Follow up trip in Tansen - Updates

The last few days have been spent following up on some patients we saw in the community during the official visit back in March. Prior to that I was taking some time to see the workings of Green Pastures and working and mentoring the new physio there. We took some time to review the Bobath techniques with the other physio staff who took the workshop in Kathmandu. Overall, I think there was good integration of the techniques, however, they just need the right patients to practice! I also got to learn a bit more on the leprosy side of rehab and got to apply a plaster cast and tibial transfer bar for ambulation. Unfortunately, due to the Bobath training course, conflicts with Nepali New Year and Easter holidays, I wasn't able to do any visits with PFR while I was in Pokhara.
On my visit to Tansen, I arrived just in time to attend the physio session that Amrita, the nurse who had Guillain-Barre Syndrome, has in OPD. It's a big feat that she now has therapy sessions out of her home and has also been attending nursing inservices within TMH as well. When I saw her, I was so pleased to see how she's progressed as you all would have been as well. She's put on a lot of weight (healthily!) and she's so motivated for all therapies. I worked with her for about 1.5 hours and she was eager to go home and do meal prep!
Her mobility has improved and we worked on increasing her independence on transfers, she still is quite weak in her extensors and lower extremity but she has gained more strength in her upper extremity and trunk. She is even standing for short periods unsupported and ambulating short distances with a walker or with support.
She is doing well, and as per our last recommendations, she may benefit from bracing to increase her mobility independence and she has been put on the waiting list for short term stay at Green Pastures for fitting and assessment.
It was great to see these improvements and to see how a little education in rehabilitation has made great differences. Amrita was not aware of the potential of her body after her illness and was confined to her home, however, with persistence with exercises she has made gains and is slowly resuming some of her previous activities.
I spent the other days doing rounds with the surgeons, co-treating with the physios and doing a little bit of teaching on ortho techniques with the PT staff. It was a short but sweet visit. I am back in Kathmandu now and will be visiting the new SIRC centre and staff again tomorrow!

Teaching at GPH

After our sessions in Tansen, we travelled four hours to the lovely town of Pokhara where Green Pastures Rehab Centre is located. We attended rehab and leprosy rounds with Dr. Biswal and through observation of this, we were able to see the effects of untreated leprosy, which we don't see in Canada. On Wednesday we started our first session with the staff on Team Skills and Goals.
At times it was a bit difficult as some of the concepts were abstract and sometimes difficult for the staff to translate to daily practice. But the group sessions worked out well and all the staff participated in the brainstorming and goal setting practice.
The seating presentation with the pressure mapper were great successes with great interest in the technology.
The practical skills that Sylvia taught them worked very well and the smaller group session on Friday was a great success and many of the staff integrated all the new teachings well! It was also a great experience for the staff to try out the new wheelchair park and see how difficult it is to maneuver the same wheelchairs they give to their clients in the community.
It will be great to follow up on the next teaching sessions to see how it's been adapted to their purposes and the innovative solutions they have created.
During this time we were also able to present the vast amounts of donations we've accumulated.
They were much appreciated and many thanks from GPH!
We also had to have a bit of fun so we all went paragliding off Sarangkot, it was a scary experience for some, exciting for others, and sickening for me and Erica. We enjoyed it but I don't think I'll do it again without some anti-nausea medications! All in all though, a great experience!

Community visit

We finally had the chance to do some community visits after many days of teaching and prep work. We had 3 patients planned, one specifically by the staff because this person was a nurse who was ill with GBS (query, maybe polio) and has not had rehab since discharge. The other 2 were out in the villages about 1.5 hours walk away and we were following up on their status since the September team had paid them a visit last time.
Amrita was the first client seen since she was very close to TMH, she lived in a very inaccessible place even though she was maybe 5 minutes away. Her house was offroad and the only way to get there was a very narrow rocky ridge which would have been impossible in her case. She had been bedridden for about 6 months and exhibited a lot of muscle wasting (partly due to her disease), and learned non-use. We worked on basic bed mobility and compensatory strategies on moving her legs since her hands were very weak and on sitting trunk balance. We also attempted standing for weightbearing and taught her and her husband on muscle strengthening and stretching. I will try to get back there after my trip into Pokhara to follow up.
After Amrita, we had to rush and took the jeep to visit the other patients. Saraswoti was a walk down the valley and when we arrived at her house, she was happily making baskets and small brooms that she was planning to sell later. She was sitting on the lovely cushions that September team had provided and showed us that she knew all about pressure relief and management. She had good skin integrity and mobilized well in the space she was in. Her wish was to be able to mobilize a bit more independently on the porch and around her house and we brainstormed and thought maybe we could build a platform with wheels that she could push around with her hands or with sticks. We also left behind a Thermarest which she could use on her bed (she was sleeping on a hard plank) or when she wanted to lie out on the porch.
We then visited Tika, who was not feeling well and whose husband reported signs of a seizure previously. She also seemed slightly confused and with slurred speech. She had not been ambulating because she had not been feeling well over the last days. We saw her ambulation and decided that maybe a bandage wrap to stabilize the ankle would help her feel more stable with ambulation and it did seem to work. However, we were more concerned with her medical status and advised her husband, who is 91 years old and the primary caregiver to Tika, to send her to TMH as soon as possible for follow up. We were able to arrange for funding and hopefully transportation there and back as well since they are in a very inaccessible place. It's only when you do these visits do you realize how difficult it is to get proper and timely care in these hilly regions.
We went on a walk with Ganesh, the guesthouse owner today and we had hours at a time when we were not on a main road to get to a bus or car. Many of them would have to be carried to help and risk further injury.


