Scarf Injuries in Bangladesh: Exploring the Impact on Females who live with Spinal Cord Injuries

Background: A growing number of female passengers of a newly-introduced battery powered taxi, referred to as the `Easy Bike´, sustained Spinal Cord Injuries and anterior neck lacerations. This severe injury occurs, as their traditional scarves entangle in the taxi´s engine drive shaft. Injuries sustained by entanglements of scarves in machinery has been known in the literature as Scarf Injuries. This study aimed to conduct key informant interviews to explore Scarf injury survivors challenges in receiving adequate care and maintaining a high Quality of Life (QoL). Methods: We conducted semi-structured in-depth interviews with 12 Scarf Injury survivors and their caregivers after discharge from a rehabilitation center in Bangladesh. Results: The main themes that emerged from the qualitative data were 1) perceived level of health, function and possible participation, 2) access to emergency and acute care and quality of care, 3) challenges in community reintegration. Participants often perceived their ability to perform activities and tasks to be lower than their bodily functions allowed, leading to a self-limitation in their daily social life. Commonly reported health concerns were urinary and bladder control, infections and breathlessness. None of the participants perceived that they received appropriate emergency care at the injury site, and transportation to a medical facility usually occurred in unsafe vehicles due to limitations in general awareness and knowledge of the injury sustained. At the facilities there was a reported gap in knowledge and competencies regarding the etiology of this type of SCI, leading to multiple referrals for diagnosis and delayed management. Community and social reintegration was mainly impacted by lack of financial resources, lack of realistic goals, poor mental health including suicidal thoughts and previously mentioned secondary complications.

Conclusions: Increasing awareness and knowledge about SCI emergency and acute care might contribute to improved long-term clinical outcomes and survival rates among Scarf Injury survivors. Moreover, greater competencies and awareness among providers to manage this unique mechanism of injury would increase the patient´s and caregiver´s level of understanding of their condition, and would result in earlier adoption of a coping process.

Implications: Early rehabilitation that focuses on physical and mental health, alongside empowerment and integration, appears to be lacking in this setting Further studies are needed to identify effective and culturally sensitive intervention programs for females living with Scarf Injuries in LMICs.