Challenges of Physiotherapy in the Third World

In 2010 I spent six months living in Nepal and completely fell in love with the country, the people and the culture. In 2014, I decided to return and offer physiotherapy services to Khagendra New Life Centre in Kathmandu.

Khagendra is a programme of the Nepal Disabled Association and was established in 1969. The centre provides short- and long-term management and care for children and adults with conditions such as cerebral palsy, spinal cord injuries, amputations, multiple arthritis, stroke, congenital disorders and many others. Khagendra is the only organisation of its kind in Nepal. The residents of Khagendra have rudimentary wheelchair-accessible facilities, daily physiotherapy, nursing care and hot meals. Having previously volunteered in two separate Nepalese organisations, I was very aware of the lack of resources, staff and expertise available in Nepal. Nepalese culture tends to believe that those with disabilities are being punished by the Gods for their wrongdoings in a previous life; this is especially true in rural areas. Those with disabilities are therefore shunned from society. The government does not provide basic aid such as healthcare or rehabilitation programmes. The sad fact is, as a result, that those who cannot afford treatment are left to die.

The physiotherapy room in which I worked contained equipment provided by previous volunteers—plinths, a tilt table, parallel bars, pulleys and children's toys. The room was covered with a thick layer of dust hinting at its infrequent use. My first patient was a man in his 50s who was severely disabled from a bout of meningitis ten years previously, but this was not the cause of his current prognosis of immobility. When he was first diagnosed, his family thought it best to keep him bed-bound in their rural village. The prolonged bed-rest caused contractures that quickly became irreversible. Unfortunately, this was not an uncommon story amongst my patients—in fact most of them had developed contractures from prolonged bed-rest in hospitals or in their family home. Aside from the obvious lack of equipment and resources a major hindrance to my treatment was a lack of medical records of the patients' conditions. Thanks to previous volunteers, who had collectively compiled incomplete diagnoses, I was able to gain some idea of the patients' past medical histories. Perhaps the most significant difference to Western healthcare was the patients' attitudes towards their predicaments. One patient with a complete lesion at C3 and who was paralysed from the neck down was always up-beat and eager for conversation. He was involved in the up-keep of the centre's website and was able to communicate with friends around the world thanks to a contraption gifted to him by Dutch medics—a tablet with a helmet and a stylus attached so that Krishna could type using head movements.

One of the most debilitating aspects for the residents at Khagendra was the lack of wheelchair-accessible facilities in Kathmandu. The roads in Nepal lack pavements and generally consist of a chaotic mixture of cars, cows, monkeys and people all attempting to walk alongside each other. My experience at Khagendra forced me to use initiative and think outside the box as a physiotherapist. Anyone who is looking for a placement to boost their confidence and broaden their skill set should consider working abroad in a third-world country, where there are endless opportunities to contribute and learn. And, most likely, you will end up making a lifelong commitment to your cause as I have with Khagendra. 

Sonya Ostashevskaya-Gohstand


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