Member Spotlight: Dr. Noor Bismillah
April 5th, 2018
Dr. Noor Bismillah graduated medical school at the University of Malaya in Kuala Lumpur, obtaining a MBBS degree in 1996. She also completed her postgraduate studies at the University of Malaya, obtaining a Master of Rehabilitation Medicine in 2005. From 2006 to 2008, she served as the head of the Rehabilitation Department at Hospital Raja Perempuan Zainab II, the state hospital of Kelantan state in northeastern peninsular Malaysia. She next served as the head of the Rehabilitation Department at Queen Elizabeth Hospital, the state hospital of Sabah state in Borneo, from 2008 to 2011. From 2013 to 2017, she served as the head of the Spinal Rehabilitation Unit at Hospital Rehabilitation Cheras (HRC) in Kuala Lampur. HRC, which opened in July 2012, offers comprehensive outpatient and inpatient rehabilitation medicine services and has 166 beds. It is the first hospital of its kind in the Southeast Asia region. HRC, an initiative of the Ministry of Health, Government of Malaysia, is designed with an emphasis on energy efficiency, green spaces and therapeutic landscapes. It is locally known as the “Hospital in the Park.” Dr. Noor Bismillah currently continues to serve as a rehabilitation physician on the Spinal Rehabilitation Unit at HRC. She has been a member of ISCOS since 2015.
How did you get interested in the field of rehabilitation medicine in general and spinal cord injury (SCI) medicine specifically?
My interest in rehabilitation medicine started when I was still in secondary school. I really wanted to do more for my late father who had a stroke at the time. The interest grew even deeper when the health clinic where I was working was selected as the first health clinic in Malaysia to run a community outreach program for disabled children. From there on, my enthusiasm to learn more about rehabilitation medicine grew even stronger. When I learned that there was a Master of Rehabilitation Medicine programme being offered by one of the local universities (University of Malaya), I immediately seized the opportunity and sent my application. To my utmost happiness, I was accepted into the 4th batch of postgraduates enrolled into this programme and started my training in 2001. I was first introduced to SCI medicine during this programme. Since then, I have continued to have a deep interest in learning everything I can about SCI medicine and wanting to help as many patients with SCI as I can.
What have been your main areas of interest within the field of SCI/rehabilitation medicine?
I have an extra interest in the management of neurogenic bladder in SCI because I just love to see how the team comes together to contribute so much to this. As a team, we can design the best bladder management programme for each patient to get the best results. We have a saying here that, “Together each achieves more.”
Please tell us about the situation related to medical care and rehabilitation of persons with SCI in your hospital and in Malaysia in general.
I am very grateful to have been able to see and contribute to the development of rehabilitation medicine services in Malaysia. After I graduated from the Master of Rehabilitation Medicine programme in 2005, I served in two government state hospitals. During that time, rehabilitation medicine was still very much an unknown to most of the hospitals in Malaysia. I consider myself to be very lucky to have had the opportunity to personally experience the challenges in starting a rehabilitation medicine service in each of the hospitals where I worked. When I first started the service in one of the hospitals, I did not have my own chair to sit on or my own table to do work. However, with the strong support from hospital administrators and my colleagues, the services progressed very well. After about 4 years, we managed to open a rehabilitation ward and clinic for our patients. Now, Malaysia has a total of 86 rehabilitation physicians serving in 16 government hospitals, 7 university hospitals, 6 private hospitals and one social security rehabilitation centre.
Management of rehabilitation patients in Malaysia in general has its own unique challenges. As Malaysia is a multiracial country, not only do we manage patients from various races, but we also have to deal with various languages, dialects, cultures, religions and socioeconomic backgrounds. The key points to successful management are respect for all the differences and treating each patient as a special individual who deserves the best treatment regardless of social background.
What improvements in the lives of persons with SCI and other disabilities in Malaysia have you seen over the years?
Over the years, with the expansion of rehabilitation medicine services in Malaysia, I see less and less of our patients suffering from medical complications related to SCI such as pressure ulcers and joint contractures. On the other hand, I am seeing more and more of our patients able to live independently. A large number of our patients have been reintegrated back into the society and have become productive members of the community. Some of our patients are now serving the community through their original professions despite the various physical disabilities that they have.
What accomplishments are you most proud of?
