Mitigating the cultural, social and organisational barriers for meeting the needs of patients with major limb loss (MLL) in Northern Uganda

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As the world goes through one of the most turbulent periods in its recent history, the health, social & economic consequences associated with 'post-conflict disability' arising through major limb loss (MLL) has gained importance as a significant public health issue. Our preliminary observations and community engagement activities in two post-conflict societies - the Sub-Acholi Region in Northern Uganda and Northern/Eastern provinces in Sri Lanka, have demonstrated this to be an under-appreciated complex and multi-faceted problem characterised by:a: Lack of suitable services capable of addressing the complex needs of the affected populationsb:Inability of the affected population to access the existing services due to poor transport links, poverty and ignorance.c: Ad-hoc service development using non-sustainable funding sources at the time (or the immediate aftermath) of the conflict with inadequate characterisation of the needs of the local population.d: Social-cultural factors and belief systems that adversely affect the day-to-day experiences of the victims and prevent their reintegration into the society.Influencing and engaging with future policy making in this field therefore requires an integrated approach involving multi-disciplinary teams. This proposal aims to bring together the 'Humanitarian and Conflict Response Institute (HCRI)' - an institution specialising in global health and 'In Place of War (IPOW)'- an organisation with expertise in conducting cultural programmes in post conflict settings, to focus on the multi-faceted problem of disability associated with MLL in two post-conflict societies - Uganda and Sri Lanka. The project will link HCRI and IPOW with Gulu Medical Faculty (GMF)-established specifically to address the health needs of Northern Uganda, the 'Gulu Referral Orthopaedic Workshop (GROW)' - the only centre providing prosthetic limb services in Gulu district in Northern Uganda, and 'Meththa Foundation UK' (MF)-a charity that pioneered prosthetic services in post-war Sri Lanka using recycled components from the UK and an innovative outreach model for service delivery. The involvement of Geographical Information Scientists (GIS) from University of Manchester (UOM), surgeons/public health officials from Northern Uganda and the Uganda-UK Health Alliance (UUHA) - the official intergovernmental body with a mandate to create sustainable partnerships between the two countries, will strengthen the proposed network. Research output from this network will: a. Evaluate the impact of arts and social theatre in challenging entrenched cultural views and bias associated with MLLb: Highlight the harm caused by ad-hoc service development in conflict environmentsc: Provide the forum, pilot data, policy options and critical appraisals of delivery systems in low-middle income countries to deal with the rising tide of MLL cost-effectivelyd: Fabricate and deliver 50 prosthetic limbs using an outreach service delivery model (successfully implemented in post-war Sri Lanka) and assess its suitability, acceptability and cost effectiveness in Northern Uganda.The partnership will also create a quality assured environment where UK based professionals and students will be able to undertake short/long term volunteering and student placements with mutual benefits to both countries. The involvement of UUHA and Health Education England (HEE) as project partners creates a window of opportunity to champion the cause of disabled people in the region (and the UK) by influencing training, research, policy making and funding priorities. We submit that the policy documents, particularly those in relation to the feasibility/desirability of outreach prosthetic services in LMICs, will have wider applications in service planning in many other post-conflict societies in Asia, the Middle east, and Africa