Blog SCI Nepal

 Welcome to our blog

Ongoing needs:

Spinal Cord Injury Collaboration, SpiNepal, continues to be needed. Our main objective achieved, we DO hope SpiNepal can continue to provide financial support over the next few years for Continuing Medical Education, fellowships, observerships, etc as our trainees hone sub-specialty skills in the area of spinal cord rehabilitation and spine/spinal cord surgery. Where we can, we contribute to clinical needs in the hospital and its related programs. We expect to support a rehabilitation medicine training program for which planning is beginning between Dr Raju, the SIRC board and the regulatory authorities, and are in the meantime sponsoring a second Nepalese physiatrist in the final years of his training program in Dhaka. Your donations will continue to be of utmost importance and 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).

Jun 24 2020 

In Nepal the epidemic phase of COVID-19 is being seen with a rapid increase in the number of cases confirmed by testing after an initial phase in which testing machines were unreliable and/or unavailable.  Leaving a similar situation in Bangladesh Jas, our rehab trainee now entering his final year of rehab training in Dhaka, has finally been able to fly home where he is now in quarantine for two weeks total. The trip took longer than usual, as he followed the required course through the ‘holding centre’ to be sent to his home province. Necessary protocols were repeated by the government officials at the airport, the holding centre and various checkpoints taking 20 hours to reach his home in Pokhara from Kathmandu Airport which would usually take 7-8 hours. Jas was on an early flight home and wondered how well the system would work with larger numbers of returnees later.  He was however impressed with their thoroughness in tracking people coming from abroad and noted that the local authorities have been very cautious because of surge in the Nepalese returning home. They are being tracked by use of a provided smartphone app and sim card.

Meanwhile, Jas has received written confirmation that he may progress to final year. He must undertake a research project and be examined on his thesis this year. The topic will be an assessment of quality of life in patients with Ankylosing Spondylitis, piloting a Bangla version of the SF-36 health survey instrument to the mental and physical aspect of quality of life.

This year the annual meeting of the International Spinal Cord Society to be held Sept 1-5 will be virtual for the first time. Raju and his group of SIRC colleagues in Nepal, as a lower-income country, have been able to obtain sponsorship to attend the meeting – without any of the costs of flight and accommodation. And, saving tons of carbon dioxide! Congratulations on the award!

Jun 2 2020

It is now just over four months since the novel coronavirus landed in Nepal. Prakash wrote yesterday that the first COVID case in Nepal was reported on 23 January 2020 when a 31-year-old student, who had returned to Kathmandu from Wuhan on 9 January, tested positive for the disease. He reports that there are in Nepal now 1572 confirmed cases and 8 people have died of COVID 19 (June 1 2020, 12:15 pm). He has been going into his hospital but the volume of neurosurgery is less and he has made time for a couple of continuing education projects. First was a UBC online course addressing the special consideration needed when considering surgery during the pandemic (certificate right). Last week he joined a webinar chaired by VGH’s Dr Brian Kwon, addressing current concepts of Degenerative Cervical Myelopathy (DCM), which he found very valuable. To download his full report click here.

May 19 2020

The photo (right) taken by our friend Himalayan guide Agasta Mukhiya in the last few days in the formerly bustling tourist centre of Thamel shows stores boarded shut and empty streets.

The COVID-19 statistics for Nepal, on lockdown since March 24, now mirror those of other countries. The numbers of confirmed cases has today reached 402 (with 2 deaths), according to the Johns Hopkins ‘Dashboard’. For comparison Canada is this morning reported as having 79,411 (5960 deaths) and Bangladesh 25,121 (370). We recognize that all these statistics probably underestimate the true numbers which are only for those with a positive test. While most Canadian Provinces are beginning to relax the restrictions on businesses as our curve ‘flattens’, the same cannot be said for Nepal and Bangladesh, both with normally very mobile and dense populations, and whose numbers are expected to rise rapidly. Many Nepali expatriates working overseas would like to be be able to return home but have not been allowed to at this time.

