My first home visits

Monday morning the two visiting Canadian doctors, Manoj (the head of the occupational therapy department) and myself headed out to visit two spinal cord injured (SCI) patients from Green Pastures Hospital in their homes. The first had a wheelchair, and lived in a village on the river plain. After driving out of Pokhara for about half an hour in the Land Rover, we headed off road down the river valley. When we reached the patients village, we found her out in the community, visiting with her neighbours. Community development people from Green Pastures Hospital had built her a 2 room house that she could use her wheelchair in, with ramps going in both doors. Unfortunately, due to space constraints, the ramps were too steep, and she was unable to get in and out of her house on her own. Still, it was reasonably well set up.

However, she was not too healthy and she had several pressure sores. One from sitting to much – since she needs help to get in and out of her house, she couldn't get inside to lie down easily, and so stayed sitting. She had an open wound on her leg, where it was rubbing against a lever on the wheelchair, and a pressure sore on her foot where her foot rubbed against the footrest. There is nothing like working with leprosy and SCI patients to see how important pain is in keeping ourselves healthy.

We weren't able to do too much at that point to help – I poked around with the wheelchair, and found that the lever was necessary to keep the foot rest on, so I couldn't do anything immediately to help besides binding up her leg with a piece of cloth. The pressure sore from sitting was deep, and will require surgical treatment – so if she comes back to the hospital I could do something a bit more permanent with fixing her chair. The sore on her foot was not so advanced, and it was suggested that she wear shoes, slippers or even socks at all times when in the chair to allow it to heal. She didn't like wearing shoes inside, and didn't own any socks or slippers. That's easy, I thought, I'll give her the socks I'm wearing. So I did. And we added socks to the growing list of things we would remember to bring on home visits in the future.

We went for lunch at Begnas Lake – a lovely spot not to far from the village we visited. It's a bit of a touristy area, yet despite that, we had a lot of trouble finding a place that had cooking fuel. The blockades and strikes on the plains on the border with India had been going on for two weeks, and many commodities were in very short supply. We eventually found a place that would make us instant noodles, and we headed off to the second patient's village. This involved a hair raising ride up a rough narrow road that snaked it's way along the side of the hill up above the lake. The views were beautiful, but we were quite alarmed when we met a tractor pulling a wagon piled high with wood coming the other way. At this point we were going down hill, and he uphill. He couldn't back up, so we had to back uphill along the narrow track, until we could get to a slightly wider part. We felt like at any point we might head off the edge of the cliff on one side of the road.

We drove as far as we could, then had to walk uphill for another 50 mins. I was regretting my decision to give up my socks at this point...thankfully though it turned out to only be somewhat uncomfortable, and and I didn't get any blisters. We finally made it to the second patient's house. Her spinal cord injury was lower in the spine, so she had some function in her legs, and was able to walk with a walker. It was a good thing, because there is no way she could have managed at all in her village perched on the side of the hill with a wheelchair. She was quite young and had good family support (except for her husband who had disappeared since her injury), and seemed to be doing really well. She was hoping to learn tailoring skills so that she could earn a living. This was a very encouraging visit, and certainly a beautiful location.

From the wheelchair patient we visited, we got an idea of something I might be able to do to improve the chairs of patients. It is probably not unusual that patients are unable to get into their houses on their own, and thus are forced to sit for long periods in their chair. If there were a way to allow them to adjust the angle of the chair (seat and backrest together) while they were sitting in it, they would be able to shift the location of pressure from contact with the seat from one spot to another on their body, hopefully reducing pressure sores.

There are some huge challenges for wheelchair use in Nepal, and there are going to be lots of things that will be nearly impossible to solve. However, on my first visit to patients in their homes, I was reasonably encouraged by how much they are able to do, and that already we have some ideas on how I might improve things for them.

Once again, I'm having trouble posting pictures with my blog, but you can see pictures of our day by clicking here.