Voices from Nepal: A Ray of Hope

Mr. Sunil Pokhrel is currently the Senior Injury & Rehabilitation Officer and Physiotherapist with Handicap International Nepal. He is responsible for injury management, early detection, health promotion and rehabilitation and assistive device services. Sunil is featured in the Hilton Prize Coalition Storytelling Program documentary “On Shifting Ground,” sharing the work of Handicap International Nepal before, during and after the 2015 Nepal earthquake. In this piece, he highlights the importance of rehabilitation services and the different collaborations that have occurred across the country since the disaster.

A Ray of Hope

by Sunil Pokhrel

In April 2015, I had been looking forward to presenting for the first time at the largest international gathering of physical therapists, the World Confederation for Physical Therapy (WCPT) conference, but I canceled my participation. The event was to be held in Singapore just eight days after the earthquake that shook the foundation of my country. I still remember the moment when I faced the dilemma of whether to fly to the event or to be in Nepal and support the country, which had been reduced to rubble. A voice within me directed me to stay and help the 23,000 injured, to be a ray of hope to the broken.

The earthquake was one of the biggest disasters in the history of Nepal. Local, national and international organizations lent their helping hands to respond together. My decision to stay was influenced by the individuals and organizations that have shaped me as a humanitarian working to strengthen my community. Handicap International Nepal has always prioritized preparedness for unexpected disasters, and this work helped to set the tone for the response from the first day. Sarah Blin, the Country Director at the time, provided sound leadership that was instrumental in allowing the organization to respond to the overwhelming demand of injury management and rehabilitation. I was also inspired by SOS Children’s Villages Surkhet – Nepal, the place where I studied from nursery school to 10th grade; it is my second home that inculcated the humanitarian spirit in me right from childhood.

When the earthquake happened, I was immediately sent to work at the largest government teaching hospital, and I still remember those initial heart-wrenching moments. There was limited space and limited resources to respond to the high need to save people’s lives. My role at the hospital was to support the existing medical team, transferring them safely from ambulances to triage zones; to triage injured survivors, bracing the injured parts on the first initial days. Later on, I was tasked to teach exercises, provide assistive devices (crutches, canes, wheelchairs and braces) after proper assessment and user training and to educate the patients and their family members about the need for follow-up rehabilitation.

In Nepal, rehabilitation services are not fully integrated into the healthcare system, but this is a very important part of healthcare, linked with minimizing the complications and preventing the disabling effect of the injury. Demand for rehabilitation exponentially rises in post-disaster scenarios like earthquakes. Working in post-disaster scenarios is especially difficult because the survivors are experiencing psychological trauma as well as physical injuries.

After the earthquake, I was based at the same hospital for almost three months, directly providing services and also supervising the emergency rehabilitation physical therapists recruited later by Handicap International. I met more than 1,000 injured survivors and family members during that time. Most of them came from remote areas in Nepal where rehabilitation services were not available. During the initial days, it was very difficult to convince patients and their family members to get actively engaged in the rehabilitation process as they were in psychological stress due to injury, loss of family members and property. One main focus at that time was to listen, to explain, with examples, the stories of people with disabilities who have succeeded in life. This practice helped to make the exercises and rehabilitation process easier and participative.

Without the patient’s active involvement, rehabilitation is not effective. One woman with a single leg amputation was in deep distress and was not cooperating during the rehabilitation process despite several attempts by our team. We had an idea to facilitate interactions with Ramesh, a boy with a double limb amputation whom we had trained to use a wheelchair. Ramesh explained to her how rehabilitation had helped him, and this was the turning point for the woman to agree to participate in her own rehabilitation process. Not long after that, one of the most unforgettable incidents occurred during the second earthquake on May 12, 2015, when Ramesh transferred himself from his bed to his wheelchair and was able to secure himself in the safe zone downstairs due to the training we had given him just a few days back. I still remember him expressing, with his eyes full of tears, “I would have gone into shock if I didn’t have the wheelchair and the ability to use it to get to safety.” This made me more dedicated and proud, because I felt the immediate impact of my work on the ground.

(Sunil Pokhrel – right – assists a patient during a physiotherapy session)

(Sunil Pokhrel – right – assists a patient during a physiotherapy session)

(Sunil Pokhrel – right – assists a patient during a physiotherapy session)

© HANDICAP INTERNATIONAL

Today, more than a year after the earthquake, many Nepalese still live with the nightmare of the catastrophic disaster. Through Handicap International, I support physiotherapists based at six earthquake-affected districts. After seeing a gradual decline of patients in Kathmandu hospitals, our focus shifted to the homes of survivors to ensure follow-up care. Rehabilitation requires time, and therefore continuum of care is very important. Rehabilitation units in these districts are providing follow-up care in close collaboration with the Nepalese government through the support of organizations like DFID and USAID.

Though the earthquake was catastrophic in terms of loss of life and property, it provided solid evidence on the importance and relevancy of rehabilitation services in Nepal’s healthcare system. Currently the government of Nepal is working to define long-term strategies and plans for healthcare. Together with HelpAge International, we at Handicap International are providing the technical back up on this work so that health and rehabilitation issues of people with injury/disability and senior citizens are well addressed.

I do not have any regrets on losing an opportunity to present an abstract paper at my first international conference. More opportunities will arise. In fact, I have been selected as a speaker on the symposium titled Physiotherapy in Disasters in July 2017, in Cape Town, South Africa, during which I am going to share my experiences and lessons learned from my involvement after Nepal’s earthquake with the world.

(Sunil Pokhrel with a patient in Nepal)

(Sunil Pokhrel with a patient in Nepal)

© HANDICAP INTERNATIONAL

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