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The Spinal Injury Rehabilitation Center’s needs for trained doctors to work there can be supported through our Spinal Cord Injury Collaboration – SpiNepal. We are now raising funds for the final stage of the current project as our trainees complete their specialty education and examinations. Donations can be made through this link. UBC will issue Canadian income tax receipts and can also accept donations from the US (contact us for directions on how to do this).
May 5 2017 (Kathmandu)
Dear friends and supporters,
We (Claire and Peter, travelling with supporters and friends Dave and Darby) reached Kathmandu Friday a week ago after four days in Hong Kong to explore and to successfully get over jet lag. We were met by Dr Prakash and taken by minibus to the Happiness Guest House near Boudha (pictured above), the Tibetan area of Kathmandu that is walking distance to the Nepal Orthopaedic Hospital (where SIRC begans its life 15 years ago) and to Raju’s family. The post-earthquake tent city ironically near the Hyatt Hotel had just disappeared; new buildings were in evidence; the major road to Boudha and Jorpati (where SIRC began its life) was being widened by the partial demolition of buildings beyond their legal footprint, and city water from the distant Melamchi River was being piped into the city so that the potholes were much worse than usual as the water mains were buried under the road. Kathmandu is preparing for its first municipal election in 20 years in a few days. Over the weekend we were able to spend time with Raju and Sheela (expecting their firstborn in a few months) and Prakash, Laxmi and a very lively 19-month old Ritika (right).
We planned to make the trip now to synchronize with Dr Raju’s return to SIRC and our major goal for the trip was to offer mentorship and a ‘sounding board’ on his early return to a very different role than he had before. Further, we had spoken with Dr Christine (seen left with new Admin Director Sanjeeb) who has been a great mentor to the two junior physicians (Drs Arjun and Abhishek) who are providing routine clinical care. We had not yet met Christine face to face but from all we had heard knew that she would be a great support to Raju also.
Raju’s news: His training has concluded with the successful completion and defence of his thesis (comparing two conservative treatments for low back pain). He now has his MD specialty qualification in Physical Medicine and Rehabilitation. A big “Thank You” is due to the BSMMU faculty for having the faith to accept him and to train him over the last five years. Part of Raju’s training has been attending conferences and visiting other centres – these have included: the Irish National SCI Centre, the Indian Spinal Injury Centre and rehabilitation training centres in Melbourne, Toronto and Vancouver, the latter in association with attendance at the PM and R review course in Toronto. A further wonderful opportunity (and a logistical challenge) presented itself a few days before we left for Nepal, when we learned that the SCI team was to leave on April 29th for Switzerland as guests of the Swiss Paraplegic Centre (the SPZ) in Nottwil. As these are the people that Raju will be working closely with, this clearly presented a real opportunity for him to work closely with his colleagues in a stimulating learning experience. Thanks to our supporters, we had sufficient funds in hand to cover his expenses in joining them. Our Swiss colleagues were supportive, and the Swiss embassy here was extremely efficient in providing a visa within days so that Raju left May 2 for Zurich and has now joined his colleagues from SIRC. An interesting additional note: a newly formed international Cochrane Rehabilitation was launched December 2016 to which Raju was invited to participate to represent his region.
Unable to attend the ISPRM meeting in Argentina at which the group was to first meet in person, he rose at 2:30 am May 2 to join a conference call with the group, prior to heading to the airport in Kathmandu. For news from Switzerland, watch your Facebook pages – thanks to the team for these pictures!
Prakash news: Prakash has been continuing his active neurosurgical work at Bir Hospital, although he is still on a ‘daily’ casual employment basis and looks forward to sometime in the future when he may become a staff member. In the meantime he has had a poster on epilepsy treatment in Nepal accepted for an international meeting in Barcelona this September and been awarded partial support to attend that meeting. This may also link in with a three month neuroendoscopy training course in Germany that he is considering attending. Congratulations, Prakash! He invited the four of us to join a number of his neurosurgical mentors and his former general surgical chief and a favourite restaurant (the Alice) last evening – a delightful way to celebrate completion of his neurosurgical training. To complement this – we had a spectacular lightning display over Kathmandu and the foothills of the Himalayas to the north of us.
As of the end of April the major training phase has thus been completed and both doctors cease income support from Spine Nepal. However, there are “bridging” needs that we are currently exploring and will discuss in more detail on return home. For Dr Raju, we are supporting the costs of the current course at SPZ. For Dr Prakash, there may be some assistance to support his application for a one-year spine surgery fellowship (which should be self-funding), the place yet to be determined, to qualify him to pursue a spine surgery practice at an academic level on return home.
May 3rd was like the old days for us. We were up early and walked through the Boudha stupa area, where hundreds of people walk quietly around the majestic structure, murmuring, working rosaries, spinning prayer wheels. We had a ten minute wait to watch the bustle on the Jorpati road, then it was on to the big yellow bus for the one-hour ride to SIRC. We met Sanjeeb, the new Adminstrative Driector (read: COO) and talked with many old friends. P spoke with Prajjwal, formerly the Community Based Rehab worker visiting homes and arranging necessary modifications. He is now a manager with VOICE, a vocational training program, of which more later. A brief breakfast was taken then Claire and Darby joined the three MDs for rounds (below).
