Charitable works: My Experience as a Physiotherapist Volunteer in Nepal (Part 2)

In my previous article I discussed the reality of treating the Maidi people. I believe we certainly had an impact in specific areas but in others it was a lot more challenging. Here I will discuss how I think we helped and what I think needs to be done for the future.

Dealing with the Challenges

The Over-Prescription of Pills

The over-prescription of pills was evident through my very first interaction with the villages: “do you have any pills?”. Through my days treating I would say to every person that walked through “pills cannot fix this, only exercise can”. It became a mantra in the outpost – anyone that spoke reasonable English would help me by translating this phrase over and over again.

Women’s Health Issues

Unfortunately I was not able to tackle this issue to the extent I had hoped. There simply wasn’t enough time, resources or space for this. However, I was able to make a very small amount of headway. At the end of the first very long day I gathered the four nurses that assisted the doctor to try to educate them on some women’s health issues.

We discussed incontinence and prolapse, as well as certain techniques that could be taught to some of the locals. We practised different pelvic floor and transverse abdominus (lower core) exercises and discussed the importance of these pre- and post-natally. Pictures of the exercises were prepared on handouts. This was in an attempt to try to breakdown the language barrier. I also created written instructions on restrictions to lifting after birth. To be conservative I specified the following:

• 0-3 months pre-natal: normal lifting
• 3-6 months pre-natal: less than 10kg
• 6-9 months pre-natal: less than 5kg
• 0-3 months post-natal: less than 2kg
• 3-6 months post-natal: less than 5kg
• 6-9 months post-natal: less than 10kg
• 9-12 months post-natal: return to normal lifting

Lower Back and Knee Pain

This should have been the easiest ‘challenge’ to overcome, but unfortunately it was not. It was the easiest area to impart knowledge and treat the locals. However, ongoing care and progression would be non-existent and the aggravating factors (working in the fields) cannot be avoided. To ‘overcame’ this challenge is near impossible but the locals certainly had short improvements and reported large improvements since Craig’s visit 6 months earlier. This will definitely be ongoing.

For the ‘Lower Back’ Group I educated them on:

• Hamstring Stretching
• Glute Stretching
• Correct Lifting Techniques/Squatting Techniques

For the ‘Knee Group’ I educated them on:

• Quadriceps Stretching
• Hamstring Stretching
• Correct Lifting Techniques/Squatting Techniques

Very generalised, very basic, yet very effective. For the majority of clients these techniques worked really well. However, I wondered how much of the lifting technique would be remembered. Then felt slightly deflated knowing that I would not progress them beyond very basic stretching when focus eventually needs to move to strength.

Handouts

Prior to heading to Nepal I created very simple handouts covering most of the basic exercises. Throughout the two treating days I handed every single client a copy with their exercises circled and advised to complete every day for the rest of their lives. Overkill, but may just get the message across.

The village responded very well to these handouts, despite being very basic. It also means they have the capacity to continue working on them without forgetting and possibly teaching family members and friends.

Future Direction For Our Volunteering

Even with very limited days within the village it is obvious that we make a difference. It was also obvious that there is still plenty we can do. We will never be able to change their lifestyle. However, we should be able to provide education and small changes that could possibly create a huge difference in their lives.

Education

Nurses

I was able to spend two hours with the local “nurses” teaching them VERY BASIC women’s health issues and solutions. Much more can be done here. In future visits we will be spending more time with the health workers covering the most common conditions. We will also provide them with written information so as to try to cover the language barrier.

 

Children

I believe the biggest impact will come from educating the younger generation. Especially the women. The old saying “With Knowledge Comes Power” is very pertinent here. By educating the youth of Nepal we can empower them to change customs. To change the way they look after themselves, possibly integrate new systems to decrease injury and hence could improve their quality of life.

This is obviously not a short term solution. It will have to occur over many years. However, slowly but surely this system should start trickling down into the younger generation.

I had hoped to attend the local school and sit down with the students to have an open discussion. I wanted to get an insight into their understanding of sexual health, menstruation, pelvic floor and pregnancy. Or more so what they don’t understand and where the gap in this education lies. I believe we then need to integrate an educational program into their ‘curriculum’ so we can see a change from the grass roots. I want to teach them about pregnancy, how to look after your pelvic floor from a young age to avoid problems in the future. Educate them of the importance of looking after themselves after childbirth and limiting heavy lifting. Unfortunately these topics are tabooed and are usually not discussed. Not even between mother and daughter, father and son or between siblings.

Beyond the schooling system there are plenty of other avenues for education.  We have already started this through treating the locals and imparting our knowledge.

Elderly

I do believe the key to success is through the children of Maidi. However you can’t ignore their customs and the hierarchy system they live by.

The villagers of Maidi listen intently to their elders. They are in charge and their word is considered gospel.  Majority of the elderly I treated were very responsive to me. I found some even began helping me explain when language was an issue! If the younger generation see the elderly looking after themselves they are likely to follow suit.

Female Only Treatment Days

In a previous blog I introduced you to a lady who I believed had suffered from prolapse. With the surrounding crowd, who were predominantly male, she was too afraid to speak up.

For future visits we will endeavour to have female ONLY treatment days (not sure how the locals will respond). We may even try to source a private area to allow the women to feel comfortable talking.

Nepal Handbook

Over the next year or two we plan to develop and create a Nepal specific handbook. This will certainly help with the language barrier. It will similarly help with our goal of education. And it will also help our message last longer.

We will take these handbooks with us and have it translated to Nepalese. It will include to most common complaints, as well as simple physiotherapy treatments. If successful it may even produced on a large scale.

This however is a long way off. It will entail a large amount of work and possible outsourcing.

Continuing Volunteer Work

Unfortunately over time the benefits during our volunteering will be forgotten. Pain and injuries will return, the handouts will be lost and without continuing education the same cycle will continue. At Sport and Spinal we are hopeful to continue imparting our knowledge and spending time with the locals by sending 1-2 of our physios per year. With this cycle we can continue to grow on previous education. We can progress exercises and treatment. And hopefully we can slowly change some of the barriers to make a huge difference in the lives of the Maidi people.