Emergency and humanitarian action

In for the long-haul: Rehabilitation and Nepal’s ‘step down’ process

Perched midway up a steep embankment in Nepal’s undulating Kavre district, the Spinal Injury Rehabilitation Centre (SIRC) is at first glance unassuming. Its front gates are barely marked and the turn-off easy to pass. Once inside, however, the capacity and scale of the non-profit facility becomes clear: Ramps with gentle gradients lead to expansive therapy and vocational training rooms, while a multi-terrain wheelchair course is visible through large, light-filled windows. A hydrotherapy pool planned before the quake to be open in May will now be fully functional once immediate patient needs are met.

Since Nepal’s 25 April and 12 May earthquakes, SIRC has worked closely with the Ministry of Health and Population (MoHP) and WHO to provide critical care to those who sustained spinal cord injuries in the disasters. Along with Pokhara’s Green Pastures Hospital, SIRC has received referrals from health care centers throughout the 14 most affected districts, and has expanded its bed capacity from 51 to 200. As a result of SIRC’s impressive facilities and close coordination with health care partners, the center will form an integral part of the country’s ‘step down’ process designed to provide ongoing care and rehabilitation to those injured in the quakes. Along with accepting referrals of spinal cord patients, the center is working with the MoHP, WHO and other partners to ensure that the needs of those with multiple injuries and other complications are met. With Nepal’s emergency phase ended, the provision of ongoing care and reintegration services for the injured remain a priority.

According to Administrative Director Dipesh Pradhan, when the magnitude 7.8 earthquake tore across the country on 25 April, the SIRC was rehabilitating 39 patients. In the days following the quake, the center’s staff supported spinal cord patients presenting at Kathmandu’s major hospitals, and worked closely with Nepal’s MoHP and other health partners to refer them on to SIRC to gain specialized care.
In response to the post-quake influx of patients, SIRC has increased its capacity and now has the resources to provide the long-term care required. “We are planning to accommodate around 200 patients so we have sourced extra material and manpower. In addition to our regular staff we have hired four rehabilitation therapists and also two psychologists to provide psychosocial counselling,” said Pradhan. It costs donors and supporters approximately USD 3100 to support 3 months of a patient’s rehabilitation care, he said.
WHO/Joe Swan
Twelve years ago Sonika Dhakal was injured during Nepal’s annual Dashain festival. For the past decade she has been leading group counselling sessions at SIRC while demonstrating the possibility of living an independent, mobile life despite disability. In the post-quake context her services are more important than ever. “After the earthquake many of the patients have lost their family members and have accommodation problems. They have much more psychological pressure than they normally have. This drives me to give patients the best support we can,” she said.
WHO/Joe Swan
Keshab Prasad Sitaula manages SIRC’s occupational therapy department. After working at Kathmandu’s Bir Trauma Center for two weeks following the 25 April quake he returned to SIRC and now works to enhance his patients’ motor skills. He also coaches them in the use of assistive and adaptive devices. Despite his heavy workload, Sitaula says that he is ready and able to provide care to incoming patients.
WHO/Joe Swan
According to 23-year-old Shashi Shrestha, who runs SIRC’s physiotherapy department, the job of the team she commands is clear: “We try to make our patients as independent as possible,” she said. “When we are giving them the therapy we also make them realize what they can achieve.”
WHO/Joe Swan
Kshetra Gurung has worked at SIRC since the center first opened in 2002. In 2013, the one-time occupational therapy assistant moved over to the center’s workshop and began custom-fitting wheelchairs for the facility’s patients. Given the post-quake demand for his services, it’s a good thing Gurung’s technical expertise are well-honed. “I did basic and intermediate training for wheelchair assembly given by WHO in Pokhara last year and three months basic prosthetics and orthodics training in Thailand,” he said. “We assemble our wheelchairs according to the WHO guidelines on the provision of manual wheelchairs in less-resourced settings.”
WHO/Joe Swan
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