|LETTERS TO EDITOR
|Year : 2018 | Volume
| Issue : 2 | Page : 148-149
Socioeconomic impact of cervical Spinal Cord Injury (SCI) operated in patients with lower income group
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
|Date of Web Publication||2-Aug-2018|
Dr. Birudu Raju
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Raju B. Socioeconomic impact of cervical Spinal Cord Injury (SCI) operated in patients with lower income group. Indian Spine J 2018;1:148-9
|How to cite this URL:|
Raju B. Socioeconomic impact of cervical Spinal Cord Injury (SCI) operated in patients with lower income group. Indian Spine J [serial online] 2018 [cited 2018 Dec 10];1:148-9. Available from: http://www.isjonline.com/text.asp?2018/1/2/148/238387
We read the article titled, “Socioeconomic impact of cervical spinal cord injury (SCI) operated in patients with lower income group.” Being a medical and psychiatric social work practitioner working in mental health, neurosurgery, emergency, and trauma care setting in a tertiary care hospital, I would like to congratulate and appreciate the conscientious and scientific observations made by the authors.
The study had many positive outcomes. The study findings highlighted the impact of SCI on socioeconomic status of lower-income families, especially unskilled labor or farmers, occupational changes or job lost, occurrence of disability, impaired functionality, possible neurological improvements, importance of health insurance, need for rehabilitation measures in the community, and need for immediate support from government for individuals suffering from cervical SCI. Further, the results depicted low satisfaction levels with respect to treatment care and reduced mental well-being which led to depression. I do agree with the authors’ statement that their study was first of its kind scientifically to look into socioeconomic status of cervical SCI in lower-income families. The physical, personal, financial, and social impact of SCI is such that most patients are lost to follow-up. Recent systematic reviews reported that psychosocial research in trauma setting was far behind in India. In this context, the current study is an eye opener for many professionals working in neurosurgical conditions because socioeconomic status of individuals and their families who are undergoing surgical interventions in general is not known.
However, I have certain concerns in the methodology part. Following information would have been strengthened the methodology robust: how many days after surgery, follow-up was done? What were the reasons for choosing respondents to contact over the phone? How many respondents got concession from government tertiary care hospital for surgical interventions? How many respondents had undergone cervical SCI surgery under health insurance scheme? Did individuals with cervical SCI (Grades 3, 4, and 5; n = 60) enroll to get disability benefits after surgical interventions? Were there role changes in the family since bread winner lost his job? What were the scales used to measure the depression and mental well-being? The authors reported that reduced mental well-being led to depression level. This finding was extremely important, but not described clearly. The available treatment facilities and services for SCI were limited to urban areas in developing countries. In spite of implementation of Disability act 1995 with respect to rehabilitation, there is a lack of access to opportunities in health, education, vocational guidance, and employment. Emotional, psychological, and mental health needs are unmet. In addition, housing, transportation, public infrastructure, availability, accessibility, cost, and community attitudes are still reported to be barriers to community reintegration.
Therefore, there is necessity to bring awareness on health insurance schemes and enrollment in different health schemes such as Sugamya Bharat Abhiyan (Accessible India campaign), Rashtriya Swasthya Bima Yojana, Bhamashah Swasthya Bima Yojana, Mukhya Mantri State Health Care Scheme, Bhai Ghanhya Sehat Sewa Scheme, Bhagat Puran Singh Sehat Bima Yojana, MukhyaMantri Swasthya Bima Yojana, Rajiv Arogyasri scheme, and Vajpayee Arogyashree Scheme to yield benefits for lower socioeconomic and below poverty line families. All these state government schemes must be integrated to central government tertiary care hospitals to ensure better SCI treatment care and reduce the economic burden. State governments, central governments, and hospital management also must be flexible to welcome the newer initiatives for the welfare of the needy people. Establishment and initiating institution-based rehabilitation, research-based rehabilitation, and community-based rehabilitation can be useful to gain quick and maximum recovery. Based on the strengths of individuals with SCI in postoperative state, alternative occupation can be thought of by linking them with local regional vocational centers and national skill development program to retain economic stability and to save right to work.
On the other side, most of the time, importance has been given more to medical care than psychosocial care. Research on mental health and rehabilitation issues among individuals with SCI, caregivers, and their families are neglected. Health-seeking behavior, pain, pre- and postoperative anxiety, depression, stress, somatoform disorders, activities of daily living, work and social adjustment, sexual and marital concerns, social support and coping, family dynamics, functionality, disability, lifestyle, caregiver burnout, burden, psychosocial interventions, and quality of life of individuals with SCI, their caregivers, and family members before and after surgical interventions are potential areas of psychosocial research in India, but forgotten. In addition, early identification of ergonomic risk factors, lifestyle modification, and initiatives toward the prevention of road traffic accidents gives platform for researchers to reduce the economic burden. The rigorous research must be planned for the benefit of individuals suffering from SCI, caregivers, and their family members by collaborating with multidisciplinary health-care professionals.
Further, funding agencies such as the Indian Council of Medical Research, Department of Biotechnology, Indian Council of Social Science Research, Council of Scientific and Industrial Research, and state and central governments must come forward to encourage psychosocial research, establishment of community rehabilitation centers and to develop newer and effective models with respect to SCI rehabilitation. Therefore, to conclude, psychosocial research in the field of SCI is in infancy stage in India. Once again, I congratulate the authors for their good work and commitment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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