So Many Faces...
James Bardy, OT Reg (BC)
There are so many faces.
As a clinician, it’s hard to know which faces will occupy a special place in your heart forever. Who will you remember from your journey to Nepal? Whose story will touch you in a way that is truly unforgettable? There are many.
Let me take you to a town in Nepal called Tansen - a little known gem, off the tourist’s map and nestled in the foothills of the Himalaya. At United Mission Hospital there is a rehabilitation team, including a physician, speech therapist, physiotherapist, occupational therapist, nurse and rehabilitation assistant. They are a dedicated and hard working team, and you come to immediately understand that the need for rehabilitation in Nepal is great.
One day on the unit you meet Muna.
Muna is 17 years old. She has been admitted to the neurorehabilitation ward, diagnosed with an ischemic anoxic brain injury. Buckling under the stress of school and college placement exams, she tragically tried to hang herself. Upon admission she is non verbal, flaccid and non responsive. The physiotherapists work with Muna over the next days, getting her vertical on the tilt table and working on weight bearing; trying to get her to respond. We speak with her distraught family, who indicate that Muna has been depressed for the last year, feeling distressed over entrance exams. Depression among teens in not uncommon in Nepal and like most countries in the world, struggles with mental health are often undetected, poorly understood and hard to address. Her parents stay at the hospital and tend to her bedside while she starts her recovery.
Her therapy involves the whole team - physicians to help stabilize her intracranial pressure and prevent seizures, physiotherapy to help get her sitting up in bed, and speech and occupational therapy to help her with word finding, facial recognition and object recognition. Brain injury affects every aspect of a person - mood, cognition, speech, strength, balance, vision and more.
Slowly, Muna starts to progress. She is motivated to recover and young. Two promising factors that she will improve. And she does improve - quickly! After the first few days she is working with the speech therapist, Sarah. She is now able to verbalize 2-3 words and can identify objects (she could not speak when she was initially admitted). She is still labile (dramatic spontaneous mood swings) and laughs every time she stresses herself (when trying a new activity or movement with physiotherapy, for example). The team uses her cellphone to show Muna photos of her family and animals on her home property. This helps her remember names of loved ones. Over the course of a week, Muna’s ability to express words improves dramatically, and within a week of daily physiotherapy she is able to walk with a 2 wheel walker up and down the length of the hallway. Her parents, who at one time thought they would lose their daughter, are overjoyed at her progress!
After 2 weeks of hard work and rehabilitation she is discharged home. She still has a long way to go in her recovery, and she will have lifelong deficits. It is very hard for any family to have a loved one in hospital, but even more so in Nepal. For every day that the family stays at the bedside to help their loved one recover, each rising and setting sun signifies an unworked day without pay and productivity. There are no sick days for the family or workers to take their place. They must get home as soon as possible to keep working, earn an income and in this case, they must take Muna with them. She will return as an outpatient and continue with the hard work that she has started in the hospital.
As a clinician, it’s hard to know which faces will occupy a special place in your heart forever. Who will you remember from your journey to Nepal? Whose story will touch you in a way that is truly unforgettable? There are many.
Let me take you to a town in Nepal called Tansen - a little known gem, off the tourist’s map and nestled in the foothills of the Himalaya. At United Mission Hospital there is a rehabilitation team, including a physician, speech therapist, physiotherapist, occupational therapist, nurse and rehabilitation assistant. They are a dedicated and hard working team, and you come to immediately understand that the need for rehabilitation in Nepal is great.
One day on the unit you meet Muna.
Muna is 17 years old. She has been admitted to the neurorehabilitation ward, diagnosed with an ischemic anoxic brain injury. Buckling under the stress of school and college placement exams, she tragically tried to hang herself. Upon admission she is non verbal, flaccid and non responsive. The physiotherapists work with Muna over the next days, getting her vertical on the tilt table and working on weight bearing; trying to get her to respond. We speak with her distraught family, who indicate that Muna has been depressed for the last year, feeling distressed over entrance exams. Depression among teens in not uncommon in Nepal and like most countries in the world, struggles with mental health are often undetected, poorly understood and hard to address. Her parents stay at the hospital and tend to her bedside while she starts her recovery.
Her therapy involves the whole team - physicians to help stabilize her intracranial pressure and prevent seizures, physiotherapy to help get her sitting up in bed, and speech and occupational therapy to help her with word finding, facial recognition and object recognition. Brain injury affects every aspect of a person - mood, cognition, speech, strength, balance, vision and more.
Slowly, Muna starts to progress. She is motivated to recover and young. Two promising factors that she will improve. And she does improve - quickly! After the first few days she is working with the speech therapist, Sarah. She is now able to verbalize 2-3 words and can identify objects (she could not speak when she was initially admitted). She is still labile (dramatic spontaneous mood swings) and laughs every time she stresses herself (when trying a new activity or movement with physiotherapy, for example). The team uses her cellphone to show Muna photos of her family and animals on her home property. This helps her remember names of loved ones. Over the course of a week, Muna’s ability to express words improves dramatically, and within a week of daily physiotherapy she is able to walk with a 2 wheel walker up and down the length of the hallway. Her parents, who at one time thought they would lose their daughter, are overjoyed at her progress!
After 2 weeks of hard work and rehabilitation she is discharged home. She still has a long way to go in her recovery, and she will have lifelong deficits. It is very hard for any family to have a loved one in hospital, but even more so in Nepal. For every day that the family stays at the bedside to help their loved one recover, each rising and setting sun signifies an unworked day without pay and productivity. There are no sick days for the family or workers to take their place. They must get home as soon as possible to keep working, earn an income and in this case, they must take Muna with them. She will return as an outpatient and continue with the hard work that she has started in the hospital.