Home visits

On Wednesday we were able to go on a home visit to a couple of SCI patients from GPH. This was partly to give Lynn (Shaun left that morning) a chance to see the realities of housing challenges in Nepal, but also to get our feedback on the modifications they are now doing. There is more funding for home modifications for SCI patients through the USAID grant, which is great, but it is still fairly new territory for the Community Based Rehab workers to adapt houses for wheelchairs. We were invited along to see how they are doing, and make some suggestions, along with Shweta, one of the Physiotherapists from GPH.

This was the full home visit experience – we drove an hour on the main road, then 2 hours up a jeep track into the hills. Spectacular scenery, but you arrive feeling very jostled. We then walked about 20 mins down to get to the patients house. She is still in the hospital recovering from a pressure sore, but they have already built a wheelchair accessible toilet (another thing resulting from the USAID grant, getting home modifications started before the patient goes home if possible). We also talked a bit about the ramps and railings they could add to make her ground floor kitchen and bedroom accessible to her.

The toilet they had made was good, big enough for a wheelchair to enter and turn around, with a shower area and a western toilet. However, it seems the western toilets they have available in the rural areas are only 12” high, too low to transfer easily from a wheelchair (usually around 18” high). The best thing will be still to add a higher toilet chair over the western one – making us wonder what advantage they had over the floor level Asian ones. The other challenge is to decide where is the best location of bars to allow for transfer – the bars have to be supportive, but not in the way of wheeling the chair up close enough to the toilet so they can actually transfer. It seems the Community Based Rehab workers have the basic concepts of how to make a toilet accessible, but lack the clinical experience to think about all the practical issues. This will come with time, for sure, and we were able to make some recommendations to help out with this.

We spent quite awhile looking at things, and then relaxed in the shade while the daughter-in-law cooked us dalbhat. We ate with our hands, sitting on the floor in the smoky kitchen a meal of locally grown rice, lentils and curried vegetables. It was so yummy, and the real Nepali experience. The family was quite well off, so it was a very nice Nepali rural house – stone and mud like most are, with cows, buffalo, goats, pigs and chickens, as well as mango, lychee and banana trees. We were startled to discover a 9 mo old baby hanging in a hammock between the posts of the veranda – she was very cute, and seemed not too bothered to be put there whenever her mom had to do work around the house.

After the meal, we headed uphill in the heat of the day, and then jostled back down the jeep road to the main road. Not perhaps what we'd choose to do on a full stomach, but so worth it for the visit!

We stopped at the house of a second patient on the way home, only a few minutes off the main road. She was a challenging case that they had seen at Green Pastures since I had left – she had had both legs amputated because of serious pressure sores. They had to make a molded socket for her to sit in, so she had enough stability to sit in a wheelchair. She is currently living in a small house that isn't wheelchair accessible – she can be in her room in her wheelchair, but the veranda is too narrow for her to get out onto it in her wheelchair. When she wants to go around the yard, her son lifts the chair down a big step, and then lifts her onto it. Even from there, she couldn't access the main road, or go very far from her house. In addition, she was living with her husband's second wife that he had taken after her injury, a practice that is still accepted here in Nepal, and the family was not very supportive. (Shweta stumped both Lynn and I by asking what the word in English was for 'your husband's other wife')

The Community Based Rehab (CBR) worker had already negotiated the building of a small shop right at the road, where she could also live - it would have a small bed and an accessible toilet. This way she could make some income, and have a more accessible place to live. It was mostly done, but also needed some modifications for the toilet, and needed a wider veranda. Most of the funding for the shop had come from grants from INF's CBR organization. However, to get the community involved, they solicited funds from community members and local organizations to help fund the shop. This will hopefully help with her inclusion in the community, and give them a sense of responsibility for her.


We then got to witness the community aspect of CBR. The community was called around to talk about the few remaining modifications that needed doing. The practicalities were discussed, and agreed to be possible. However, the patient's brother-in-law had been getting drunk and accusing the community members of stealing the money for building the shop. The community members were understandably upset about this, and were reluctant to contribute more until the family contributed some too. The conversation got very heated, and lasted most of an hour – typical of negotiations here in Nepal – everyone needs to have their say (repeatedly) before a decision can be made. We were grateful for Shweta's translations to let us know what was going on. An amusing moment was when the woman complaining the loudest about the drunk brother-in-law was brought up short by another community member who pointed out that she sold the raksi (local home brew) in her shop, so if she didn't like him was when he was drunk, she shouldn't sell him raksi! After it all, they agreed that they would provide labour and materials, the family agreed to contribute some money as well, and the patient herself was given the responsibility of looking after the money from the community. We left feeling reasonably hopeful that things would be done eventually to give the patient some income and independence.

It was an amazing day. I've posted the rest of the pictures here. I loved getting out again into rural Nepal, and it was a great way for Lynn to spend her last day in Pokhara. She headed off to Kathmandu this morning, and I'm sticking around Pokhara for a few days to catch up with friends. I've been enjoying a quiet morning in the hotel this morning before checking out, a respite after the very busy schedule we've had so far!