Peter and David walked around the hospital. Things that impressed us:
Completion of the upper level. This facility expansion sponsored by MSF Belgium now houses offices and part of the vocational training program – the area where machine sewing skills are taught. The former SIRC patients come back to SIRC for three months and learn a number of skills: sewing, pickle making and canning, or English and IT skills.
Downstairs one major change was seen: underfloor heating has been installed as a pilot project in one ward. Weather and indoor temperatures will be monitored to assess the effectiveness of the solar water-heating panels. As it is, the expanded solar water heating (below) and photovoltaic panels installed on the hospital have reduced the monthly cost of electric power for the hospital from about 100,000NR to 30,000NR (1 CAD = 75 NR).
The physio and OT areas were busier than we have ever seen them, and we hope that this work is charted on an integrated chart to ensure that the treatment plan and its progress is quickly available to other care team members .
SIRC is preparing to accept stroke patients for rehab, capitalizing on the earthquake expansion of capacity. Not all team members are yet fully trained and ready for this step but the date is nearing when this will take place.
The therapy pool (suited for selected SCI and stroke patients) temperature is not yet high enough for these patients whose temperature control may be impaired, and facility modifications to correct this are planned.
The VOICE program is a bold vocational training program being undertaken with the support of the Korea International Cooperation Agency of the South Korean government and the Korea SCI Association. We hope to learn more about this today.
Ram, one of the five peer mentors at SIRC, is planning a new yatra throughout Asia to enhance awareness of SCI. He plays the sarangi (left), and now has a musical ballad on YouTube that tells his story in a very Nepalese way, but with English subtitles : https://youtu.be/fE4hBBnSyIE
We (joined by Prakash) will be out at SIRC again today to meet with CEO Esha, to learn more about the exciting changes, and to join Drs Arjun, Abhisek and Christine in a teaching session this afternoon. Then, dear friends, we depart Sunday for Pokhara and a trek to the Mardi Himal and Ghorepani areas, Age-Related-Symptoms permitting. We return after that for another week in Kathmandu before heading back to Canada.
April 8 2017
Raju has successfully completed his Physical Medicine and Rehabilitation training and, apart from attending to the paperwork, has one more step to go: please joining us in saying “Good luck” to him for success with his final hurdle – defense of his research thesis April 15 (News Flash – he was successful!! 😀 ). Then it will be time for Raju and Sheela to pack up for the last time and prepare to move home to Kathmandu. There will be practical issues to sort out as he joins the SIRC staff again, this time with clinical and administrative responsibilities as the senior physician and only physiatrist (trained rehabilitation specialist) practicing in Nepal. He is looking forward to working with the patients, with administration, the care team and, of course with the two staff doctors there. Volunteer physiatrist Dr Christine Groves will be a wonderful mentor for Raju at this stage. Unfortunately, the details of his employment have not yet been addressed and will keep him busy when he first returns, as well as addressing the practical issues of how to organize his work week, where to live, how to commute etc. Meanwhile, Prakash has been working steadily at the Bir teaching hospital with Dr Prakash Bista, his teacher. He has been enhancing his surgical skills, is considering a couple of research projects, and will probably be seeking a position at some future time as a spine surgery fellow, the usual ‘next step’ for an orthopedic or neurosurgical spine surgeon.
SIRC has been marking its 15th anniversary this week with a celebration, parts of which are described in Kate Coffey’s blog, while you can also find a photographic record of the ceremonies through the Facebook page. Here, you see some of the attendees at the SIRC ceremonies outside the facility. (photos courtesy of SIRC, Maggie Muldoon and others)
Left: CEO Esha Thapa with Founding Chair Kanak Mani Dixit, board member Anil Bahadur Shrestha and supporter Goma Dulal. Right: Esha, Christine, Chanda, Mandira and Sonika
Claire and Peter leave for Nepal on April 23rd. We shall travel with long-term supporters and good friends Dave and Darby. We plan to spend a few days in Hong Kong to help us get over the jet lag associated with the 12 hour time change, arriving in Kathmandu April 28. We expect to spend two weeks working with Raju and Prakash and trek for about a week – the details of what we can most usefully do with respect to our trainees have yet to be determined.
One of our tasks will be to say a big thank-you to SIRC founding chair Kanak Mani Dixit and his fellow-board members as well as others in Kathmandu who have contributed to the development of SIRC. We are still working out how to do this as Kanak can be very busy. Interestingly, Kanak will be speaking in Berkeley on May 8th: more about that here.
Kanak remains very politically active through his work as a writer and blogger – our thanks to him for drawing our attention to the Madhesi Youth Photo Project by Puru Shah here. (The Madhesi are the inhabitants of Nepal’s low-lying Terai region.) You may also be interested to look at some of Puru’s other work: the unhappy story of a Nepali work migrant’s problems in Saudi Arabia here and an excellent infographic about migration patterns in/from Nepal here – this is excellent use of interactive graphics following the stylistic approach of Gapminder – founder Hans Rosling would have been delighted to see this work.
