Chad: portrait of Wilfreed, physiotherapist with HI

Hello Wilfreed, can you introduce yourself?

My name is Natoyallah Djimingaye. I am 29 years old, I am a physiotherapist and I work at HI as a rehabilitation technical officer. In my role, I provide technical support to the rehabilitation projects of HI Chad and contribute to the development of the intervention strategy of the rehabilitation sector.

What is your background as a physical therapist?

The training of rehabilitation professionals in Chad is very limited. In order to train myself, I benefited from a scholarship fully funded by HI for a complete training course in physical therapy at the Faculty of Health Sciences of the University of Abomey Calavi in Benin. After my studies, in 2021, I joined HI as a Rehabilitation Technical Officer, which is my current position.

Why did you choose to become a physical therapist? What do you like most about your job?

There are two scenes that marked me during my adolescence. The first one is that of my cousin Irene. She would have been 26 years old this year and would perhaps have become a physiotherapist, an occupational therapist or a speech therapist, if she had not succumbed to the after-effects of cerebral palsy at the age of 18 because of lack of adequate care. The second is that of a child from my native village who lost his life at the age of 2. He was born with a congenital malformation and his parents considered him the source of a curse. I chose the career of physical therapy to give other children a better chance to be accepted by their environment, to grow up better and to participate fully in their community. What I like most about this profession is the contact with the patient: someone who comes to you for treatment, who trusts you and can count on you when they need someone to trust.

What is your best memory since you joined HI?

I participated in a mission in Bol (Lake Chad) to train the mothers of children with cerebral palsy in the practice of simple gestures to improve their autonomy in daily life situations: dressing, washing, eating, walking. After 3 days of exchanges and practice, the expression on the mothers' faces gave me an indescribable joy! In 3 days, they saw a child over 1 year old start to crawl when he had never done so before. Seeing this convinced them of the importance of our action and made them realize that what their child is suffering from is not at all related to witchcraft or a curse. That day, I had realized my dream!

What barriers persist in Chad to accessing rehabilitation services?

Lack of awareness of the rehabilitation sector is a barrier that slows down any effort to advance access to services. There is a lot of talk about infectious diseases and vaccination campaigns, but not enough attention to chronic non-communicable diseases and the growing need for rehabilitation. Rehabilitation is usually associated with disability, yet everyone could benefit from rehabilitation services at some point in their lives.

To date, there is no national policy for the rehabilitation sector in Chad, although HI has supported the development of a national rehabilitation plan that has yet to be validated.

The only two centers that offer rehabilitation services are not subsidized by the state. There is one state center but it is not functioning for several reasons. At the moment, HI is one of the only international NGOs working in the rehabilitation sector in Chad.

Moreover, there is no training school for professionals in the country. There are only 20 physiotherapists and 10 orthoprosthetists trained abroad. Most of these rehabilitation professionals work in N'Djamena, the capital, so the rest of the country is poorly served. The presence of rehabilitation professionals at the hospital level is almost non-existent, and sometimes rehabilitation is carried out by other health professionals who have not had adequate training.

In May 2023, the World Health Assembly will vote on a resolution on integrating rehabilitation in health systems, which will be the first of its kind. What could be the impact of such a Resolution in Chad?

I believe that the adoption of this resolution would advance our advocacy efforts for the recognition of the sector, as our rehabilitation projects cannot be sustained without the effective involvement and ownership of the dedicated state structures and the World Health Organization (WHO). In Chad, for example, this instrument could stimulate the validation of a national rehabilitation policy and the implementation of its technical strategy.

Rehabilitation could also be integrated into the national health development plan, which would allow for greater political ownership and facilitate the allocation of substantial resources (material, financial, and human) to the sector. These resources are needed to re-launch the national center for orthopedic devices and rehabilitation, to create training schools for physiotherapy, orthopedic devices, speech therapy, etc.

In addition, technical support from WHO would be welcome and could have a beneficial impact on the sector. For example, a WHO rehabilitation focal point in Chad could facilitate training and exchange of experiences between rehabilitation specialists and other health actors and support the development of the sector in general.

I am therefore keeping my fingers crossed that the resolution will be adopted, but especially that concrete actions will be taken by our states to guarantee access to rehabilitation for all. And since everyone will need rehabilitation services at some point in their lives, it would be beneficial for all of us to pave the way now.