SIRC: Nepal’s Spinal Injury Rehabilitation Centre

The Spinal Injury Rehabilitation Centre (SIRC)

Several hospitals in Nepal provide spinal cord injury rehabilitation. They include SIRC, the nearby Hospital and Rehabilitation centre for Disabled Children (HRDC – near Banepa), Green Pastures Hospital in Pokhara and the United Mission Hospital at Tansen.

Now in its fifteenth year of operation, the Nepalese SIRC is gradually expanding its capacity. The italicised text is adapted from the SIRC web site:

The idea of a spinal injury rehabilitation centre emerged after Kanak Mani Dixit, editor and publisher, fell down a cliff-side and suffered from a spinal cord injury while trekking around the Annapurna Region in August 2000. Fortunately, he managed to recover completely over the course of the next year. Dixit’s experience exposed him to the severe lack of facilities available to the spinally injured in Nepal. Thus, in late 2000, he along with a few friends and colleagues came together to start the Spinal Injury Sangha, a non-profit organization registered with the Social Welfare Council of Nepal (Regd. No. 15354). Of the many challenges that needed to be addressed in responding to spinal injury in Nepal, the Sangha felt that a rehabilitation facility was most urgent. The Sangha’s objective was to roll back, as far as possible, the despair that is the burden of the spinally injured and their families. Consequently, the Sangha founded the Spinal Injury Rehabilitation Centre with 31 beds in a converted facility (adjacent to the Nepal Orthopaedic Hospital) in Jorpati, Katmandu, in collaboration with the Nepal Disabled Association.

The Centre was inaugurated on April 7, 2002 by the late Sir Edmund Hillary, who at the time of the inauguration stated: “From my work in the Solu Khumbu region, I know that this kind of facility is extremely important for this country. The hill people who injure their backs as a result of fall from trees, trails and hillside require a rehabilitation centre such as this.”

Construction of New Centre

Even as more patients who come for treatment of the ‘traditional’ forms of spinal injury (eg falls from trees), the number of victims from road, construction and industrial accidents is on the rise. The decision was made by the SIRC Board of Directors in mid-2004 to move from the modest facility at Jorpati to a purpose-built centre to provide comprehensive rehabilitation management for a larger number of patients. After a two-year search in Kathmandu Valley and the neighboring region with strict criteria a 2.5 acre site was located at the western end of Banepa Valley, 20 kilometers east of Kathmandu’s city centre and just beyond Bhaktapur town. The Kadoorie Charitable Trust (in Hong Kong) provided support to enable completion of most of the first phase of construction, allowing occupation by the end of 2008. The development of the Banepa facility into the National Spinal Injury Centre, as we envisage it, requires the ability of SIRC to upgrade the level of services. We seek to achieve a high standard of professional competence and scientific enquiry, in addition to the success already achieved in service delivery.  http://www.sirc.org.np/

(We are most grateful for the financial assistance provided by the Swiss NGO Mountains to Mountains, for planning and other help from the UK/Irish NGO Livability Ireland, and for ongoing staff training from the Swiss Paraplegic Centre. Without these major contributors, our work would not be possible.)

At our first visit the Saanga site had fifty-one beds in operation, and occupancy was steadily rising as the Nepalese medical community becomes aware of the need for and availability of specialized SCI rehabilitation. The building has been expanded since then, both before and after the 2015 earthquakes. The SIRC constructed an outbuilding to act as a family room/stepping stone for patients nearing readiness for discharge, and the therapy space on the lower level was completed. Now, an additional floor has been put into service and has been used for vocational training, but will form part of the stroke rehabilitation unit.

In the last two years a program funded from a joint partnership between SIRC, the Korea Spinal Cord Injury Association (KSCIA) and Korea International Cooperation Agency (KOICA) has led to the Construction of a new facility to house vocational rehabilitation. (More details of this program to follow.)

Some problems remain with respect to staffing the centre. A number of the longer-serving staff commute daily in a small hospital bus from Kathmandu. This commute consumes a lot of their time as the main road has been under construction for some years. The provision of medical care has been difficult as the SIRC did not have its own doctor for a number of years. At the Jorpati site where SIRC started operations, medical staff from the Orthopedic Hospital provided care. When SIRC moved to its current facility medical support came from orthopedic staff at the nearby Dhulikel hospital. For the last seven years, a dedicated physician has been caring for the patients, initially part time and more recently on a full time basis. Unfortunately, some of the young unspecialized doctors have moved on to other areas after a short time leading to loss to the hospital of their trained skills. Training in physical medicine and rehabilitation and especially in neurorehabilitation is required to meet the needs of the people of Nepal and will be planned to provide additional future rehab physician-specialists.

You may wish to read more about the Nepalese health care system.

SIRC-specific Links

Short SIRC promotional video: https://youtu.be/Ky6m7Lyi6Ek

Ram’s Sarangi: Ram, athlete and musician and one of the five peer mentors at SIRC, has undertaken a wheelchair pilgrimage (yatra) through Nepal to enhance awareness of SCI. He plays the sarangi, 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

Patient’s experience after earthquake: https://youtu.be/XBi1umZzUB4 (SISN promotion)

Early post earthquake video with SIRC’s Executive Director Esha Thapa: https://youtu.be/X0njbGQ3uvM

Many of these single topic video guides are from Aug 2016:

First responder exercise: https://youtu.be/gFi_8SttFzk

Bed transfer: https://youtu.be/iYPZPcf5yO0

Music therapy: https://www.facebook.com/spinal.nepal.3/videos/1609403889173684/?hc_ref=ARTWi_uMSnT5s7KtL6KDeG7bHCoptlQtiX1kAttmgneOuyBHbYljLeZQ2WovIqLbJS8&fref=nf

Vocational therapy: https://youtu.be/jqksV4yQ508

Wheelchair evaluation: https://youtu.be/TW8pf3YfLpo 

Basic wheelchair skills: https://youtu.be/mIvCUYV3LJw

Advanced wheelchair skills:https://youtu.be/hIfhlUS5sqo

Toilet transfer (perhaps the most popular): https://youtu.be/ze5jt4pvPkg

Peer counsellors (plus Tom Haig): https://youtu.be/yrAuDDWGwDg

Spasticity management: https://youtu.be/I_VcnW2EYQk

Tetraplegic hand grip skills https://youtu.be/87di400GqtQ