On return from Nepal and in consultation with our colleagues in Nepal, Canada and elsewhere we hope to bring all our supporters up to date with the ongoing Spine Nepal plans for support of spinal care in Nepal.
Feb 20 2017
Another major goal achieved: Congratulations to Raju on passing his final examination on the first try. He now has an MD degree in Physical Medicine and Rehabilitation. He must still complete his dissertation and anticipates that the defense examination will be complete by April. He will stay in Dhaka until then, most likely, and expects to participate in an ultrasound course. In the meantime he will attend regular rounds and academic sessions at the hospital. He expects to be back in Kathmandu around the middle of April, perhaps missing the 15th anniversary of the SIRC (see below).
Raju and Sheela plan to sell some of their small collection of furniture; the rest will be given away. Packing and planning for the return home begins now – he has amassed a number of books he needs to take home. Raju has sent a brief note of relief to us all which you can read here.
Claire and Peter were hoping to attend the 15th anniversary celebrations, but the priority is for us to be there as Raju begins work in his new position as Medical Director of SIRC, so we now expect to travel a little later – perhaps early May.
Raju’s wife Sheela, meantime, is looking for other work opportunities to take effect when she is back in Nepal – she obtained her Master’s of Public Health degree in Dhaka.
Prakash has renewed his contract renewed as a junior neurosurgeon for another 6 mos at Bir teaching hospital in Kathmandu; he is performing an increasing number of spine cases and has recently submitted a case report for consideration for publication. From time to time he discusses details of case management with Scott and/or Peter. The requirements to enter employment in a Nepalese government hospital are quite strict so he may look for opportunities in another situation such as the Kathmandu Model Hospital. He is interested in completing a spine surgery fellowship first and is seeking opportunities for this. On the home front, little Ritika is now walking and chattering away.
We lost a great man this week – you may be interested to learn about him. He was a renowned Swedish public health physician: Dr Hans Rosling, who succumbed to cancer at the age of 68. We have heard him speak a number of times on the subject of world health using United Nations/World Health Organization data which he presents most eloquently using specific software developed through the Gapminder Foundation. If you have not heard him speak, spend an hour or so on one or both of these videos:
….after which you may wish to check out his TED talks, or to download the Gapminder software and enjoy manipulating the data yourself.
Finally, SIRC celebrates its 15th anniversary April 6-8. Follow their plans as they become available here. We hope to report on it in due course.
Dec 29 2016
Dear friends and supporters – it has been a quieter year and a year of ongoing recovery for our colleagues in Nepal. SIRC has been working on the development of a stroke service and we look forward to learning more about that on our next visit. Our two young specialists-in-training are a bit closer to their target. Dr Prakash passed his neurosurgical specialty exams in Pakistan this year, is now working at a junior level in the Bir Hospital in Kathmandu, and considering his options for further training in the spine surgery area. Dr Raju has further work to do on his research project and will in mid-January be taking his final clinical exams; if all goes well he will return to Nepal to work in SIRC at the beginning of April, as SIRC celebrates 15 years of providing service to those with SCI. We hope to return at that time.
2016 will soon be over: the year end is upon us, and if you have not decided how to direct your tax-deductible charitable donations this year, please keep this project in mind. As our goals of providing training to two doctors near completion we will work with colleagues on a longer term plan. We invite questions by email through the contact link above.
Other countries also have much work to do for those with SCI and we bring you here a couple of news items from Africa: In many African countries the situation for those with SCI is similar to Nepal, but new units have been developing, notably with the help of our friends at the Spinalis unit in Stockholm. Check out this short video which is a brief vignette of the SCI rehab unit set up in Gaborone by the Spinalis team from Sweden working with their colleagues in Botswana. Swedish TV has developed a longer video about this project and we hope that will become available in due course. And, read this recent Guardian article about two developments in Kenya – be sure to follow the links to see the developer’s ingenious power wheelchair prototype in action.
Thanks for following our progress. We wish you a Happy New Year – may it bring you happiness and fulfilment!
Peter and Claire
PS: To provide a tax-deductible end of year donation, follow the link above.
Dec 5 2016
Reconstruction seems to be proceeding in Nepal, according to the Nepal National Reconstruction Authority. Nepalese life follows its calendar, which has recently brought some of the major annual national holidays. There are, with regional variations, nearly 40 holidays annually in Nepal. However, this is offset by the working week in Nepal which is six days, with only Saturday as a fixed day off. Both Dashain (about 10 days) and Tihar fall in October, and bring families together in the same way that Christmas and Thanksgiving do here. Below, staff at SIRC celebrate Tihar.
Tihar, the Nepali equivalent of Diwali, is a five day holiday, each day having a different function and acknowledging different beings. As Wikipedia says: “Tihar is the second biggest Nepalese festival following Dashain. It is considered to be of great importance as it shows reverence to not just the humans and the gods, but also to the animals like crows, cows and dogs that maintain an intimate relationship with humans. People make patterns on the floor of living rooms or courtyards using materials such as colored rice, dry flour, colored sand or flower petals outside of their house, called Rangoli, which is meant to be a sacred welcoming area for the gods and Goddesses of Hinduism mainly Goddess Laxmi”. https://en.wikipedia.org/wiki/Tihar_(festival) These holidays are the occasions for major family reunions, and both Raju and Prakash were with their families over Tihar this year. (Right: Prakash’s family – Laxmi with young Ritika at Tihar.)
