Supporting rehabilitation and psychological wellbeing after Nepal's earthquake

This year marks three years since the devastating earthquakes that hit Nepal in April 2015.

As part of the UK’s support to the Nepal government, we managed a Transition and Recovery programme (TRP), responding to some of the immediate needs. Part of this involved supporting people who had been seriously injured during the earthquake and were now having to live with life-changing disabilities. We worked with a number of NGO’s, including the Spinal Injury Rehabilitation Centre (SIRC), to support rehabilitation and psychological support to those affected.

With up to 110 patients aged two to 86, SIRC is the only rehab centre of its kind in Nepal. In April 2015, its capacity had to increase rapidly to deal with the aftermath of the devastating earthquakes.

The scale of the earthquakes have been well-documented. Killing almost 9,000 and displacing over 3.5 million people across the country, it was the worst natural disaster to affect the region in 81 years. It also caused a spike in spinal injuries unlike anything those working at SIRC had ever seen before. 3-400 men, women and children sustained spinal cord injuries across 14 districts and 120 of them completely lost their homes. Those working at the centre sprang into action – focusing on training new staff members and strengthening its services to confront the sudden, urgent need for support.

SIRC was founded in 2002 and back then, there were only 10 beds, three staff and three patients. During the 2015 earthquake, it became home to up to 150 patients.

“We were lucky, because our building was unaffected by the quake, so we had the facilities to help – unlike a lot of hospitals and medical centres in the region,” explains Baniya. “But nobody was anticipating the number of men, women and children who would come to us having lost everything – not least the use of their legs.”

Kesh Bahadur Gurung was one of them. A then 26-year-old mountaineer, he’d jumped into action after the first earthquake hit on April 25th and mobilised a team of local volunteers to distribute aid across Gorkha – his home district, and just west of the epicenter of the disaster.

“The aftershocks continued on a regular basis, but I thought we were over the worst of it,” he recalls, wheeling his chair back and forth absent mindedly as he remembers the events that changed his life. “We were driving along a road high in the hillside on June 1st with a truck full of supplies when the ground just seemed to give way below our vehicle, and we were sent flying down the cliff-face”. Thrown from the window, he tried to grab onto the trees – eventually catching hold of a branch with his left hand. “Even as I hung there, I felt like my lower body had been cut off. I almost had to psych myself up to check my legs were still there.”

They were – but one of his vertebrae had become dislodged and he could feel it protruding from his back. Still, Kesh hung on for 15 minutes before anyone heard his yells for help. “I thought all my friends must have died. I later found out they’d all escaped with just a few bruises.”

Eventually rescued by another passing aid vehicle, it took four hours before he could reach a hospital – carried in a stretcher made out of a blanket. Still, despite realizing something was wrong with his lower limbs, permanent paralysis didn’t cross his mind. “You think you’re infallible, you know? I just figured that technology and medicine would make everything OK. So when the doctors told me I’d never walk again, I cried for weeks and weeks. I thought my life was over.”

The centre follows a multi-disciplinary, team-led approach for holistic rehabilitation – working with both the individual and their family. With three wards (one male, one female, one mixed), vocational training classrooms, on-site occupational and physiotherapy facilities and even a wheelchair basketball and dance team, it changes people’s lives.

“These days, a lot has changed,” explains Mandira Baniya, the centre’s Nursing Supervisor, who oversees the nurses who work around the clock to provide 24 hour specialised care. Together, they work with doctors and a team of therapists to ensure every patient is only discharged after meeting a comprehensive set of physical and emotional requirements, as approved by TRP team.

Manoj Thapaliya, a physiotherapist at SIRC says, “Our role is to show patients that actually, very little has changed. Master the basics of managing your health, and then start focusing on what you <can> do, rather than what you can’t.”

“When I first arrived [at SIRC], I’d just had surgery and was lying in my hospital bed feeling like I might as well give up” says Kesh. “But I saw all of these other guys my age whizzing about in their chairs, and they looked so confident. I don’t remember exactly what changed, but I suddenly thought ‘I bet I could do that even better than them’. I’m quite competitive, so I decided to teach myself to be the best person here in a wheelchair. I’d tell anyone in my situation, ‘Look, this sucks. But you can still do everything. You just have to change the way you approach it.’”

How TRP has supported SIRC since the earthquake

Following the earthquake, SIRC needed to urgently increase its capacity from 51 beds to 150 beds. Determined not to let those suffering from spinal disabilities fall behind, as Nepal’s population tried to pick itself up from the earthquake, our team gave priority to the following areas:

TRAINING

Increased numbers of patients required a sudden increase in staff numbers. We supported hands-on spinal-cord injury-specific training for 148 health workers, while neuro-training was given to 50 nurses, and targeted training camps were provided to 129 people with disabilities. All staff received training on disaster management.

AWARENESS

The realisation that Nepal hadn’t been prepared for a natural disaster on this scale was a call to action – and led us to conduct an extensive internal audit of how facilities and services could be improved. The system of referrals from other health facilities was consequently strengthened, and 2000 members of the public participated in awareness camps.

REHABILITATION

Services and support don’t end when patients leave SIRC. Following the earthquake, the widespread destruction meant community-targeted assistance was even more vital to SCI-affected individuals, and over 400 home visits were conducted within the first year of recovery from the earthquake. Patients also began receiving vocational-skills training to ensure they could lead their own, independent rehabilitation.

“Rehabilitation is a collaborative effort,” explains Baniya. “We can’t make our patients walk again, but we can give them the tools to fulfill their ambitions and live independently.”

SIRC was supported by Options between 2015-2017 through the Transition and Recovery Programme, funded by UKAid. TRP was part of the UK government’s support to Nepal following the 2015 earthquake and supported Nepal’s Ministry of Health to build a resilient health system providing good quality health services for all.