Raju has been working from home, going in to the hospital as needed. Three house doctors cover most patient needs on a week-at-a-time rotation, as do the multidisciplinary teams. Prakash has been rotating call at Mediciti Hospital which, when we last spoke with him, had been able to test all patients but had not yet had admitted COVID-19 cases.

We had a lengthy Zoom conversation this morning with Dr Jas Bahadur Gurung, our second physiatry trainee in Dhaka, together with his wife Durga and their two children. Jas and Durga both come from military families; Durga and the children currently live in Kent in the UK, close to other members of her family. Durga has recently returned to part-time work (with PPE precautions) and the children have been home. 

Jas, sharing an apartment with two other residents, has been studying and is also being trained mostly at home with respect to COVID-19 care. It is possible that he will be called to assist with the hospital care of COVID patients as the volume in hospital rises. He is prepared to return to Nepal to face two weeks of mandatory quarantine and to possibly train and work alongside Dr Raju once flights and airports are available.

April 2 2020 – Preparing for the Pandemic

Raju has been corresponding with our colleagues at GF Strong, and we are also sharing what we hear about hospital management and, in particular, the impact that the pandemic may be having on our disabled people. Thanks to Drs Andrea Townson and Rhonda Willms for supporting Raju by sharing our procedures and practices with him.

Founding Chair of the Board, Kanak Mani Dixit, has this (right) on his FaceBook site.

March 29 2020 – COVID-19 in Nepal

The COVID-19 pandemic has now swept around the world; its toll is reflected in the daily numbers brought to us. Our countries, states, provinces, regions and hospitals have been bringing their best planners into play. Elective patient loads have been shed and emergency facilities rapidly acquired or built.

We were visiting friends in Florida in early March and the pandemic declaration by WHO was yet to occur. Raju got a visa for his invitation to present at the annual meeting of the International Society of Physical and Rehabilitation Medicine (ISPRM) Orlando but discussions about the COVID-19 epidemic within his family led to cancellation of his attendance at Orlando. We were disappointed but it became very clear that the potential for mandatory quarantine – possibly twice – completely justified his decision.

Today’s WHO situation report shows that Nepal has five known cases. Borders are ‘closed’. However, a group of returning Nepalis coming back from India, detained for a while in a poorly fenced facility, decided to leave by hopping over a fence, making a poor start to the campaign against the virus.

The government will build a public quarantine facility for at least 5,000 in the Kathmandu valley that can be immediately converted into a temporary hospital if needed. Each province and metropolitan city will be asked to build quarantine facilities for at least 2,000 individuals. Every sub-metropolitan city will have to build 1,000-bed quarantine facilities, etc. It remains to be seen how these will be managed logistically (isolation, food, management of clinical disease).

School closures were felt to account for the decision of many people to head for their ‘home’ villages over several days. As many as 130,000 people were going daily, especially school and college students, for their home towns.

We had a most rewarding Zoom session last evening, with Raju (lower left) and Prakash (upper right) and their families, (including Ishita, aged two today) joined by supporters who have been to Nepal to visit SIRC: Dr Joana Mereu with husband Frank Gish (upper left), Dave Hess and Darby Honeyman (bottom right), birthday girl Claire and Peter (top centre). Both Prakash and Raju are in lockdown mode. Prakash and his colleagues are rotating call one day in six. Raju, who has swung into telehealth mode, is available for remote online consultations and/or for urgent attendance at SIRC. The hospital bus is not in use now, staff and patient transfers are done by a smaller vehicle that is thoroughly surface-cleaned after use.

Staff are committing to staying in the hospital for several day shifts in a row and to isolating themselves when off duty. The hospital population, normally around 70-80, has been dropped to the mid-60s. Plans are in hand to isolate any newly admitted patients for the incubation period of the virus. We discussed the progress of the pandemic and planning for it at some length and think they are doing a great job.

Dr Jas Gurung, in his rehab residency in Dhaka, is also subject to a stay-at-home order at present. With both countries ‘locked down’ and restrictions on travel, his hopes of having his family join him in Dhaka or even in Nepal later in the year are looking less certain. The pandemic also means that any electives, conferences etc cannot be planned until the situation is more stable and the economy gets going again. Jas – we’re thinking about you!

