Hitchcock R, Hutchings C J, Stephenson S, Ward C D
School of Physiotherapy and Occupational Therapy, Southampton University, UK.
J Allied Health. 1998 Winter;27(1):45-9.
Both countries face considerable challenges to their rehabilitation services. Although contextually different, the problems and challenges are common to both. Two contrasting views of disability have been presented. In the UK disability may be viewed as a disaster, while in Asia illness and disability may be viewed as inevitable. Personal independence is not a universal goal of rehabilitation, because in some cultures dependence on others is an expected consequence of disability. Disability in Indonesia translates into a large burden of care for the family, whereas English families may expect greater help from the government in caring for their relative. Western rehabilitation is increasingly patient directed, whereas the Indonesian model is more likely to be determined solely by professionals. The problems observed by the team in Indonesia were remarkably similar to those experienced in the UK. A patient centered goal setting approach can be considered vital to neurological rehabilitation, although the focus of the goals set is likely to be very different in these two cultures. The fundamental importance of a multidisciplinary team is recognized in both cultures, although team working may not be easy in either situation. Managerial commitment is essential for the survival of a team, yet both structures sometimes fail to provide the necessary support. Hierarchical leadership can inhibit team development both in the UK and in Indonesia, as can frequent rotation of staff. Prescription of therapy by doctors inhibits the development of therapists in both cultures, and therefore the overall effectiveness of the team. In both the UK and Indonesia, the value of rehabilitation as a specialty is not widely recognized. The absence of life and death situations means that services are often out of the public eye, and poorly understood. However, the prevalence of disability will increase the need for rehabilitation services worldwide. Many challenges remain in both the UK and Indonesia to the development of more effective rehabilitation services. Issues like the lack of recognition of rehabilitation as a specialty, the importance of team work, the paucity of managerial support, and increasing demand for rehabilitation services will need to be recognized and addressed. Despite the different approaches to disability in the two cultures, the problems faced are similar. These problems will need to be solved if there is to be significant progress in this multidisciplinary field.
两国的康复服务都面临着巨大挑战。尽管背景不同，但问题和挑战在两国都很常见。文中呈现了两种截然不同的残疾观。在英国，残疾可能被视为一场灾难，而在亚洲，疾病和残疾可能被视为不可避免。个人独立并非康复的普遍目标，因为在某些文化中，对他人的依赖是残疾的预期结果。在印度尼西亚，残疾给家庭带来了巨大的照料负担，而英国家庭可能期望政府在照料亲属方面提供更多帮助。西方的康复越来越以患者为导向，而印度尼西亚的模式更可能完全由专业人员决定。该团队在印度尼西亚观察到的问题与在英国遇到的问题惊人地相似。以患者为中心的目标设定方法对于神经康复至关重要，尽管在这两种文化中设定的目标重点可能非常不同。两种文化都认识到多学科团队的根本重要性，尽管在任何一种情况下团队协作都可能不容易。管理承诺对于团队的生存至关重要，但两种结构有时都未能提供必要的支持。层级式领导在英国和印度尼西亚都会抑制团队发展，人员频繁轮换也是如此。医生开治疗处方在两种文化中都会抑制治疗师的发展，进而影响团队的整体效能。在英国和印度尼西亚，康复作为一门专业的价值都未得到广泛认可。由于不存在生死攸关的情况，康复服务往往不为公众所关注，且鲜为人知。然而，残疾患病率的上升将增加全球对康复服务的需求。在英国和印度尼西亚，发展更有效的康复服务仍面临诸多挑战。诸如康复作为一门专业未得到认可、团队协作的重要性、管理支持的匮乏以及对康复服务需求的不断增加等问题，都需要得到认识和解决。尽管两种文化对残疾的态度不同，但面临的问题相似。如果要在这个多学科领域取得重大进展，就需要解决这些问题。
