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Federico Montero: strengthening rehabilitation services
Perspectives
Profile Federico Montero: strengthening rehabilitation services As a young medical intern, Federico Montero was driving home from work when he fell asleep and crashed. The accident left him dependent on a wheelchair for his mobility, but it also brought him to a new career path that has focused on improving the treatment and standards of care for people with disabilities. Montero worked with WHO’s Disability and Rehabilitation Team from 2002 to 2007, rising to become its Coordinator. As the Deputy Director of the National Rehabilitation Centre in his native Costa Rica, Montero says that although progress has been made towards ensuring the rights of people with disabilities, far more remains to be done: “Countries are promoting policies on prevention and management but there is very little on rehabilitation.” He adds that there is an urgent need to strengthen and integrate rehabilitation into primary health care and into wider policies on education, transport, housing, and employment. Montero’s experience at WHO gave him a more universal vision of the realities facing people with disabilities, but left him frustrated at the lack of global resources. WHO’s small Disability and Rehabilitation Team is part of the Department of Violence and Injury Prevention and Disabilities and has few overlaps with other clusters. “I think the programme needs to be strengthened and be given much more support because it has the potential to influence and improve wider services and policy development around the world”, he says. WHO estimates that some 650 million people live with disabilities, mostly in low-income countries. But Montero says the definition of disability is too broad and that better tools are needed to gauge the true number of people affected to draw up more tailored plans and services. Of the many people in developing countries who need a wheelchair, only a small minority ever access one. While working for WHO, Montero travelled in Africa and other regions and recalls how “people were interested in my wheelchair and wanted to learn about me. That made me really think. I saw so many people staying in bed with spinal injuries because nobody had any training to treat them.” He explains that life expectancy for someone with a spinal injury in some African countries is usually 2 or 3 years at most. Even in developed countries, there is frustration over the low priority given to spinal injuries. The International Spinal Cord Society is leading the collaboration with WHO on International Perspectives in Spinal Cord Injuries, a document that will highlight the needs and rights of individuals with spinal cord injuries, says society President Wagih El-Masry. “We still see complications we knew how to prevent 65 years ago”, he says in reference to pressure sores, contractures of muscles, urinary infections, and other ailments. 1814
The USA has been at the fore of championing equal rights and access for disabled people and involving people with disabilities in planning legislation. Other high-income countries have followed suit, but practice often lags behind the principles. Even in Switzerland, Montero says, he had to telephone the federal railway company one day ahead of travel to make arrangements. Despite slow progress and lack of commitment from the current authorities, Montero is proud of Costa Rica’s track record; Congress approved legislation for equal treatment for people with disabilities in 1996 and the nation has ratified the Convention on Rights of Persons with Disabilities. Apart from trying to strengthen community-based rehabilitation, Montero spends much time trying to improve facilities and access in public buildings and transport. Transport is becoming more accessible with the provision of ramps, “but the quality of the ramps and the attitude of the drivers is not always the best”, he concedes. After medical studies at universities in Costa Rica and Mexico, Montero had intended to specialise in paediatric surgery, but the accident changed his ambitions. He spent 6 weeks in a Costa Rican hospital, but the country had little experience in treating spinal injuries and he transferred to a US specialist unit in Phoenix, Arizona, where he met his future wife, Annie, who was a nurse. Montero subsequently won a scholarship to the UK’s National Spinal Injury Centre, at Stoke Mandeville Hospital, and also studied at other British spinal injury and rehabilitation units between 1976 and 1979. El-Masry was a senior registrar at Stoke Mandeville when Montero was a houseman and recalls that “He was a very caring human being and he fought hard to give the individual with spinal injury a voice in the debate.” Montero used his training in the UK to set up a small spinal injury unit in Costa Rica. In 1983, however, Montero’s wife Annie died while she was pregnant with their second child. Montero says he somehow “kept going” with his 4-year-old son Miguel, who is now a 30-year-old physician. Montero continued with his work at the unit and also travelled within Central America to lecture on spinal injuries. Before moving to WHO, he hosted a phone-in radio programme for Costa Ricans: “it was a great opportunity to answer questions from people with disabilities and from parents who had doubts. I really enjoyed it and it had a big impact”. Montero is cautiously optimistic about the future. He would like to see more interest from health services and other services to incorporate disability into basic planning, and to devote more time and resources to people with disabilities. “But I think things are moving”, he says.