Overall, the community visits were very enlightening and we all wished we could have had more time to see more patients.

Teaching days

The last 2 days were spent in teaching sessions with the allied health staff and MDs regarding various topics, such as stroke, SCI, Guillain-Barre Syndrome, contracture management, and practical sessions for the nursing staff for positioning and transfers. Overall, I think the reception of the sessions were largely positive. The nursing staff really enjoyed the hands-on part of the session and we had a hard time ending the talk!
We had a tour of the hospital and were really impressed with the complexity and scope of the hospital. It has orthopedic and medical inpatient wards (including burns), physiotherapy and soon to be occupational therapy services, outpatient services (medical and rehab), laboratories, imaging labs (x-rays and ultrasound mainly - they get their CT scans down in the larger town not too far away). It's a very comprehensive hospital with good support from expat staff and knowledgeable and eager staff. It was a great pleasure to meet all of them and to work with them.
Our wish was that this could have been a longer trip on this site to have more time to consult and assist the PT staff. The staff we met, Rajendra and Pratima are great therapists who are so eager to learn as much as possible and acquire new skills. Rajendra is the senior therapist and has been there for ~15 years. He has developed a local style of crutches made out of bamboo, it's really innovative and most importantly, it works and is cheap!!
The other staff here have been really friendly and have been trying to help us settle in as much as possible. Last night there was a graduation ceremony for the outgoing interns and most of the medical staff arrived and much fun was had!
Today we leave on our community visit to see 3 patients and hopefully be able to help them out a bit more!
Sorry about the late posting of pictures, soon to come!

Safe and sound in Tansen

Hello all,
Arrived safe and sound and a bit tired after 27 hour journey from Toronto to Kathmandu. Had a great time trying to fit all the luggage into a cab, since we had 5 suitcases with us. By chance bumped into Shaun and Erica on the streets of Thamel which was a great coincidence since we had never met! Had to get used to the lack of electricity in KTM, which has been reduced to 4 hours/day and even that are at inopportune times ie. 12AM -4AM. It makes for many candlelight dinners and early bedtimes!
We caught our early flight the next morning to Pokhara where we met with Carol Scovil and dropped off part of our luggage (donated seating equipment and braces) and then headed off to Tansen. It was a long winding road through fantastic scenery. However, the many hairpin turns did make me a bit nervous at first, but we had a more than competent driver who got us safely to Tansen. We have settled in at Tansen, and met some really great people who have given us a feel for the hospital and the town. We will be preparing our presentations tonight and will start on our first presentation/workshop tomorrow afternoon on Bobath approaches.
Very happy to be in Tansen and back in Nepal!

We're on our way!

Making the final preparations for the trip to Nepal. Cannot wait to get back, but also a bit nervous about the conferences. I've never really taught in such a large group before and hope I don't mess up or seem incompetent!
Managed to pack in 3 suitcases mostly full of donations, thank you to everyone who donated items/cash! Much appreciated!
We are always looking for more donations, hopefully to purchase more medical equipment ie. CT scanner, treadmills in the future.

Itinerary to KTM - fly from Toronto, to London (meet with Monica and have a quick tour of London), to Bahrain, then to KTM. Supposedly massive power outages now and up to near 50 hours of no electricity. Our target airport has been closed down due to resurfacing of the runway so we have to fly in and out of Pokhara and then drive 4-10 hours to Tansen. I hate roadblocks.