The school support network (SCIN) has finally secured a new plot of and started to build on 1st March with the mayor laying a foundation stone. He will finalize all necessary documents very soon and has said that some municipal funds may follow. (If 5 million Nepali rupees are raised then municipality will match 5 millions. We look forward to seeing the drawings! The school students final examination finished by March 18th with other college student examinations likely to be postponed due to the corona virus. At the moment all schools, colleges and universities are closed for a month. Some medical items like face masks and hand sanitizer are scarce. Anxiety about COVID-19 has spread; so many people have left Kathmandu to head home to their village including a number of the SCIN students. Those remaining are being very good in hostel, with the admonition to stay home unless allowed out from the hostel for essential work.

 

Feb 12 2020 Update – President’s Award and more!!

Congratulations to SpiNepal and all who work with us!!!!   We are proud to announce that on Wednesday Feb 12th we received the University of British Columbia President’s Award of Distinguished Service by UBC Emeriti 2020, which reflects entirely the efforts of Raju, Prakash, Jas and all the people who have worked in and with SIRC.  The newly-formed UBC Emeritus College presents one or more President’s Awards for Distinguished Service annually to UBC Emeriti who have, since attaining UBC Emeritus status, displayed exceptional leadership in volunteer community services. These services may benefit others in Canada or abroad. In addition to the recognition of the Award, recipients will receive $1,000. (It is anticipated that the recipient(s) will direct the fund to an organization, charity, or fund of their choosing. SpiNepal will be the happy recipient!). Conveniently, the current UBC Emeritus newsletter features a short account of the work of SpiNepal, adapted with permission from the earlier COA Bulletin article. The slides we used for the talk we gave can be viewed here:    Presidents award talk

This article from a recent issue of the Nepali Times centres on a funded research and demonstration project that SIRC and Raju have recently launched in collaboration with a group from Leeds University in the UK. The sizeable grant from the Leeds Global Challenge Research Fund is for the pilot study of “Telerehabilitation to Improve Quality of Life of Long Term Disability in Nepal.” In a partnership with the Leeds faculty, the team of about 6 people from Leeds and 5 from SIRC will address the problem of follow up of discharged patients living in remote areas of the country. If this application of telerehabilitation proves valuable, a larger grant will be sought to expand the program.

Raju plans to travel soon to Orlando to attend and present at the annual meeting of the International Society of Physical and Rehabilitation Medicine “ISPRM-2020” (and AAPMR/AAP March-4 to 9). For this, he has been awarded a special grant (10 grants were awarded to 200 applicants.) His paper title is “Spinal Cord Injury Rehabilitation in Low Resource Settings – The Experience of SIRC”. Another application for necessary additional funds for this trip is pending. By coincidence we (Claire and Peter) have arranged a visit with friends for a week in nearby Lake Worth and will be able to meet with Raju in Orlando for a couple of days before returning to Canada. As a bonus, we shall also meet there with our respected colleagues and good friends Marcalee and Craig Alexander, currently still (as far as we know) en route walking from Canada to Key West to highlight the particular problems the disabled may face with the worsening Climate Crisis. Marcalee and Raju share an interest in telerehabilitation – we look forward to eavesdropping on their conversation!

Drs Raju and Christine Groves have co-authored an article titled “Rehabilitation in Nepal” which was published in the November 2019 issue of PM&R Clinics of North America. An additional good news item from Christine is that she now has received a working visa for Christine is now permitted to work at SIRC as a physician upon getting the appropriate licence from the Nepal Medical Council.

SCIN, the Spinal Cord Injury Network, continues to thrive, providing accommodation in two small hostels for spinal cord-injured children from around Nepal so that they can pursue their education in Kathmandu. We have received thorough reports from administrator Keshav with activity levels, financial reports and information about the evolving plans for building on dedicated land. Please contact us if you need more information.

