Neurological rehabilitation in Indonesia and the UK: differences and similarities

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.