Medicine & Healthcare, Physiotherapy in Nepal by Emma Parsons
Before I started my final year of my physiotherapy degree, I headed over to Nepal for a two month adventure including one month volunteering. I can honestly say it was one of the best experiences of my life.
My Physiotherapy Placement
My placement was at Bhaktapur Community Based Rehabilitation Centre (CBR), a day school for children with multiple disabilities based near Bhaktapur’s Durbar Square. I must say I was not entirely prepared for my first day. We were taken into the small building for orientation and sat on small chairs, clutching our chai, watching the chaos and wondering what we had gotten ourselves into. There were around thirty children, some lying on the ground, the slight smell of urine, and the crash and bang of many musical instruments (we later learned that the craziness of music day was only once a week!).
My trepidation did not greatly improve on the second day when I was handed a file on all the children and instructed to begin. I had never worked in paediatrics before! Where did I start?
I took my time in the first week, trying to find out which child was which and what their condition was – it was a real mixture of cerebral palsy, down’s syndrome, developmental delay, autism and even some with ‘behavioural problems’ (we suspected ADHD). There was no physiotherapy in the centre, but past volunteers had compiled a good file on each child complete with pictures and left good notes about past treatments.
I began to get my head around who was who and begin some actual physio, mainly consisting of stretching, sitting and standing practice, head control, and even walking and stairs for the more advanced. The children were all beautiful! They adored the attention and their smiles never failed to brighten up even the toughest day.
Another challenge to completing any treatment was the need to help out with the day to day activities – we would sing songs in the morning, then move all the children to their specialised chairs, then help with feeding them twice a day, as well as helping to take them to the toilet and change them. The children were also not always so good at waiting their turn – I was even sat on once! And you can’t forget the need for cups of tea at least twice a day. It was a busy atmosphere with a hundred things happening at a time!
Part way through our placement, the children went on vacation, so there was no school. After spending a few days cleaning and painting the centre, we commenced home visits so the children could still receive therapy. This was a fantastic experience; to be able to see where the children lived and meet their families. One thing that struck me was the family’s extreme hospitality despite obvious poverty. We received tea and biscuits, and even buff momos at one house! The families also showed such love to their kids and were keen to learn what exercises they could be doing at home.
Another thing that will stick with me was how you have to think about what each individual person needs to be able to do. We were working on sitting and standing with an older girl with CP, when the local staff and her family tried to encourage a deep squat. I was baffled as to why they were teaching her to do that but then I realised, it was so she was able to use the Nepali toilet - a skill that is very rarely taught in Australia is essential in Nepal for basic daily activities. This really hit home to me how you have think about cultural and individual differences.
Overall I felt that I learnt a lot from this experience – from how to convince a severely disabled child to eat, to engaging children with large cognitive deficits, as well as invaluable lessons in respect and tolerance.