Oct 20 2019 Fundraising Schubertiade event

Julius Schmid’s 1897 painting of Schubert with a gathering of friends – a ‘Schubertiade”.

We have a large group of musical friends in Vancouver, some of whom are keen cyclists and many of whom are also numbered among the supporters of SpiNepal. Among these are Stanis (an architect and an excellent clarinet player) and Joanne (a hand therapist), who have developed a lovely tradition of hosting small concerts at home, which invite donations to different non-profit groups. One such was on October 20th, in the form of a ‘Schubertiade’ – an evening celebrating the music of composer Franz Schubert (1797–1828). Stanis assembled a talented group of players to perform Schubert’s Octet in F Major, D 803. The musicians decided to support two nonprofits: SpiNepal and a local mental health charity. The audience gave generously and we thank both them and the musicians for their time and skills.

While we are not able to bring you a photo of video of the event itself, the reader may wish to enjoy this YouTube recording of the music, which runs for a little over one hour in its entirety:

The musicians in this recording are (from left to right):  Antje Weithaas, Violin; Alina Pogostkina, Violin; Veronika Hagen, Viola; Sol Gabetta, Cello; Robert Vizvari, Double Bass; Alejandro Núñez, Horn; Gustavo Núñez, Bassoon; Sabine Meyer, Clarinet

The music is presented as Six movements (sections):

1. Adagio. Allegro 0:00
2. Adagio 12:00
3. Scherzo: Allegro vivace 24:10
4. Andante; 7 Variations 30:50
5. Menuetto: Allegretto. Trio 43:12
6. Andante. Allegro 50:24

Oct 5 2019 Dashain begins

Dashain and Tihar, Nepal’s two major festival holidays, both occur in October. Families get together, each day having special significance. Government offices take a week-long closure with additional days later in the month.

So – Happy Dashain to all!

Oct 2 2019 COA Bulletin article published

We were asked earlier this year to publish an article summarizing the SpiNepal program for members of the Canadian Orthopaedic Association – with only about two pages to summarize ten years work! You may read the full article in the bulletin here. (If you cannot access the journal, the article alone is here.)

ASCON annual meeting Kuala Lumpur Sept 13-15 2019

The annual Asian Spinal Cord Network (ASCON) meeting was held in Kuala Lumpur, hosted by Dr Nazirah Hasnan. SpiNepal  provided partial funding for the attendance of six staff members – Executive Director Esha, Medical Director Dr Raju, Adminstrator Hari, peer counsellor Sonika and therapists Sanjita and Saraswati. This group was joined in Kuala Lumpur by Dr Jas Gurung (more about Dr Jas on this page). Jas is shown circled below in the SCI training workshop held before the conference.

 

On September 5  SIRC celebrated SCI Awareness Day complete with a brief speech by Raju summarising the history of SCI care, a cake and dancing.

September 3

News on this date from Keshav from the Spinal Cord Injury Network, which provides accommodation and support in Kathmandu for spinal cord-injured children:

“Last Friday to Monday Khagendra New Life Special School (where our 7 students are  studying in different classes) organized outdoor program and our five students participated for 3 nights 4 days outdoor program. And as a guardian I was invited. Participants included students, teachers, volunteers, guardian and officials – all together we were 52 people. We went to Kakani in Nuwakot district,  about 30 km away from Kathmandu. The main objective of outdoor program was to teach students how to work in group, how to help each other and how to face challenges in case of emergency.

We had 6 groups and students prepared food in all groups for all days and it was first ever experience of sleeping in tent to us.

During outing program our students had experience of zip lining, hiking and rock climbing however rock climbing was much dangerous to wheelchair users so we didn’t did. It was great experience to all. I have attached some photos then you can guess how was our outdoor experience. Thanking you all !! This program was financially supported by Freedom Social Foundation and we got some photos from them.”

August updates

From our perspective, the summer has been fairly quiet but there are several initiatives under way.

