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We talk about Turning the World Upside Down where low income countries have something to reach high income countries about the delivery of health care.   But is it real?
Well, here's an illustration. 
In the UK we struggle to "sell" the benefits of Pulmonary Rehabilitation to payors or patients. We struggle to provide services that match the evidence because PR is often provided in church halls and community centres with very limited equipment and fewer staff.  A group of 12 breathless people with COPD, each with a different body mass index, strength and knowledge  in a church hall with some chairs, one set of weights and a few traffic cones. Sound familiar? 
But in Uganda there's a unique project underway that may help. Having started with people who have survived TB, a PR programme is being rolled out to people with chronic lung disease in Uganda and then Vietnam, Kyrgyz Republic and Crete. 
Applying the principles of implementation science, it is adapting the evidence to the local resource-poor context. 
There are two main differences. Here patients do not have access to any inhaled medicines. So, we can see if PR alone can make a difference to their lives. Here, where there is no government safety net, we can also count the benefits of economic productivity and social capital. 

New film
Physiotherapist colleagues in the UK may be inspired seeing how patients can benefit and also how adaptations are made to the local context.  See a link to a new film here.
For now, the key questions for me are:

  • What makes people turn up?
  • What makes people complete the programme?
  • What elements are transferable anywhere in the world such as endurance exercises?
  • What about strength exercises: the ones that train muscles to use less oxygen so more is available for breathing - how can these be calibrated to individuals with very different starting points? 

For a practical background to PR see  IMPRESS guide to pulmonary rehabilitation  

Siân Williams

Executive Officer, IPCRG