I am very grateful to have been able to initiate a spiritual support programme at my current workplace. This program is aimed at encouraging and helping patients participate in their spiritual activities. By this, we are hoping to be able to help them achieve optimal spiritual health and ultimately reach a more holistic recovery at the end of their rehabilitation programme. Under this programme, we organise a number of activities which include providing a disabled-friendly praying area for patients who are wheelchair dependent. We also provide the necessary equipment for our patients to perform their prayers and guide them on how to perform the ritual despite the physical limitations that they have. We also provide free food for suhur for patients who are well enough to fast during the month of Ramadhan. This spiritual support programme gives me the utmost satisfaction in my management of patients with SCI because I have a chance not only to manage their physical disabilities, but also to help them become more holistically healthy.
In my 12 years experience of working as a rehabilitation physician, the most interesting experience was when a newly paraplegic patient requested of our team to help him prepare to perform Hajj within three months of admission to our hospital. It was such a great challenge for us, but with a combination of the patient's strong determination, the team's tireless efforts and excellent networking with Malaysian Hajj Institute (Tabung Haji), we managed to fulfill his wish and he successfully performed the Hajj as planned.
Member Spotlight: Dr. Federico Montero
February 1, 2018
Dr. Federico Montero attended medical school at Universidad Autónoma de Guadalajara and Universidad de Costa Rica. His medical internship was interrupted by a motor vehicle accident resulting in a spinal cord injury (SCI). Subsequently, he changed his plans from becoming a pediatric surgeon to specializing in SCI. He underwent postgraduate training at the National Spinal Injury Centre at Stoke Mandeville Hospital, Rivermead Rehabilitation Centre and University of Costa Rica. His career highlights include Coordinator of the World Health Organization [WHO] Disability and Rehabilitation Team; and Director General, National Rehabilitation Center, Costa Rica. He was a member of the Editorial Committee of the journal Paraplegia (now Spinal Cord). Currently, he is teaching in the postgraduate training program in physical medicine and rehabilitation (PM&R) at the University of Costa Rica. He is also currently the President of the Red de Organizaciones de Personas con Discapacidad de Centro América y el Caribe (REDODICEC, http://www.redodicec.org).
How did you become involved with ISCoS (formerly IMSoP, the International Medical Society of Paraplegia)?
Soon after my injury, I considered the fact that the rehabilitation offered and expectations for a person with SCI at that time in Costa Rica were not very favorable. Thanks to the help of my cousin, a physician working in Phoenix, Arizona, who found out about a good option there, and with my parents’ support, I was able to travel and be admitted to the SCI unit at Good Samaritan Hospital. It was there where I had my first contact with IMSoP. Invited by Dr. John Young, the Director of the SCI unit, I was able to attend a scientific meeting on SCI organized in that city, while I was still a SCI patient. On my return to Costa Rica, I worked as a general doctor for about a year, then managed to get a scholarship through the British Council to initiate my SCI training at the National Spinal Injuries Centre, Stoke Mandeville Hospital in the UK. During my time spent at Stoke Mandeville and working closely with Dr. Hans Frankel, I had the opportunity to attend various scientific meetings and meet well respected people in the field of SCI medicine, including many members of IMSoP.
What improvements in the care and lives of persons with SCI in Costa Rica have you seen over the years?
After my training in the UK, I returned to work at the National Rehabilitation Center in Costa Rica, which had recently opened its doors to inpatients. All patients with SCI who were admitted to the general hospitals were later transferred to the Rehabilitation Center. Most of these patients had all sorts of complications. Most persons with tetraplegia, in fact, died during their general hospitalization before transfer to the Rehabilitation Center, while others died at the Rehabilitation Center due to these severe complications. This situation provided me with the opportunity to rapidly organize a small SCI unit, staffed with personnel properly trained for the comprehensive management of patients with SCI. Subsequently, all patients with SCI admitted to other hospitals were sent to our unit and the development of complications reduced significantly, including a 0% incidence of pressure sores. Currently, despite the fact that the Costa Rican health system is very good, there are significant limitations in providing patients with the required assistive devices and resources for neurogenic bladder management. Nonetheless, the unit has strengthened, and most patients return to their homes fully rehabilitated. Many continue to follow up in the outpatient clinic. Unfortunately, sometimes complications appear, due to poverty and all its consequences.
What do you wish other physicians and health care providers in your experience knew about SCI medicine that they do not seem to understand?
