships, and individual donors.
it has been done before. anywhere else in America. Someone in Vermont just needs to listen to a deaf woman.
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