“What problems do military personnel face during rehabilitation?”, — write: www.pravda.com.ua
Last autumn, “Princip” completed the study “Rehabilitation of Ukrainian military and veterans: experience of overcoming non-systematics”. The name is telling, because at each stage of the path of the wounded, problems were recorded that significantly complicated the process of successful recovery of the interviewed fighters.
The identified problems will obviously not surprise anyone who has encountered this field: a complex route with non-obvious steps; bureaucracy, which prevents receiving rehabilitation services at the time of need; actually the services themselves, which do not always meet the needs of the wounded. And, of course, there were complaints about the non-inclusive nature of the premises. However, the data was collected to develop actionable recommendations for those empowered to change the field, not just to identify pain points.
Let’s analyze the conclusions of the report in more detail.
Availability of rehabilitationLet’s start with the fact that adequate rehabilitation of servicemen is hindered by their legal status, which in practice results in excessive bureaucracy: obtaining the necessary documents slows down the provision of rehabilitation assistance. That is, those who were wounded on the battlefield, and in the future must return to the ranks of the Security and Defense Forces, already have lower chances of receiving timely rehabilitation than civilians.
71% of respondents reported shortening or interrupting rehabilitation due to bureaucratic procedures, and only 11% of respondents completed all necessary rehabilitation cycles.
58% of respondents reported that they did not receive rehabilitation during the acute period. These are the first hours and days of a wounded person being treated in a health care facility. It is during this time that the patient’s condition should be evaluated and the provision of rehabilitation assistance should be started, so that the prospects of restoring the lost functions are higher.
In general, military personnel and veterans cited the following reasons that prevented them from completing rehabilitation:
- they did not receive information about the need to continue rehabilitation at all (35%);
- the military unit did not allow rehabilitation to continue (26%);
- the military medical commission did not extend the leave or did not indicate the need for rehabilitation in the decision (37%).
Therefore, the legal status of a military serviceman often leads to the shortening of rehabilitation terms and the interruption of rehabilitation cycles in order to coordinate bureaucratic procedures.
Routes of the woundedOn average, one soldier or veteran changed four institutions for treatment and two institutions for rehabilitation, that is, we can talk about 6 health care institutions in which a wounded person stayed for the purpose of treatment and rehabilitation. We are also talking about treatment facilities, since rehabilitation should begin as early as possible.
A third of the military reported being forced to change rehabilitation facilities due to completion of rehabilitation cycles. 47% said that they searched for the next institution for transfer on their own or involved relatives in this process.
One of the important obstacles on the way – the respondents talked about the need to find the exact institution where there are the necessary rehabilitation specialists who work with a certain type of injuries. For this, the wounded and their families had to independently contact institutions and coordinate all bureaucratic procedures with the military unit.
Military and veterans said they lacked information about what type of rehabilitation was available at which facilities. Due to the frequent change of institutions, they came into contact with different specialists, and therefore with different approaches to the provision of rehabilitation services. The wounded were left alone with narrow-profile information, meanwhile the recovery process was obviously delayed.
Satisfaction with rehabilitation servicesDuring the research, a fairly high proportion of those satisfied with rehabilitation services was recorded – 57%. However, one cannot be sure about the quality of such services, because there are no standardized approaches to providing rehabilitation in Ukraine, and outdated practices in providing such assistance are still popular. Service recipients may be satisfied, but this does not indicate good quality or responsiveness to respondents’ needs. The problem definitely needs further study.
Inclusiveness of institutionsOn the one hand, the respondents assessed the care facilities as accessible, on the other hand, these assessments are subjective, which correlate with the patients’ previous experience and needs during the rehabilitation period. Therefore, it is worth paying attention to the difficulties of the participants of the qualitative stage of the research:
- absence or malfunction of elevators;
- non-inclusiveness of bathrooms;
- lack of a system to call staff when it comes to patients who are less mobile or immobile.
However, the inclusivity of institutions should focus primarily on the needs of those patients whose ability to move is the most limited. At the same time, it must be recognized that the existing premises are relatively accessible to those who can move independently or with the help of rehabilitation aids.
Read also: Military health care: a priority area of the Ministry of Defense is at risk of being stopped
Briefly, what changes are needed first of all:
- first of all, to inform patients in general about the need for rehabilitation, since a certain part of the respondents did not know that they needed it at all;
- informing about rehabilitation should be in an accessible format and be based on evidence-based methods (in simple words: a military or veteran should know where they can rehabilitate their arm and where their back, as well as why mud baths and contrast showers are not rehabilitation). We emphasize that patients should receive information about rehabilitation services with proven effectiveness. In this way, we will avoid a situation where sanatorium “treatment” is interpreted by patients as rehabilitation, and not as an opportunity to rest;
- access to rehabilitation for military and veterans: bureaucratic needs and financial status should not be an obstacle to receiving the required amount of rehabilitation;
- the routes of the wounded: they should be thought out in order to reduce the number of institutions to which the wounded must move. At the same time, this optimality should include those institutions that specialize in providing rehabilitation services that the patient needs;
- improving barrier-free facilities with a focus on those with the greatest mobility limitations.
The study outlines recommendations for each stakeholder that cares for the wounded – in particular, the Ministry of Health, National Health Service, Ministry of Health, Ministry of Veterans Affairs, Ministry of Internal Affairs, Ministry of Social Policy. You can get acquainted with them in detail in the text at the link.
General data about the study
Quantitative and qualitative research (through self-completion of linked questionnaires and in-depth interviews)
Target groups: servicemen and veterans who were injured in military service, relatives of servicemen and veterans who cared for them during treatment and rehabilitation after injury, providers rehabilitation services, rehabilitation experts at the national level, who are involved in the formation and implementation of rehabilitation policies
The number of productive quantitative research interviews: 290
Number of in-depth interviews: 44