Prakash’ career took a major step this year when he passed his neurosurgery specialty exam in Pakistan. The Islamic holidays (Eid) delayed the oral part of the exam and he had to spend several extra weeks in Pakistan in preparation which included gaining comfort in Urdu which he needed for talking with patients in the exam. He passed first time – a relief for all of us and unusual for Nepali candidates.
His ongoing career plan is less certain. Now back in Nepal he hopes to work within the public system, but unfortunately the government requires five years of experience, excluding training, prior to eligibility for a government surgeon’s appointment. He has about 1.5 years’ qualifying experience at this time, (actually, at least six years if his training time is included). He has been able to secure a medical officer position in Bir hospital (a major trauma and teaching institution in Kathmandu at which he was a resident), but is very junior and what we would term a “casual” as he is paid by the hour. The pay is not good but he is able to augment this to some degree with sessional and fee-for service work in a private hospital which his chief, Dr Bista, visits. He is gaining experience and will be looking for other options to advance his career. Mentorship continues: we’re in quite frequent contact with Prakash as he shares with us interesting cases so that we can discuss management.
The big questions remain: will Dr Prakash be able to attain a more senior position and, if so, when? Also, will he choose to and be able to subspecialize in spine surgery, and what can he expect to undertake as a spine surgery fellowship (usually a year of additional spine surgical training). We hope so as we believe that a well-trained neurosurgical spine surgeon with a focus on contemporary management of spinal injury is much needed in Nepal, and expect that we will need to provide a measure of financial support to attain this goal.
Meanwhile, Dr Raju will finish his training in the spring of 2017. While he has completed his thesis project (a comparative study of two conservative treatments for low back pain), he encountered some difficulty in the examination and will need to revise the dissertation prior to having this accepted. His final clinical exams will take place early in our New Year. We anticipate that, by the time he meets all requirements and takes an available ultrasound course, he will be able to return to Kathmandu about April, when he will join the full time staff at SIRC as Medical Director. Various friends and colleagues will assist us in mentoring him as he takes up this new role. Raju and Sheela are looking at their options for accommodation to support his new responsibilities.
The charge nurse at SIRC, Mandira, has had an eventful year including attendance with SIRC support and the company of physiatrist Dr Christine Groves at the International Spinal Cord Society annual meeting in Vienna (September), when they linked up with spinal rehab colleague Dr Renee Maschke. Following this she paid a visit to the Swiss Paraplegic Centre at Nottwil upon which the SIRC was modelled; the Swiss team has visited and taught at SIRC on numerous occasions. You will recall that Mandy was also awarded a scholarship to Adelaide, attending a course there in May. She was scheduled to attend for the second part of this course in November but was denied an Australian visa. The provision of visas to young professionals appears capricious and can make planning very difficult.
SIRC will celebrate its 15th anniversary in the spring 2017. While we don’t yet know the dates, we hope that it will be with Dr Raju back at SIRC, assuming his new role as Nepal’s first physiatrist (medical rehab specialist) working alongside Dr Groves. We (Peter and Claire) hope to return to Nepal at that time and expect to find a lot of changes in the way the hospital is working. We have heard that the executive has been working with Drs Raju and Christine on the development of stroke rehab service but have no details yet.
[As the reader is probably aware, all our contributions received from our supporters over the last five years have contributed directly to the trainees’ educational and related costs (their travel, tuition and so forth). Those of us from Canada and other countries who have participated in this project have been directly or indirectly self funded (ie, sometimes fully paying our own travel costs through the fund where that offers a benefit). CW and PW are helping the two doctors find housing as they settle back into the Kathmandu area, with the understanding that they will continue to support the development of spine and spinal cord care.]
July 27 2016
You passed your Fellowship exams! It has been a long and tough five years of residency as you acquired the skills needed to practice as a neurosurgeon. We have listened with pride when you described with wonderful enthusiasm some new procedure you completed successfully. You have worked hard, harder still during the aftermath of the 2015 earthquakes. We couldn’t be more proud of you (though not surprised) than we are today when we learned that you’ve passed the neurosurgical specialty exam. Your performance over the years and on the exam have justified the support of our Canadian and American friends over the years of your training, and we are sure that you will be a great asset to your country. The pass rate for the Pakistani specialty exam was approximately 20-25%; despite the fact that many candidates were taking it again after several unsuccessful tries. You worked hard and prepared well.
Now that you have passed this hurdle, we hope that you are still interested in taking your career further in the direction of becoming a Spine Surgery subspecialist.
