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The need for rehabilitation service in Nepal
The need for rehabilitation services in Nepal is immense. Currently, there are only 25 physical therapists to service the entire country, and almost no occupational therapists or speech language pathologists. Health care providers hold education levels comparable to North American assistant levels (e.g. physical therapy assistant program). Personal care workers with very limited formalized training often provide care for people with disabilities.
Though neurological conditions such as stroke, spinal cord injury, encephalitis and traumatic brain injury are common in Nepal, rehabilitation services for these populations are virtually non-existent. For example, the rehabilitation services at one of the hospitals visited in October 2006 are as follows:
- The typical length of stay in hospital for stroke patients is approximately three days
- Patients are then discharged home to the community with almost no follow up
- Outpatient physical therapy services are geared primarily to musculoskeletal conditions
- Typically, physiotherapy is the sole professional therapy service provided, and often at the day of discharge
- With the exception of Green Pastures Rehabilitation Hospital, there are no other adult rehabilitation services available in Nepal, outside of Kathmandu
- Individuals in the community with neurological conditions are typically left to manage their disabilities with little support, not only because of limited resources available in the community, but also due to lack of education regarding the role of rehabilitation for maximizing independence and optimizing quality of life
- Mountain geography, lack of infrastructure and decreased access make servicing remote regions challenging, despite the efforts of community based rehabilitation
The rehabilitation needs of Nepal are set in the context of significant health and economic challenges. Nepal ranks 140th out of 177 countries on the Human Development Index. This compares to Canada’s ranking of 4th (see table below).
Comparisons related to international development for Nepal and Canada, adapted from the Canadian International Development Agency (www.acdi-cida.gc.ca)
| |
Nepal |
Canada |
| Population (millions, 2004): |
25.7 |
32.0 |
| Population density (per km2, 2004): |
175 |
3 |
| Gross national income (per capita, 2003): |
US$240 |
US$23,930 |
| Human development index ranking (out of 177 countries, 2002): |
140th |
4th |
| Life expectancy at birth (1960, 2003): |
60 |
79 |
| Mortality rate under 5 years old (per 1,000, 2003): |
82 |
6 |
Adult literacy rate (% 2000-2004):
Total
Men
Women
|
49
63
35 |
99
99
99 |
Population using improved drinking water sources (%-2002):
Total
Urban
Rural |
84
93
82 |
100
100
99 |
The need for rehabilitation training and support
Through communication with Canadian medical colleagues working in Nepal and Nepali clinicians who hosted the team’s first field visit, the project team learned that Nepali clinicians wanted more knowledge and skills in the following rehabilitation topics:
- Interdisciplinary team function: What is it? What are essential components for effective team function?
- Neurorehabilitation skills and knowledge including:
- Physical assessment
- Swallowing assessment and management
- Respiratory rehabilitation
- Management of severe tone
- Balance and mobility
- Functional movement re-training
- Sexuality following spinal cord injury
- Medical conditions
- Prevention of pressure ulcers
- Bladder and bowel management
The Response: Project Description
In response to the immense need to develop rehabilitation services in Nepal, an enthusiastic interdisciplinary team has been assembled under the leadership of Dr. Nora Cullen, a physiatrist at the Toronto Rehabilitation Institute. The team is comprised of physical therapists, occupational therapists, speech language pathologists, nursing, neuropsychologists, students, managers and researchers. The team has been meeting formally since November 2005 to plan a rehabilitation education project in Nepal.
Our Objectives
1. To support empowerment and the rights of disabled persons in Nepal
2. To liaise with Nepalese health care providers, people with disabilities and their families regarding their perceived learning and resource needs
3. To raise awareness by advocating at government levels for enhanced health care for people with disabilities
4. To develop and provide a sustainable education program to local Nepalese to meet and enhance the health care needs of those living with disabilities in Nepal
5. To build partnerships with Nepalese health care organizations and community agencies with similar aims..
6. To raise funds in Canada to support the vision and mission of NepalAbility
7. To research the epidemiology of disability and the effect of implemented strategies in Nepal
8. To facilitate collaboration opportunities for Canadian health care workers and trainees to travel to Nepal at minimal cost to themselves to participate in rehabilitation activities and exchange programs
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