This represents a very frustrating reality within the medical field. Despite the fact that Costa Rica has a very inclusive health system, as well as high quality and dedicated health professionals, knowledge about proper SCI care is still limited, even amongst many specialists. Most patients with either traumatic or non-traumatic SCI are well managed during the very acute stage, but not so much afterwards if they have to remain in the general hospitals. So, I wish that the specialists working with those patients could be more aware of at least the relevant pathophysiology of SCI, as well as the potential complications associated with these injuries. At the least, nurses should be properly trained in the prevention of pressure sores, proper positioning and proper bladder management.
Please tell us about your most memorable encounter with a patient.
When I first arrived at the SCI unit in Phoenix, my English was not very good. The nurses put me in contact through the telephone with another patient who spoke Spanish to translate. I must say that there was not much that I could understand from this gentle Mexican-American fellow, but his explanations relaxed the nurses enough to proceed with their routines on the recently graduated young doctor. I met the Mexican-American fellow personally the next day and we became very good friends. He had a long-standing SCI and was in hospital due to pressure sores. He used to work in construction before his injury, and lived in Yuma, Arizona. This great and easygoing man, who weighed more than 300 pounds those days, provided me with the information and support I needed at the time. He saved me a lot of money I would’ve had to pay for consultations with a psychologist.
What professional and personal accomplishments are you most proud of?
When I got married, Dr. John Young, who was the Director of the SCI unit at Good Samaritan Hospital, where I was treated after my injury, gave me Sir Ludwig Guttmann’s textbook as a wedding present. In the book, he wrote, “…it has been a privilege and joy to know you. I have no doubt you are destined to follow the lead of Sir Ludwig bringing health and pride to your paralyzed countrymen.” Despite the fact that I did not have all the resources I would have liked in order to do my job better, to provide patients with all the resources they need and deserve, I think that Dr. Young wouldn’t feel disappointed.
What differences have you seen in the care and lives of persons with disability in the developed world versus the developing world?
I have had the opportunity to personally undergo the rehabilitation process in a developed country, and participate in various activities in the USA, UK and others. This has helped me to understand the situation of people with disabilities in developed countries. As a person with a disability myself, working in Latin America, a region where social and economic differences are so visible, and in a public hospital, I have also been quite exposed to the reality of people with disabilities in developing countries. More recently, I had the opportunity to work for the WHO in Geneva for almost 5 years, where I traveled to many countries in Africa. I went to rural areas and met people with disabilities, and my knowledge and understanding about the situation of people in developing countries deepened even more. I have seen large gaps in the care and lives of persons with disability throughout the world, and even within the same country.
What keeps you busy these days?
I am currently retired from regular hospital work, but continue as a member of the Post-Graduate Committee on Medical Rehabilitation at the University of Costa Rica. I am in charge of the SCI course for the PM&R residents. I am also collaborating with ISCoS to improve access to information and promote knowledge of SCI in the Latin American and Caribbean Regions. In this respect, we have already carried out activities in Guatemala and Honduras in 2017. We have plans to be in Uruguay this March, and possibly Ecuador in October. With the help of a Costa Rican translator and other Latin American colleagues, we have translated the ISCoS eLearn SCI modules into Spanish. I also support some PAHO [Pan American Health Organization] and WHO activities in the region and I am currently the President of a regional network of Organizations of People with Disabilities called REDODICEC. So, my sociopolitical involvement for the rights of people with disabilities also keeps me quite busy in my country and regionally. I also enjoy a piece of land in the countryside in a small town called San Mateo.
Do you have any advice for those starting out in SCI medicine or rehabilitation medicine in general?
The specialty is one of the most complex and, at the same time, a rewarding one. We work with a population, although truly more empowered over the last 30 years, still is one of the most segregated, with no access to basic needs and services in many parts of the world. Rehabilitation, as well as SCI medicine, require deep knowledge and understanding of many other areas of medicine. Our field goes beyond many other specialties, however, because of the struggle of the people we work for, which goes beyond the rehabilitation process. We may provide them with the first tools for recovery, but the specialty also commits us to be allies of our patients and of all people with disabilities, in their struggle for a life with dignity and enjoyment of all human rights.
Who is the person(s) you would most like to thank and why?
My wife, who unfortunately died not many years after we married, and my son, who was born in England during my training. They both inspired me to work and study very hard during my training in SCI. My wife, a nurse, accompanied and helped me in the development of the SCI unit in Costa Rica and the training of personnel. My son continues to provide me with satisfaction and happiness!!