It has been a couple of months since our last ‘visit’ to these pages, but much has been happening since our last entry on May 8, as our trainees approach their final stages of training. Time to bring you up to date:
Nepal As other disasters compete for headline attention, Nepal’s difficulties have not been in the news, but they are not over. The five-month border blockade preventing fuel and supplies from reaching Nepal from India was finally lifted in February although we understand that it took a while for fuel supplies to return to useful levels. Earthquake reconstruction has still been progressing slowly as the second monsoon since the earthquake began June 15th (80% of Nepal’s rainfall arrives during the monsoon). Flooding has adding to the problems of some communities already damaged in the earthquake. The Nepalese Government’s National Reconstruction Authority (NRA) had spent only 9% of its promised funds released in the first 9 months but this now seems to be proceeding better – the Authority announced a few days ago that “as of Friday, the NRA has signed … agreements with 223,830 households–of the total 533,058 households identified as ‘true beneficiaries’ in 11 districts. A total of 24,428 families from seven districts have received the Rs 50,000 first instalment of the pledged Rs 200,000 (CAD 2440) in rebuilding aid.” (More information at http://bit.ly/29t4Kgf and http://nra.gov.np/ . We were delighted to learn that the German government is assisting with rebuilding the heritage structures in Bhaktapur.
Our SIRC Family: Dedicated readers of this blog know that there are a number of people with long-term involvement and commitment to the project. Here’s an update:
Esha and Renee. We heard SIRC Executive Director Esha Thapa Dunghana make a very impressive presentation about SIRC’s response to the earthquake at the December 2015 ASCoN annual meeting in Kathmandu. In late May she was invited through friend and colleague Dr Renee Maschke (who we introduced to SIRC) to repeat this presentation at the annual meeting of the Deutschsprachigen Medizinischen Gesellschaft für Paraplegie (the German Medical Society of Paraplegia – photo on the right taken in Hamburg). Esha was able also to visit the spinal injury centre in Murnau. Esha and husband Kiran also stayed with Renee in her home near Perugia (where we Skyped with them). The photo (left) is of Renee, Esha and the manager of the SIC in Perugia. Good work, you two! More recently Esha again showed her talent for rising to any occasion when Ram Janam Chaudhary, the Nepali Minister of Health, dropped in unannounced to visit SIRC on June 29 2016 (right). On the home front, she organized what appears to have been a very effective and well-supported SIRC team-building exercise at a local resort in May.
Mandira: SIRC has continued to thrive with the support of many overseas groups. Mandira Baniya, the nurse in charge at SIRC, was awarded a fully sponsored clinical fellowship this spring to attend two 9 day courses at the Joanna Briggs Institute in Adelaide – the first was in June and she is expected to return for the second in November this year. And, this is in addition to the Wellspect award she has received from the International Network of SCI Nurses – more information here. This photo was taken of Mandy with staff members at the recent team-building exercise in Kathmandu. (Congratulations, Mandira, and thanks for the Facebook picture!)
Fiona Visiting staff member, Fiona Stephenson (left), a senior SCI nurse from the UK who has been such a wonderful support person in Nepal since the earthquake was recognized this spring when she received the fellowship award from the UK Royal College of Nursing at their annual meeting in Glasgow in June: http://www.livability.org.uk/livability-international-co-ordinator-awarded-prestigious-royal-college-nursing-fellowship/ (This is the 100th anniversary of the Royal College of Nursing.) Fiona is shown here teaching staff soon after last year’s earthquake.
SIRC will celebrate its 15th anniversary next spring – we hope to visit again then.
Raju. Bangladesh has been having troubles lately with the murder of a number of expatriates in a café, and the government there has been criticized for not controlling the level of apparently “religion-motivated” violence around the country. We had a long Skype chat this week with Raju and Sheela, now four months into their last year in Dhaka. Dhaka is not an easy place to live but our young couple continues to make the best of it. Sheela’s visa was finally extended to April 2017 but not before she had to come up with a USD100 “broker’s fee” after waiting for several weeks. Raju’s PM and R training in Bangladesh will reach completion at the end of February 2017 following which he will write the specialty exams there, then return to Kathmandu .
Raju was an invited speaker at the recent annual meeting in Kuala Lumpur of the International Society of Physical and Rehabilitation Medicine (ISPRM). He has made a number of excellent connections through ISPRM and through ISCoS (the International Spinal Cord Society). Here he is seen with local and visiting faculty. The photo, taken at a session of young PM&R doctors includes (right to left) Dr. Raju, Dr. Farooq Rathore (Physiatrist at Pakistan Naval Hospital Shifa, Karachi , Pakistan, a well-known internationalist with who has been a supporter of Dr Raju and was a great support in the early days after the Nepal ‘quake). Next, Dr. M. Oh-Park (Physiatrist at Kessler Institute, USA), Dr. J. Melvin Physiatrist at Thomas Jefferson University Hospital, USA), Dr. Strasser (Physiatrist with Emory Health Care, USA) and other young physiatrists (from Malaysia).
