Having filled gap for years, hospital plans future of long-term care

DUBAI // With no purpose-built long-term care facilities yet available for patients with brain and spinal damage in Dubai, staff at Rashid Hospital have been plugging the gap for the past 37 years. In the past decade, as the emirate has expanded, capacity has become an issue, and the hospital is now looking at alternative options to take the pressure off nursing staff and allow patients to return home.

There are 52 long-term patients at the 500-bed hospital, most of whom are either geriatric patients or expatriate workers who have suffered brain or spinal damage in construction accidents. "With the increasing population of Dubai came increasing construction site activity, and, so, injuries," said Dr Lama al Ramahi, the acting head of the hospital's case management department, which was set up five years ago to address the issue. "The [number] of car accidents began to rise and lifestyles changed."

Among the hospital's longest-term residents is 11-year-old Khalifa, who was two when he was hit by a car while playing outside his family's home. The accident caused spinal damage that left him quadriplegic, and a ventilator supports his breathing. Aside from one trip to Europe 18 months after the accident for unsuccessful medical treatment, Khalifa has never left the hospital's intensive care unit.

His mother, Shukria Rahim, leaves her Jumeirah villa every evening and makes the journey to the hospital to spend time with her youngest son. "I miss him very much and often ask why my child is in the hospital," said Ms Rahim as she stroked her son's head. "Khalifa is clever, quiet and very kind. But the care he receives here is very good." While the hospital administration is looking into developing long-term care and a project has been prepared for such a rehabilitation centre, Dr Suad Trebinjac, the head of the hospital's physical medicine and rehabilitation ward, could not confirm when that would be established.

He runs a state-of-the-art rehabilitation ward that was opened last June to provide spinal cord-injury patients with a holistic rehabilitation programme that includes physical, occupational and speech therapy. Psychological support and advice on adapting family homes to cater for patients' needs when they are discharged is also provided. With only eight in-patient beds, staff are forced to select a handful of patients with acute spinal injuries requiring 24-hour nursing who are medically stable and able to tolerate three hours a day of therapy. There is a long waiting list.

Less intensive physical and occupational therapy is available to those patients on general wards. While it was not an ideal scenario, it was a start, said Dr Trebinjac. He presented proposals for the further development of rehabilitation services to the hospital's administration last year. They included community-based rehabilitation units linked to existing primary health care centres, which could provide support to families of spinal cord and brain-injured patients at home; care at a hospital level for both acute and post-acute patients; and specialised centres, similar to facilities in Kuwait and Saudi Arabia, for more complicated cases.

Dr Trebinjac is keen to develop services so that patients no longer feel the need to travel overseas in search of treatment. "They may get some recovery, but eventually they need to come back and face problems adapting back into society," he said. The hospital has begun training individuals selected by the families of patients to act as care-givers in a bid to free up beds and allow patients to return home.

"At the beginning, when you tell them they can take the patient, they refuse, but when you discuss it with them they get familiar with the situation," Dr al Ramahi said. "They realise that the patient is fine and that we are not closing the door to them." @Email:[e-mail]