Clare Kapp [email protected]
www.thelancet.com Vol 374 November 28, 2009
Profile Federico Montero: strengthening rehabilitation services As a young medical intern, Federico Montero was driving home from work when he fell asleep and crashed. The accident left him dependent on a wheelchair for his mobility, but it also brought him to a new career path that has focused on improving the treatment and standards of care for people with disabilities. Montero worked with WHO’s Disability and Rehabilitation Team from 2002 to 2007, rising to become its Coordinator. As the Deputy Director of the National Rehabilitation Centre in his native Costa Rica, Montero says that although progress has been made towards ensuring the rights of people with disabilities, far more remains to be done: “Countries are promoting policies on prevention and management but there is very little on rehabilitation.” He adds that there is an urgent need to strengthen and integrate rehabilitation into primary health care and into wider policies on education, transport, housing, and employment. Montero’s experience at WHO gave him a more universal vision of the realities facing people with disabilities, but left him frustrated at the lack of global resources. WHO’s small Disability and Rehabilitation Team is part of the Department of Violence and Injury Prevention and Disabilities and has few overlaps with other clusters. “I think the programme needs to be strengthened and be given much more support because it has the potential to influence and improve wider services and policy development around the world”, he says. WHO estimates that some 650 million people live with disabilities, mostly in low-income countries. But Montero says the definition of disability is too broad and that better tools are needed to gauge the true number of people affected to draw up more tailored plans and services. Of the many people in developing countries who need a wheelchair, only a small minority ever access one. While working for WHO, Montero travelled in Africa and other regions and recalls how “people were interested in my wheelchair and wanted to learn about me. That made me really think. I saw so many people staying in bed with spinal injuries because nobody had any training to treat them.” He explains that life expectancy for someone with a spinal injury in some African countries is usually 2 or 3 years at most. Even in developed countries, there is frustration over the low priority given to spinal injuries. The International Spinal Cord Society is leading the collaboration with WHO on International Perspectives in Spinal Cord Injuries, a document that will highlight the needs and rights of individuals with spinal cord injuries, says society President Wagih El-Masry. “We still see complications we knew how to prevent 65 years ago”, he says in reference to pressure sores, contractures of muscles, urinary infections, and other ailments. 1814
The USA has been at the fore of championing equal rights and access for disabled people and involving people with disabilities in planning legislation. Other high-income countries have followed suit, but practice often lags behind the principles. Even in Switzerland, Montero says, he had to telephone the federal railway company one day ahead of travel to make arrangements. Despite slow progress and lack of commitment from the current authorities, Montero is proud of Costa Rica’s track record; Congress approved legislation for equal treatment for people with disabilities in 1996 and the nation has ratified the Convention on Rights of Persons with Disabilities. Apart from trying to strengthen community-based rehabilitation, Montero spends much time trying to improve facilities and access in public buildings and transport. Transport is becoming more accessible with the provision of ramps, “but the quality of the ramps and the attitude of the drivers is not always the best”, he concedes. After medical studies at universities in Costa Rica and Mexico, Montero had intended to specialise in paediatric surgery, but the accident changed his ambitions. He spent 6 weeks in a Costa Rican hospital, but the country had little experience in treating spinal injuries and he transferred to a US specialist unit in Phoenix, Arizona, where he met his future wife, Annie, who was a nurse. Montero subsequently won a scholarship to the UK’s National Spinal Injury Centre, at Stoke Mandeville Hospital, and also studied at other British spinal injury and rehabilitation units between 1976 and 1979. El-Masry was a senior registrar at Stoke Mandeville when Montero was a houseman and recalls that “He was a very caring human being and he fought hard to give the individual with spinal injury a voice in the debate.” Montero used his training in the UK to set up a small spinal injury unit in Costa Rica. In 1983, however, Montero’s wife Annie died while she was pregnant with their second child. Montero says he somehow “kept going” with his 4-year-old son Miguel, who is now a 30-year-old physician. Montero continued with his work at the unit and also travelled within Central America to lecture on spinal injuries. Before moving to WHO, he hosted a phone-in radio programme for Costa Ricans: “it was a great opportunity to answer questions from people with disabilities and from parents who had doubts. I really enjoyed it and it had a big impact”. Montero is cautiously optimistic about the future. He would like to see more interest from health services and other services to incorporate disability into basic planning, and to devote more time and resources to people with disabilities. “But I think things are moving”, he says.
Clare Kapp [email protected]
www.thelancet.com Vol 374 November 28, 2009