This photo, also taken at the ISPRM meeting, includes (right to left) Inka Lofvenmark, a senior SCI physiotherapist involved in developing the Spinalis spinal injury centre in Botswana and also a recent volunteer at SIRC; Dr. Abena Tannor of Ghana, doing 1 year online fellowship in PM&R with the International Rehab Forum team, who expects to be the only rehab doctor in Ghana. Behind her is Prof. Andy J Haig, a physiatrist at the University of Michigan, Fiona Stephenson (see above) and Tom Haig, communication director of IRF and a recent volunteer at SIRC. In front of Raju, Dr Colleen O’Connell, a physiatrist in Fredericton, New Brunswick (a close Canadian colleague who has volunteered in Haiti for many years, who was online with help last May and also spent time with SIRC in late 2015). All are deeply involved in international work to bring care and rehabilitation of people with SCI to countries forming spinal injury centres.
Sheela (Raju’s wife) is planning to take additional course(s) in Dhaka and meanwhile looking for work in the public health field in Kathmandu as they plan their return next year.
Prakash. Prakash wrote his final College of Physicians and Surgeons (of Pakistan) exams on April 23rd. He found the format of the multiple choice questions very disconcerting but, despite not yet knowing whether he had passed the written exam, proceeded to Karachi with doctor colleague and friend Pankaj April 29 to prepare for the oral exams. Urdu (needed to examine Pakistani patients in the exam) is similar to Hindi, spoken by many Nepalis, and the two were able to refresh their knowledge of the language as they worked alongside other neurosurgical residents (they stayed at the College hostel). We were all delighted that he passed his written exam but the oral exams were delayed this year until July 26 and 27 in Islamabad, after the Eid holidays. The two returned home until July 8 when they flew back to Amritsar, thence by train to Lahore (Islamabad is about 5 hours away by bus). The postponement of the exams has led to Prakash’s having to relinquish a three month fellowship he had arranged in the Indian Spinal Injury Centre in Delhi, and we cannot plan further until he has passed the College exams. This is a problem as Spine Surgery fellowships are often arranged up to 2-3 years ahead. Meanwhile, Laxmi and baby Ritika are well (picture).
We talked on Viber July 15 (left – he was in the room he is sharing with another Nepalese exam candidate, a non-neurosurgical resident). The exam format: on July 26th he will pass through 15 stations examining on the task oriented assessment of clinical skills. There will be many medical images with questions asking for a description of the condition, its diagnosis and management. These stations will include one discussing his dissertation, one about his logbook of surgical procedures in which he has participated and perhaps a surgical instrument. On July 27 he will be examined on one long clinical case (could be spinal or cranial) and four short cases. Smiling but a bit tense he told us of the scare stories his fellow Nepalese residents recount about the challenges of the exams and the risks of failure.
Prakash had been able to obtain a two-month visa in Nepal without difficulty and he had registered at the local police station soon after arrival. It is hot, the temperature 35, dropping when the rains are on. He is staying in a very modest room with a fellow resident. He is spending several hours daily at the hospital in Lahore. He had been in the children’s hospital the day before examining children with hydrocephalus and spinal dysraphism. He is planning to go to Islamabad with other residents he is working with – one has a car and they will go down on July 24 or 25.
Wish him success!
Kate Coffey. Our Bowen friend Kate (who we also introduced to SIRC) worked with us last year to raise funds to assist SIRC through Handicap International in their response to the earthquake. She is currently back in Nepal visiting friends, and we derive much pleasure from reading her ‘diary’. Kate’s blog is already providing her news in her usual upbeat manner as she again settles into her second home in Banepa.
Claire and Peter. We are now planning our financial needs for the remaining stages of this project as we assist our two doctors towards their careers in Nepal, and will communicate directly with our loyal supporters. This recent photo was taken at a surprise birthday party for friends and supporters – Kim Vlchek and husband Uli Eggers.
We would like to close this rather long blog entry with thoughts of a community no longer with us. On an earlier visit to Nepal we were privileged to hike up the Langtang valley, through the village of Langtang up to Kyanjin Gompa. Langtang was wiped out in a massive landslide in last year’s earthquake. Those of you who have visited the lovely valley may wish to read more about what happened there in a couple of web sites: Langtang reconstruction: http://himalmag.com/langtang-the-terrible-langtang-the-beautiful/ and an oral history of the Langtang earthquake can be found at : http://www.outsideonline.com/2016856/its-all-gone
Many of you may be aware of a global initiative to remind us all of the presence of spinal cord injury and need for ongoing work to prevent and to improve care of SCI. Click on the logo on the right to view the World SCI Day website (thanks for this to Dr HS Chhabra and his team at the Indian Spinal Injury Centre) .
A brief update:
Raju has been invited to the annual meeting of the International Society of Physical Medicine and Rehabilitation (ISPRM) to be held May 29-June 2 this year in Malaysia. He is now out of his cast and his mobility is increasing, although he cannot fully bear weight yet because of pain (the fracture is expected to continue to heal for some months). He has been working on his research program and takes his compact scooter to work (centre) each day, either in a taxi (left) or on a rickshaw (right).
Prakash, still in the dark about the results of his written final exam, is preparing for the practical exams with a Nepalese friend. They are in Karachi, where they can work with Pakistani residents and patients (using the Urdu language, needed to examine patients during the exam). Religious holidays in the near future make it likely that the exams are at least several weeks away.
