Second Week of Placement

Caitlin and I are currently sitting in our room after a pretty busy and amazing week.

We started getting into the swing of things at SERC and IFCH. At SERC we have been working with a number of different children independently with pointers from Thea, who is an amazing pediatric physiotherapist from Holland. We brought over much of the donated materials, including sensory rehab kits, fine motor supplies, swiss balls, and the wheelchair ramp. We have yet to show the school physio, Pratik, how to use them because of time constraints but the managers and teachers were very eager to test out the new wheelchair ramp and excited that they would no longer have to carry their students from the front door to the classroom! After observing and a great discussion over lunch with Thea and her friend Angelika at the “Hygiene Bakery” we have decided that the best and most sustainable use of the money that was donated will go into teacher education. The teachers are very eager to learn and are doing a fantastic job! But, often children are sitting in class unstimulated and with nothing to do. Thankfully, Thea has some contacts in Nepal and we will be able to get the ball rolling when she returns from her trek in the Annapurna’s.

At IFCH we are still mainly seeing children in the burn unit and with cardiorespiratory conditions. We had the chance to view some casting and do some hands on work getting children moving to prevent contractures. We gave 2 presentations last week to the local physio Sam. The first on burn rehabilitation for pediatric patients, and the second was an overview of common cardiorespiratory conditions seen in Nepal. Our big project at IFCH is in the development of an outpatient department. So, we have been given a room to work with, brought over the donated supplies and made a list of equipment that we need to make the department functional. We have bought some toys for rehabilitation, infection control, and the amazing Dr. Shakya is sending a carpenter and seamstress to make what equipment we have requested (foam wedges, ladder, sitting support, pullies, etc). We are also in the midst of making a standard assessment sheet, and creating pamphlets to give to physicians so they know when it is appropriate to refer children to the physio department.

On Monday we visited Kanti Hospital, which is Nepal’s only government children’s hospital. The outpatient physio department was a single room equipt with much of the same equipment that we would see at home. The hospital itself was very crowded by Canadian standards. Patient beds were within feet of each other and one room would have upwards of 30 patients and their families occupying it. In total there were 300 beds and although it is a government hospital the cost to the family for a child to be on a ventilator is 1000 Rupees per night (around $11 Canadian). For meals, a cart was set up in the hall and patients or their family members would serve food themselves and go back to their bed to eat.

Wednesday, we visited a private teaching hospital and medical/physio school in Dhulikhel. The hospital and school were absolutely stunning, with mountainous landscapes seen in all directions. Most of the money has come form Swiss investors thanks to their director. The physio school was very nice and the library was more like a lounge at a fancy hotel than anything else. They did have many of the same books that we use in Canada, and the Canadian Physiotherapy Journal was proudly displayed on their shelves. The physio program in Nepal is a 4 year BSc with most of the professors coming form other parts of the world (India, Europe, Australia), and the current class has only 13 students. In the first 2 years, they focus on basic sciences and in the last 2 they focus on physio specific courses. One interesting difference is that in their fourth year, the students complete a community based rehabilitation (CBR) course with one mandatory 4 week CBR placement. During this placement, they are placed in a rural community and have to figure out the needs of the community, and carry out a project that will benefit its members. This seems like a valuable and worthwhile project for Canadian physio students! The hospital was less crowded than Kanti, but still much more than Canadian hospitals. Since it is a private hospital, the cost per night is 2000 Rupees ($23 Canadian) and the cost for a ventilator is 5000 rupees. However, they did state that if patients come and can’t afford their rate, they would do everything possible to accommodate due to the distance between hospitals,. The hospital also has satellite clinics all over rural parts of Nepal to ensure that everyone gets sufficient care when ended.

Well, that’s it for our work week! Now you hear all about our trek in Annapurna from Caitlin!

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