  • We have had extensive discussions with Raju and SIRC Board chairman Prachanda Bahadur Shrestha during and since our visit last December concerning a rehabilitation medicine training residency in Kathmandu. Dr Raju needs expert help at SIRC sooner than the 4 or 5 years that a new program would take to produce its first graduates. Thus, we are working towards recruitment and support of another Nepali trainee now halfway through his physiatry residency. Watch for details in the next few weeks.
  • The Spinal Cord Injury Network (details below and on the 2018 page) will shortly provide us with their year-end report. We hope to support them, depending on the level of funding we have available. It is unclear whether they will receive their hoped-for land grant.
  • The Asian Spinal Cord Network (ASCoN) annual meeting takes place in Malaysia September 13-15 (much closer planning is often seen than is usual in North America). Two SIRC physiotherapists have had papers accepted for presentation, one receiving a partial grant to attend. Raju will be attending the meeting, and participating in the annual IDAPP review (IDAPP is the International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project). Our second physiatry trainee also hopes to attend some of the SCI training workshop. We anticipate offering partial financial support.
  • While Prakash was not successful in his recent application for a Nepal-specific care path analysis of patients with spinal cord injury for a Jubilee grant award from AO Spine, he may be able to collaborate with a North American team that is looking at a worldwide approach to this issue. We hope to be able to tell you more about this in due course.

May 9-14 2019 – Dr Prakash Paudel returns to Vancouver

Dr. Prakash Paudel visited us in Vancouver from May 9 through May 14. He was on his way to the AO Global Spine conference in Toronto, sponsored by SpiNepal. We had hoped that his colleague, Dr. Nilam Khadka, would also be able to come, but sadly this was not the case. We made the most of his time in Vancouver, beginning with a play at the Vancouver East Cultural Centre on the night of his arrival. Prakash met a number of specialists within the Vancouver Spine program. Paul and Sherree Bishop invited us to dinner at the Point Grey Golf and Country Club, followed by a youth choral concert afterwards. (Dr. Bishop is an expert in the physiology and management of spinal disc disease, an area that Prakash had little exposure to during his training.)

The following morning, we joined Dr Viet Vu and husband Jason for breakfast. Viet is a physiatrist at GF Strong essentially doing the work that Claire did prior to retirement. Viet and Jason also happen to be our neighbors, living on a sailboat in False Creek. We lunched that day with Karalee and David Greer (right) who Prakash had met in Kathmandu, when he assisted David access the medical system because of a respiratory problem in January of this year. 

Following lunch, we drove over to Bowen Island, visiting friends and supporters at the first of two open houses.

Friends and supporters on Bowen Island. Left to right:

Chris Pollard, Ann Ramsay, Darby Honeyman/Prakash, Dave Hess, Claire Weeks, Kate Coffey and Peter Wing. Dave and Darby had visited and stayed with Prakash and his family in May 2017. Kate Coffey, a supporter of the Spinal Cord Injury Network (SCIN) in Kathmandu, had a suitcase full of art supplies and toys for the children in the SCIN hostel, which Prakash was able to deliver. (More about this on Kate’s blog)

While in Vancouver, Prakash also met paediatric spine surgeon Dr. Firoz Myanji at the BC Children’s Hospital, semi-retired paediatric neurosurgeon Dr. Paul Steinbok and Dr Patrick McDonald, the head of pediatric neurosurgery.

 

On the Monday evening our open house in Vancouver included spine surgery staff (Drs Nick Dea and Rafaelle Charest-Morin, rehab specialist Dr Rhonda Williams and final year resident Dr. Jordan Farag. (Dr. Farag had visited SIRC two years previously and hopes to be able to return once he has completed his residency.) We were also joined by consumers Teri Thorson, John Chernesky and Brad Jacobson.

 

 

Prakash left for the Global Spine conference May 14. While in Toronto he was able to meet with Vancouver Spine staff including Drs Brian Kwon and Charles Fisher, as well as Spine fellow Nathan Evaniew (right).

 

April 26 2019 – Good news from the SCI Network!!