The anniversary of Nepal’s first big 2015 earthquake has arrived, and many of you may be wondering how Nepal has fared over the year. In her current blog, Kate Coffey has posted a clear and moving video account of life in contemporary Nepal from Al Jazeera which we bring to you here (thanks Kate):
Other news media carry stories of delayed reconstruction and new homes that have yet to be built. Homeowners are starting to repair houses without government help. There are reasons given – the people of Nepal have faced unusual privations due to the blockade of fuel and building materials at the border with India, but the delay causes the people of Nepal much suffering especially for those whose family members have died, and causes us much concern. An editorial in the current issue of The Lancet medical journal focuses on the health effects of delayed reconstruction.
The (relatively) good news: together with our colleagues at the Spinal Injury Rehabilitation Centre and at Handicap International Canada we are pleased to share with you the report of how your post-earthquake contributions were spent. Last year, the government of Canada provided emergency relief support and offered to match your contributions dollar for dollar. (The government directed their matching funds to the Nepal Earthquake Relief Fund rather than to the organizations who had raised the initial matched funds including Handicap International Canada and Spine Nepal.) We suggested last year that about one third of your monies might go towards the ongoing support and earthquake-specific costs of our trainees, who were among the first to provide medical help at SIRC (below).
Dr Raju made three visits totalling several weeks to Kathmandu during 2015 both to work alongside foreign medical teams providing care to the large number of people with new spinal cord injuries and (in December) to present some of the results of that work to the Asian Spinal Cord Network meeting held this year in Kathmandu. Dr Paudel, who was in China for a course when the quake happened, returned to work with his colleagues in the Bir Trauma Hospital. Sheela Gyanwali, Raju’s partner, who has now completed her Master’s degree in Public Health in Dhaka, also assisted SIRC with data analysis during the time that Raju was providing medical care, and for an additional 4 months in the fall (with SIRC’s support).
The majority, approximately two-thirds, of your contributions were directed by you to Handicap International Canada who collaborated closely with SIRC staff and forwarded for their use the entire amount contributed, a total of almost $35,000.
Here is a summary table showing how that money was used, taken from the report prepared by SIRC:
Please note that regional medical visitors, from less wealthy south Asian countries but bringing needed specific skills to SIRC, were provided financial assistance.
Two senior personnel from SIRC attended the spinal cord meeting in Delhi in September 2015. They were able to meet many of the team members who had supported SIRC in its hour of need, to report on progress since the quake, and were also very effective in their other role of hosts of the Asian Spinal Cord Network (ASCoN) meeting scheduled for December 2015. Despite the difficulties linked with the border blockade with India, the attendance at the ASCoN was excellent leading to the meeting being financially as well as academically successful. We expect to see publication of some of the reports in the international medical literature.
We were very impressed with how much value was obtained for this amount of money. If you wish to learn more about how the funds were used, please read these documents:
Kate Coffey’s current blog highlights the support provided by Direct Relief to SIRC – a very generous donation similar in US per capita size to our donations to SIRC expressed per capita. Direct Relief’s short video is recommended.
The pain now less, Raju has found a way to get back to work despite his cast. The power scooter he was given by his rehab colleagues in Melbourne has now proven very helpful, and he takes it in to work by taxi four days weekly. Friends and supporters here have helped defray the costs of care and transportation resulting from the injury.
Raju has found a helpful and experienced trauma surgeon in Dhaka, and is now becoming more comfortable thanks to a below knee fibreglass cast. Dr Taslim, his supervisor in Dhaka, has been extremely helpful in making these arrangements and, as always, his faculty at BSMMU are also very supportive. As the pain subsides he is hopeful that he will be able to resume the needed reading program as he enters the final year of his rehab residency and prepares for his final examinations next year.
We spoke with Raju and Sheela this morning. He had a CT scan of his ankle today and will be resting at home with a partial cast for now. His right (injured) ankle is the one he uses more for weightbearing and he is appropriately concerned that his treatment be the one that will best ensure good subsequent function. He has the support of friends, of his professor and the other doctors at BSMMU and Sheela has settled back in. He has really appreciated the messages of sympathy that he has been receiving from you but it will be a day or two before he is comfortable enough to start replying – he hopes that you understand.
Raju texted us the morning of March 11th (Sheela’s birthday). He had gone to meet her at the Dhaka airport on her return from Kathmandu. A car made a rapid U-turn and hit him, fracturing his right distal tibia and fibula. They did not stop to assist him to hospital but left the scene, and he had to make his own way to the Emergency department for initial care. Xrays have been taken and he will return to the hospital tomorrow for definitive treatment decisions. Please send him your best wishes at firstname.lastname@example.org or through his Facebook page.
Raju just returned to Dhaka from a very satisfying visit to Canada. He was the first overseas resident to be awarded a scholarship by the Canadian Physiatrists Research and Development Foundation. The purpose of this International Rehabilitation Award for International Physiatrists was to provide funds to an International physiatrist to help finance the cost of educational opportunities within Canada and in particular to support the costs associated with his invited attendance at the CAPMR Resident Review Course, February 2016 in Toronto. The stated objectives:
- To provide educational funding assistance for an international physiatrist wishing to obtain PM&R medical education in Canada.
