Patient home visit

Life in the monsoon ticks along fairly predictably. It's either raining or really hot (or sometimes both). I'm going swimming with Sita and connecting up with more Nepalis from Church. There are a couple of new ex-pats arriving in August, which will be nice, but I've appreciated the way I've had to get to know more Nepali's without the easy support of other ex-pats to fall back on.

Work is busy, we have lots of new SCI patients. Many of the patients get their spinal cord injury due to a fall from a tree, while collecting fodder for their livestock. This need for fodder is highest just at the end of the dry season, so a large proportion of injuries happen then. A couple of months later, after their initial treatment, they arrive at the rehab hospital, often already with large pressure sores. Room 3 with 8 young men with SCI injuries is a little depressing right now, as most are early on in their treatment, or have very complicated cases. On the bright side, however, I did assemble a wheelchair last week with a double amputee, who was very pleased to get his 3 wheel chair. He lives in Jumla, a remote village in western Nepal, and immediately could see how much easier it was to use this chair on rough terrain.

One of the things I'm working on these days is going through our database of SCI patients to select a group of them to follow up with a visit to their home. We hope to determine how well they are managing, and hopefully some indications for rehabilitation staff as to what works well, and what is still needed to help patients stay healthy, as well as reintegrate into the community.

Since I'm thinking about future home visits, it seemed an appropriate time to finally post about the home visit I did at the end of April. We had a patient, Monikala, who had received some assistance in the past, but the community rehab workers felt that it was impossible to make her house wheelchair accessible. When she was discharged, Manoj (my OT boss) and I went with her and the community rehab worker to see what we could do. Ruth, a visiting medical student, came along to get a chance to experience rural Nepali life.

Getting to Monikala's house was an adventure in itself. We drove for a couple of hours on the 'main' road, before heading up a rough mountain track for three more hours. It's the kind of road that makes you almost wish you could walk instead of bouncing along in the car. However, at the end of the road, we got to walk anyway, it was another three hours hike up to her house. Her husband came to carry her wheelchair, and several villagers came to trade off carrying her up in a doka, the basket that is used to carry anything and everything in rural Nepal.

On the way, we visited a couple of other patients who lived in the area. This was quite encouraging – both were SCI patients who were wheelchair bound. One had been living independently with his wife and son for 10 years, and was working as a radio repair man. The other man lived on the side of the hill, but was still able to do woodworking on the front porch of his house, and had been for several years. It's nice to see the success cases – at the hospital, we usually only see again those who don't do well, and have to return for further treatment. Both of course, were not living in an area or house that were particularly accessible, but they were able to make do with what they had in an amazing way.

We reached Monikala's house in the late afternoon, where a bed was set up for her on the front porch. From there she could greet all the friends and neighbours who came by to see her, after her three month stay at the hospital. The presence of two white women was also an attraction, particularly for the children!

There was a bit of time to look at the options for making the house accessible, and it indeed was a big challenge. Built on the side of the hill, there wasn't the space to build a proper ramp up the three steep steps into her house. She already had a wheelchair accessible toilet, but there was a big step down even from the front porch that was her temporary bedroom. We brainstormed a bit, and left it at that for the evening.

We were fed dal bhat by the family, and then they put us up for the night. I shared a single bed with Monikala's teenage daughter. Despite the hard bed and confined space, I slept better than I had expected. We were up early, had tea, and then Manoj and the community rehab worker had a long and involved discussion with the family about how they could make their house more accessible. It was all in Nepali, but still, it reminded me of a group of men anywhere discussing home renovations - everyone had an opinion, and it took awhile to decide on what should be done.

In the end, some plans were made, that would require building a couple of ramps, and extending a room on the side of the house. These couldn't happen immediately, so we also worked out some short term solutions as well. This involved moving the bed to allow more room for the wheelchair on the porch, and putting up a temporary ramp. It's hard to know how much the patient's family will feel they can afford – they were reasonably well off, but there is always the question of whether accessibility is considered important enough to spend money on.

We headed off at about 8, and hiked down the three hours on just our tea and some yummy berries that were in season along the way. We certainly were ready for dal bhat at 11 when we reached the town at the top of the road. It's the traditional Nepali schedule – up early to work, then eat two big meals of rice, one mid morning, and one in the evening. I haven't really craved curry and rice in the mornings before, but once you've been up and going for awhile, it sure tastes good. More pictures of our visit, and the beautiful, not wheelchair accessible terrain we traveled through posted here.