Good news from the SCI Network today – they have been given land on which to build a new hostel, which will allow them to increase the number of children with spinal injuries who wish to continue their education: Keshav wrote: Finally, we received government land to build hostel building. From now we have to make concrete plan for further. “We have to discuss with different level governments for funding. We hope we will get support from government but we need huge amount for building. Firstly, we want to do discuss in our board meeting and will decide.”

Spine Nepal has been providing some funding to SCIN. For more information please read SCIN supporter and cheerleader Kate Coffey’s blog

April 10 2019 – SIRC swings into action after the storms

We were in touch with Raju this morning. SIRC – with the support of Spine Nepal – has a team down in the disaster area. Head of rehab Chanda, psychologist Sai Laxmi and nurse Vishnu are on the first day of a three day training course teaching caregivers the consequences and complications of SCI, the principles and practice of patient care in the first days after injury and beyond. See below – pictures courtesy of Spinal Injury Rehabilitation Centre. Addendum April 27:Although the final tally of spinal injuries may not be known for some time, some 20 people were screened with the suspicion of spinal injury, and 10 diagnosed. A patient with high tetraplegia had died, 2 patients were referred to a teaching hospital in Kathmandu for acute care. 2 were admitted directly to SIRC and have received treatment. A number of people with more minor spine injuries were being treated in local hospitals, and a few may be transferred in later from other acute hospitals.

For more general information about this event, go to Wikipedia 

 

 

April 5 2019 – a new disaster

A few days ago we read of severe weather in the south of Nepal, but did not expect to hear that spinal cord injuries would result. Earlier this week, Dr Raju told us that Vishnu, a nurse at SIRC, had joined a government team to assist with spinal cord injured people in the affected Bara district, due south of Kathmandu and on the border with India (see map). At this point we know of 10 but anticipate that about 20 patients with SCI will be needing care. Details will follow.

From AP: BHARWALIA, Nepal  — Villagers who survived a powerful rainstorm that killed at least 28 people and injured hundreds in southern Nepal searched for food and shelter Monday as rescuers struggled to reach remote areas. High winds during the storm Sunday night flipped cars and blew a bus carrying at least 40 people off a highway, killing some. Police said most of the deaths were caused by collapsing walls and falling bricks in homes and toppled trees and electrical poles. The storm swept through villages in a farming region in Bara and Parsa districts. The government administrator in Bara, Rajesh Poudel, said 27 were killed there. One person died in neighboring Parsa, administrator Narayan Bhattarai said.

The area is about 120 kilometers (75 miles) south of the capital, Kathmandu. Police officers and soldiers were helping people injured by the rainstorm. Villagers from neighboring districts were also distributing food to the victims. Prime Minister Khadga Prasad Oli canceled a visit to western Nepal and was flying to the area.

We just received this appeal from Esha Thapa, SIRC’s Executive Director:

As you must be aware that there was a devastating cyclone in the east of Nepal last week injuring more than 700 people and killing around 30 people. Our nursing staff is also deployed at the site now and he is supporting the medical teams and also working on referrals. Currently there are 10 new cases of SCI identified who are being treated in different hospitals in Kathmandu.

We have been approached by Ministry of Health to run training for health workers in this area for emergency management up-to referral. It is a very tense situation there and training needs to be planned well and done within 2 weeks.
With this email I would like to request SpineNepal to support this training. We are looking for approx USD 5500 to train around 50 health workers.

More images from the last days follow. Please read, below, the appeal from SIRC. Contact us if you have questions and/or wish to support their appeal: peter.wing@vch.ca

A woman sits in the middle of the debris of a residential house damaged in rainstorm in Bara district, 125 kilometers (75 miles) south of Kathmandu, Nepal, Monday, April 1, 2019. Rescuers struggled Monday to reach villages in southern Nepal cut off by a powerful rainstorm that killed at least 28 people and injured hundreds more. (AP Photo/Niranjan Shrestha)

 

Women grieve the death of their relatives in a rainstorm in Bara district, 125 kilometers (75 miles) south of Kathmandu, Nepal, Monday, April 1, 2019 (AP Photo/Niranjan Shrestha)