- To promote knowledge dissemination of PM&R in Canada at an international level;
- To develop international collaborations in the field of physical medicine and rehabilitation;
To make the most of his time spent traveling to Canada from Dhaka, Raju spent a week as an observer with the staff on SCI service at the GF Strong Rehabilitation Centre in Vancouver before the course and a week on the SCI service at the Lyndhurst hospital in Toronto.We are all extremely grateful to those colleagues in both cities who gave generously of their time and who extended hospitality and support at a level that will provide benefits and relationships to last Raju through his professional career. We believe that it has been well worth the effort it took to get him here with all the right papers in hand.
Sheela completed her Master’s degree in Public Health in Dhaka, and was awarded two gold medals for her excellent work. For various reasons, Claire and Peter planned that she should join Raju on his trip, although not at the expense of Spine Nepal. She was registered for the International Seating Symposium held every two years in Vancouver, and was invited to visit the research lab of Dr Bonnie Sawatzky, a Vancouver wheelchair design expert. Despite two applications and detailed explanatory letters, we were very embarrassed that she was not provided a visa by our Canadian Immigration authorities, and so instead she elected to return to Nepal to visit family during Raju’s absence.
We will provide a narrative account of Raju’s time in Canada here soon, but bring you now a few photos taken during his time here:
With George and Patty Hahn (who organized a fundraiser for the Jorpati SOS Children’s Village), Claire and Peter
After a busy week at the GF Strong Rehabilitation Centre, Raju flew to Toronto for the CAPM&R review course, attended by about 80-90 senior residents from across Canada. Raju’s photos, captions and description of his time there follow:
“Two busy weeks – I am very appreciative of the support of SpiNepal and the CAPM&R review course committee, making it possible for me to attend the 9th Canadian Standards of Physical Medicine and Rehabilitation review course. I had a chance to learn about these academic activities related to PM&R and also a chance to meet a lot of good colleagues and teachers who are most interested to help me develop PM&R activities in Nepal.
After 8 days of review course, I then worked as an observer at the Lyndhurst facility of Toronto Rehabilitation Institute, a specialized Spinal Cord Injury Rehabilitation Center, for 1 week with my Preceptor Dr. Colleen McGillivray. She taught me about the spinal cord system of care from acute care to the community re-integration and follow-up program of SCI Ontario.
I attended inpatient ward rounds, reviewed the ASIA assessment, attended team and family meetings, and outpatient clinics (continence and urology clinic, bone health, skin and wound clinics, seating clinic, spasticity and intrathecal baclofen clinic). I also met with people of SCI Ontario resource center and SCI employment center.
I am very optimistic that I can implement similar resources as I work to develop quality Nepalese SCI care after my return to Nepal.”
Prakash has completed his residency in neurosurgery and has commenced intensive reading and study in preparation for his Pakistani Fellowship exams set for April 20th (in Kathmandu). He expects the results about three weeks later, at which time he will be informed of the oral/viva exam dates and procedure; this component is likely to be held in Pakistan sometime in May. Preparation for these exams will be partly in Kathmandu and partly at the exam site. In recognition of the delayed exam dates, Dr Chhabra has permitted Prakash to begin his three month fellowship at the Indian Spinal Injuries Centre on June 1st.
Laxmi returned to Kathmandu with newly-named baby Ritika (right).
Weeks have passed but it seems only the other day that we returned from a deeply satisfying visit to Kathmandu. A young couple on the right, sitting on a shelf of a small cracked and shored-up temple in Kathmandu’s Durbar Square, typified the way the people of Nepal continue to work around the effects of the earthquakes. Similarly, we were amazed at how well SIRC managed over the last few months, helped by many people around the world. Some sent teams, some sent money and/or equipment, some offered knowledge and advice, but the SIRC staff and their friends have made it all work. We have spoken with many of you individually, and you will find more observations here.
December 2015 – the status at the end of a busy year!
Dr Raju was in Kathmandu for the ASCON meeting; he and Sheela, who was working for SIRC through the fall, have now returned to Dhaka. He is the recipient of the 1st CPRDF International Exchange scholarship and has been invited to attend the two-yearly review course in Toronto for residents preparing for their exams. We are grateful to the many Canadians PM&R specialists working to make this a reality, and to those who have agreed to provide an observership in each of Vancouver and Toronto.
Sheela and (SIRC nurse) Durga presented their review of patient data at the ASCON meeting. Christine, Sushil and Bishow reviewed and presented SIRC’s experience with quake-caused spinal injuries. Dr Wyndaele recommended that both these studies be prepared for journal publication.
Two views showing SIRC on our visit at the end of 2015:
Below – Peer counsellors Sonika and Ram act as callers as they lead a group of patients through their regular exercise session on the front courtyard of the Spinal Injury Rehab Centre.
……………and, finally, a photograph by friend of SIRC Narayan Shrestha whose drone captured this aerial view of the Centre, recently published on SIRC’s Facebook page. We do not know the exact date when this was taken. The exterior of the new addition on the upper floor is nearly complete, but there are still tents to be seen around the site and (just visible) in the courtyard – these had all been taken down by the time we were there before the recent ASCON meeting.