February – March
– we prepared a detailed report of our visit in late 2009 with some suggestions for development of SIRC.
October – November
– we attended the annual ISCoS meeting in New Delhi, at which an online educational tool for people with SCI and their professional and other care-givers was born. Dr Raju, Esha (SIRC director) and Damodar (physiotherapist) came down and presented a paper describing the SIRC program. Team members from Canada included urologist Mark Nigro who spent time with our Nepalese colleagues, spine surgeons Scott Paquette and Sagun Tuli (now in Boston), physio Grant Huston, and occupational therapist Kim van Wyk.
– 10 days in Kathmandu followed, during which time we reviewed a number of developments at SIRC, and worked with SIRC and several other partners in running two sets of workshops, described below.
Workshops in spinal cord injury (SCI) rehab and spine surgery
Nov 4 Surgical workshop
We ran this workshop at Kathmandu Medical College. Our faculty included neurosurgical spine surgeons Scott Paquette and Sagun Tuli and orthopaedic spine surgeon Peter Wing; with 45 attendees including consultants and residents. Topics included:
- SCI Prevention: concept of primary, secondary and tertiary prevention
- Spinal biomechanics – the role of bone and ligament and how bone heals.
- The Clinical Practice Guideline on Acute Care of the Adult with SCI.
- Minimum imaging for treatment planning, case examples of upper and lower cervical fractures
- Stable/unstable thoracic and T-L fractures – bed rest vs. surgery; bracing and surgical needs. Bracing after surgery – why when and how? When is surgery not needed for a spine fracture? Surgery and rehabilitation: can the patient afford both?
- The components of spine surgery: decompression and stabilization. When is each needed?
- Implant planning – wire vs. rods vs. plates. Is a brace needed? (with and without surgery).
- Case presentations of a number of different fracture patterns.
- Short discussion of various topics
Nov 9 Rehabilitation workshop
We ran this workshop at the Dhokaima Café in Patan in conjunction with colleagues from Nepalability (from Toronto). The faculty were from Green Pastures Rehab Hospital, Pokhara; SIRC; the Nepalability group from Toronto, details Vancouver and Dr Stanley Ducharme (psychologist) from Boston, USA. 46 attendees represented a large number of institutions from across Nepal. Topics included:
- Structure and Function of the Spinal Cord; Consequences of SCI.
- Acute Care of the Adult with SCI; International neurological standards
- Individual and family adjustment to SCI. Sexual function.
- Transfers and functional mobility.
- Pressure mapping and pressure sores; urological issues.
- Experience with SCI at SIRC and at GPH
- History and future of SCI.
Nov 12 Chagall exhibit opened
We were fortunate to be in Nepal when a major exhibition of Chagall posters opened at the Dhokaima Cafe, courtesy of Chagall’s granddaughter. She had linked the strange dreams reported by some people with spinal cord injury with the artist’s images of people in flight, and was moved to give a valuable set of posters to SIRC.
Nov 13 Resident education session
Peter and Claire met with a number of residents from different departments for a seminar on SCI. We were amazed by their thirst for knowledge.