Stories from Surkhet – Part 2

A week in the life of
the Surkhet therapy department.

In part one of this series of two blogs about my time supporting the INF therapy work in Surkhet I (Pippa) introduced you to some of the work that is being done there, and promised to introduce you to some of the patients.  Here are some of their stories!

Monday

Sussma comes in with her husband for assessment for in-patient therapy.  Her notes say that she is in her early 40’s, but she looks about 60 – the harsh lifestyle here ages people fast.  She gives a history of falling out of a tree 6 months ago whilst collecting food for her animals, sustaining a spinal cord injury, which was stabilised with surgery in Kathmandu.  She hasn’t stood since, but we spot that she has some activity in her leg muscles.  Three of us help her stand – she is weak and doesn’t last long, but is delighted at the hope that this gives her for the future, after 6 months of lying down without any therapy input.  We book her in to attend as an in-patient once the pressure sore which has developed on her hip has had the chance to settle. 

Tuesday

In addition to overseeing the rehabilitation of the in-patients, Physiotherapist Princy also sees a constant stream of out-patients who come in presenting with various orthopaedic and neurological complaints.  On Tuesday morning a senior army official comes in surrounded by his various minions, having had a nasty motorbike accident the day before, which left him with back problems.  We assess him and exclude any major damage, so treat and advise him.

Next, a 14 year old boy with a month long history of foot drop and knee pain comes in. On assessment he presents classically as having a nasty neurological condition called Charcot-Marie-Tooth, so after setting him up with an exercise program to follow at home, we advise more investigations.  In order to see a Neurologist he will probably have to make the 15 hour bus journey to Kathmandu. As Princy works her way through patients with neck pain, hand problems, shoulder dysfunction and strokes, I am able to review her assessment and treatment skills and work with her on her clinical reasoning and treatment planning skills. 

Wednesday

Wednesday turns out to be a long but rewarding day in the
community, driving to remote villages for monitoring visits to previous
in-patients, and to assess others to see if they would benefit from in-patient
therapy input. 

Our first patient, Krishna, was discharged a couple of years ago after rehabilitation following a complete spinal cord injury in his back which left him without the use of his legs.  On the last follow-up visit the community-based rehabilitation worker had found him lying on a mat on the floor inside the house, not really engaging with life.  We are delighted then, as we drive around the corner to his house, to spot him out in his field in his wheelchair tending his crops.  The pair of goats that INF donated to the family as an income-generator have produced enough income for the family to rebuild their house to allow wheelchair access, and to feed and raise school fees for their children.  Despite tragedy in their lives, the family is now able to financially sustain themselves into the future.

Krishna (centre), his wife, and INF community rehabilitation worker

Next stop is the tiny mud house which is home to Hari, a 9 year
old boy who lives with his grandmother after he was abandoned by his
parents.  It looks to me like Hari has
some sort of progressive muscular dystrophy – his grandmother reports a
progressive weakness over the years. 
With a complete lack of therapy input Hari’s knees are now very
contracted and painful.  The family have acquired
a wheelchair from somewhere, but it is too hard for Granny to push, and he now
spends most of his days inside their dark hut. School is out of the
question.  Swallowing has become an issue
and Hari looks painfully undernourished. 
We refer him to Tansen hospital, a few hours drive away, where a team of
Physio, Occupational and Speech therapists will be able to assess him, and
receive Orthopaedic opinions to consider surgical release of his tight
muscles.  Financially this will be out of
Granny’s reach, so we ensure that she is being given support to access charity funds
available for poorer patients, who would otherwise be excluded from accessing
the help they need.

Pippa with Hari and grandmother

Thursday

Sagar is a 40 year old schoolteacher who sustained a nasty open
fracture in his left lower leg 3 years ago in a motorbike accident.  It was surgically corrected at the time, but
he has had no therapy input or advice since then.  The metalwork was removed a few months ago,
but he presents with an extremely stiff leg with significant muscle loss, and
is spending a couple of weeks as an inpatient to begin to address this.  We spend time setting him up with an exercise
program and ensuring that he can do this correctly by himself, as his village
is several hours drive away, and he will need to manage his condition by
himself once he has left. 

Sagar

Friday

Today I spend time with Prem, one of the department’s two trained therapy assistants, as he treats a 70 year old gentleman who has had a stroke.  On admission he couldn’t sit up unassisted; he can now walk with a stick and is nearly independent in personal skills, restoring his dignity.  I hope that his walking skills progress to allow him to walk around his hillside village – a very different challenge to walking around the flat therapy department corridors.  Many, many people with mobility challenges are forced to spend their days inside their homes, as negotiating the steep hillsides around their houses are out of the question.  My hope is that the wonderful therapy work here can continue to develop and expand, so that many more people as a result can have a changed future.

Prem treats stroke patient
Living on a hillside

Patient names have been changed; photos used with
permission.