For Titus Kaloki, rehabilitation is one of the things that have worked well for his daughter, Isabella Neema, five.

Isabella, who was born with Down syndrome and a congenital heart defect, has had to be in and out of rehabilitation rooms for the past three years, a decision Kaloki has never regretted making.

In 2018, Isabella, then two, was admitted at Gertrude’s Hospital for acute pneumonia. After a few days in the ward and several examinations her health seemed to have improved.

“Isabella was bubbly and was responding well to medication and everything seemed to be going on so well and it was finally her day of discharge,” Kaloki recalls.

However, right before he was done settling the bill, his daughter suffered a stroke.

“This came as a shock because we were sure we had conquered pneumonia, only to start dealing with a stroke, something we had no experience on. On top of that, we had to change hospital and incur more bills,” he explains.
The stroke paralysed Isabella’s right side, and she had to fully depend on her parents for everything.

The days that followed weren’t any better for her parents. They were constantly in and out of hospital taking care of the child and had to look for money to cater for the bill.

That insurance covers weren’t covering a huge part of the bill made matters harder.

“Our bill was Sh500,000 and the cover only catered for Sh100,000, which wasn’t even half of the bill. This really dented our pockets. To make matters worse we had to brace ourselves for physiotherapy, which we also had to pay for out of our own pockets,” he recalls.

Isabella was later released from hospital and stayed bedridden for a few weeks.

At the hospital, the doctors had recommended three physiotherapy sessions a week. They opted for a home based option which cost Sh3,000 per session.
“We diligently attended the sessions and hoped everything turned out okay.

After a year we began noticing some response from her right leg, which was a great milestone for us,” he says.

It wasn’t long before her right hand began to respond, and she regained the ability to hold things without dropping them.

At the moment, Isabella is preparing for a heart surgery, which needs to be done before her sixth birthday. Although one of the biggest challenges has been financing her therapy, it has played a major role in stabilising her health condition.

Occupational therapy

For Titus, patience is the one virtue that has helped him in dealing with his daughter’s condition.

“One thing my daughter has taught me is that patience pays. When we started rehabilitation we were told by the doctors to be hopeful that one day things would turn out to be okay although it might have taken much longer than expected it was all worth it because now she is able to stand and do some activities on her own,” he says.

Isabella’s therapy sessions have reduced to one per week and she is now undergoing occupational therapy, which is helping with life activities such as brushing her teeth, concentrating on a task and eating.

Although some challenges they have experienced have been the cost that comes with it, Titus is grateful that rehabilitation helped in improving her daughter’s condition.

“Rehabilitation really helps, therefore it is my quest as beneficiary of this services the government and private insurance review compensation and consider incorporating it to the cover,” he says.

The family is accepting contributions for Isabella’s treatment via lipa na mpesa paybill 891300, account name Bella.

According to World Health Organisation (WHO), globally about 2.4 billion people are living with a health condition that benefit from rehabilitation.

In addition, the need for rehabilitation worldwide is predicted to increase due to changes in the health and characteristics of the population. For example, people are living longer, but with more chronic disease and disability.

At the same time, the ongoing incidence of injury and child development conditions such as cerebral palsy.

These conditions can impact an individual’s functioning and are linked to increased levels of disability, for which rehabilitation could be beneficial.

At the moment, the need for rehabilitation is largely unmet. In some low-and middle-income countries more than 50 per cent of people do not receive the rehabilitation services they require.

Rehabilitation services are also amongst health services most severely disrupted by the pandemic.

Benjamin Langat, a physiotherapist at Orine Community Training Centre, explains that physiotherapy rehabilitation aims to optimise patient function and well being to help integrate the patient back into their previous lifestyle activities whether at home, work or leisure.

“Rehabilitation focuses on changes to functional disability and lifestyle restrictions based on patients own goals for functional improvement,” he says.

Long term conditions

In most cases rehabilitation is used for recovery from injury or diseases, but can also be used in the management of long term conditions such as Parkinson, cerebral palsy, and Down syndrome. Although some might view it as a treat, it is important for rehabilitation to start as soon as possible for speedy recovery.

A physiotherapist helps patients in all phases of healing from the initial diagnosis through the restorative and preventive stages of recovery.

“Once we receive patients we ensure they undergo physical exam and evaluation, including a health history and certain testing procedures, including evaluation of posture, movement and flexibility, and of muscle and joint motion and performance,” he explains.

The physiotherapist will review the patients diagnosis and plan for short term and long term goals that would help in the treatment. They also offer self-management recommendations that would help with training the patients at home to help them function more effectively.

Treatment depends on pain management that require reduced need for opiods, avoiding surgery, improved mobility and movement, recovery from injury and trauma, recovery from stroke and paralysis, fall prevention and management of age related medical problems.

However, Langat says rehabilitation is not only for people with long-term physical impairments, rather it is important for anyone with an acute or chronic health condition, and therefore it should be available for anyone who needs it.

Besides physical therapy, rehabilitation also involves speech therapy.
Regina Mbugua, speech therapist, explains that it provides treatment and support for people experiencing speech disorders and communications problems.

She explains that this therapy is needed for disorders that develop in childhood or impairments in adults caused by an injury or illness such as stroke, brain injury, stroke, or an injury and illness.

“Speech disorders can develop in multiple ways. They can occur due to nerve injuries in the brain, muscular paralysis, structural abnormalities and development disabilities; therefore, speech therapy would be an important treatment for speech and communication disorders,” she says.

Speech therapy

In children, speech therapy could involve a lot of activities including articulation, language activities, feeding and swallowing to help strengthen muscles in the mouth to work, exercises such as tongue lip and jaw exercises around the mouth.

Whereas in adults, different types of techniques could be useful, one of them being social communication, which involves problem solving, breathing exercises to assist with resonance issues, mouth exercises suitable way to strengthen oral muscles.

The trained health professional says therapy is important in treating specific language impairment, resonance disorders, articulation disorders, aphasia, and stuttering.

“Speech therapy is an effective method for helping children and adults in developing their communication skills. Other therapies one can use alongside speech therapy include music therapy, which involves a number of music led activities, and neurofeedback treatment to help in the development of speech,” she explains.

Among adults, stroke is the most common reason patients need rehabilitation.

To clear the myths on rehabilitation, Langat explains that it is not a luxury health or an optional service to try only when other interventions to prevent or cure conditions fail.

“It is something that helps in so many ways, therefore for the full extent of the social, economic and health benefits of rehabilitation to be realised, timely, high quality and affordable rehabilitation interventions should be available to all,” he says.