Six months after Nepal’s devastating 25 April earthquake, Subhash Chaulagain is planning for the future.
From the front porch of his home – an ad-hoc construction of gleaming sheets of zinc and rust-tinged corrugated iron – the 28-year-old from Sindhupalchok says that despite the distress of losing his wife and three-year-old son, there is little time to reflect: he must provide for his two school-going sisters, as well as his parents.
Though Chaulagain sustained serious injuries in the quake, he is able to move freely thanks to the physio treatment he received following orthopedic surgery to his left leg. After the festival season, from October to November, he plans to take up a job in Saudi Arabia.
“If I hadn’t been able to regain my mobility, I couldn’t imagine what I would do,” he says.
Others have been less fortunate. According to Dr Sagar Rajbhandari, Sindhupalchok’s District Health Officer, some of the injured in his district remain deeply affected by their condition. “Many people with serious injuries from the earthquake received basic treatment in Kathmandu and then went back home, although often they were not ready,” he says, adding, “Many of the patients are traumatized and still have a lot of physical problems.”
In order to ensure that those injured in the disaster are able to optimize their post-quake quality of life, Nepal’s Ministry of Health and Population, with the support of WHO, IOM and AmeriCares, has constructed a cutting-edge injury rehabilitation facility in Sindhupalchok’s district capital, Chautara. The 20-bed Injury Rehabilitation Unit will provide intensive functional rehabilitation to groups of patients admitted to the facility based on their rehabilitation needs. Most importantly, patients will be discharged from the facility in line with clear outcome-based protocols.
Dr Rajbhandari thinks this intervention is critical to fill present gaps. “This kind of facility is necessary. We can provide longer, targeted treatment, and we will only discharge patients when they are ready to return to their regular activities back home,” he says.
Dr Mike Landry, a WHO expert in injury and trauma management and rehabilitation, says that the systematic, protocol-based design of the facility will prove vital to the long-term needs of Sindhupalchok’s injured. He also thinks it could change the way post-disaster injury rehabilitation is carried out in future. “Over the past 20 years or so, the ratio of those killed and injured as a result of natural disasters and conflicts has changed dramatically. Now, we find that relatively more people survive these tragic events, however there is a corresponding rise in the number of injuries that must be managed in their aftermath,” he says. “As health professionals we have demonstrated our ability to save life, but we now have to become better at saving the quality of life of those who now have a disability. The way to do that is by standardizing the services provided.”
According to Dr Landry, Nepal is well situated to pioneer this change. “Owing to its recent history and a range of socioeconomic factors, health actors in Nepal have had a strong focus on addressing disability. From the disaster’s outset the MoHP and other organizations involved in injury rehabilitation have been working hard to ensure the injured receive the care they need. With the realization of the Injury Rehabilitation Unit in Sindhupalchok, we have an opportunity to create change that could reach far beyond the present scenario.”
Whatever the Rehabilitation Unit’s wider implications, present needs remain the primary concern. Phillip Sheppard, an IOM physiotherapist trainer at the facility, says that while the protocols and evaluation methods being used will be uniform, focus remains on the patient’s own requirements and how best they can maximize their quality of life.
“The thing that’s unique about functional rehabilitation, which is going to be used at the facility, is that we’re honing in on the patient’s goals and what they want to accomplish. If they’re a farmer and they need to walk up and down mountains to harvest their crops then we’ll use those aims to tailor the treatment. Similarly, if they need to be able to prepare meals and perform other specific actions, then we’ll focus the treatment on achieving those goals,” he says. “When you come into the facility you’ll see people doing things that they do in everyday life.”
For Subhash Chaulagain, this approach is encouraging. Though Chaulagain is able to work, and is determined to get on with his post-quake life, he says that for others the complications are manifold. While looking out across a ridge framing the green valley opposite his home, he reiterates the importance of accessible injury rehabilitation for those who suffered quake-related injuries similar to his own.
“I need to work for the future and support my family. There are many others in a similar position that are still struggling. We need to make sure they receive the care they need,” he says.