physio in nepal

I know its been a while but recently we’ve been so short of time to fit all our souvenir shopping, sightseeing and clinics that we’ve exhausted ourselves come dusk. Its really hard to believe that in a what we first thought would be relaxing holiday is instead characterised by short bursts of extreme activity. Details on that next time…

Physiotherapy in nepal has been a real eyeopener. We began our placement at kanti children’s hospital, where we deal with cerebral palsy, torticolis, spina bifida and
brachial plexus injuries. There is only a single room where one senior physio and another physio assistant work, the former the only one really qualified with 4 years of study in india under her belt, while the latter, a local cert level only. The whole experience was very boring because there were hardly any babies to treat due to the winter cold (so parents don’t want to take their sick kids out which is silly), and the few that did were only mild cases. The physios seem to take a very passive role in educating the parents, and the only treatment administered is some passive movement of the arms and legs to deal with spasticity. Uninspiring stuff.

Hence countless hours went into playing connect four, drawing on our notebooks, playing hangman, noughts and crosses.

Beside kanti there is a another hospital called the tribuvan university teaching hospital, where thankfully there were many more interesting patients. Back home cases such as bell’s palsy (facial paralysis) and amputees are few and far between, but seen daily here. Few patients spoke english so it was difficult to obtain a history of their condition, whilst some had conditions lasting several years before even coming for physio, perhaps because physiotherapy is only 20 years old here. I was told many come from villages outside kathmandu, but are dedicated enough to turn up for daily treatment. It is really inefficient that all the patients they get are seen every day, when education and an exercise program more than fulfils the role of daily physiotherapist contact. The ‘qualified’ physios study in india before returning to nepal because no such degree exists here, and the other physios that work, while still qualified locally, need only a 3 year cert level to practise. Hopefully through mingling and sharing of ideas between the two qualifications, the disparity of knowledge will bridge.

[Fact: the most a nepalese physio can earn is 40000Rs (AUD800). So many have two or more jobs.]

What we found very prevalent here is the reliance on electrotherapy, which is the use of ultrasound, hotpacks, wax bath, infrared and other adjunct modalities to hasten healing. While well-meaning, this overuse of such modalities often is unnecessary but physios here tell us that there are so many patients that there is just no other way. Pity really, because when patients are referred for physio a tiny A5 card accompanies them, containing only their diagnosis and directions given by the doctors under which the physios robotically follow without knowing why or challenging them. As such there is little time spent on proper assessment, which really is half the treatment.

As it stands we only have a couple of days remaining with this hospital, during which we are planning to educate and to poke at their brains to get their minds ticking a little more, such that they may lift the profile of physiotherapy to the same standards of autonomy us australian physios enjoy.