Surgery for Children with Disabilities in Nepal

“The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown.” H.P. Lovecraft

I met Jyanti, her husband Hem Raj, and their infant son Modil in the forecourt of HRDC West, a satellite clinic of the Hospital and Rehabilitation Center for Disababled Children located in Nepalgunj, a large city on Nepal’s border with India. She looked tired and forlorn. “I’ve cried every day for three months because I don’t understand what is wrong with my son. Why did God give me a child who may never be able to walk? I am afraid for his future, and what this may do to our family.”

In America when a child is born with a disability, chances are there is a medical professional in attendance who can explain to the parents the nature of their baby's condition, what treatment is available and an initial prognosis. In Nepal, where most births still happen at home, no such immediate assurances may be available. Jyanti had never heard of clubfoot, had never met a person inflicted with it and assumed her son’s disability was a divine curse for some sin in a past life.

“I have two other children, both girls and neither of them are disabled. We were very happy that our third child was a boy, but then we saw that his feet were twisted, and someone told us that he would never walk. I think the sadness I feel will ever go away.”

The family had made a five-hour bus journey from the neighboring district of Kanchanpur after someone in their village told them about HRDC West. She had heard about the clinic from a friend whose child had been treated there.

I tried to allay the parents' fears by assuring them that clubfoot was not uncommon, it was easily treated and they were in the hands of a team known throughout the medical world for their work on clubfoot, but Jyanti and Hem Raj still looked skeptical. Bashu Dev Joshi, HRDC West’s manager, explained to me that the family would receive counseling and, if they agreed, Modil’s treatment using the Ponseti technique of serial casts would begin immediately. The Ponseti method, pioneered in Nepal by Dr. Ashok Banskota, HRDC’s founder and former medical director, is a nonsurgical treatment for clubfoot that uses casts and braces to help correct the shape of the foot so it can function normally.

Later the same day, I met the family again, this time at the casting table in a sunny corner of the clinic’s backyard. Little Modil was on the table with his dad steadying the infant’s shoulders and head and mom holding his right leg still while Parvati, one of HRDC West’s medical team, was applying the plaster cast to his left leg. Modil wasn’t too happy with the process and let the world know in the only way babies can. Jyanti was obviously distressed, thinking the treatment was hurting her son. Parvati reassured her it wasn’t painful and that babies just cry, but Jyanti wasn’t convinced.

The mother of another patient came up to comfort her. “It’s true, it is not painful for the kid at all. My daughter has been receiving this treatment for a couple of months, and now she is able to walk by herself.” As if on cue, a toddler walked up and grabbed her mother’s dress, and mom picked her up. “See, she still has to wear the special shoes, but the doctor tells me soon she won’t even need them.”

I could see Hem Raj was now also in tears. Parvati again tried to reassure him that his son was in no real pain. “I am not crying because of that,” he said, “these are tears of happiness. I now understand that my son can be cured. We are both so relieved.”

HRDC West offers outpatient services twice a week and sees about 30 patients each day. The clinic also has a small orthotics and prosthetic workshop and is open everyday for Ponseti casting and physiotherapy. And, thanks to generous donors like yourself, all at little or no cost to the patient’s families.

Links:

• Learn more about AHF

Walk through the front door of HRDC, and you can feel the hospital buzzing, full of children, their parents, and hospital staff in the hallways, exam rooms, and wards. Some of the children are on crutches, others in wheelchairs or with plaster casts.

But the feeling is upbeat and hopeful, and for good reason. This is the place where the Drs. Banskota and their medical team will, with skill and care, straighten twisted limbs, fix club feet, treat bad breaks and burns — all the mishaps that can befall a child.

For Nepal‘s poorest children, these mishaps can spell disaster. If their parents are struggling to feed them, affording medical care is hopeless, and the child suffers. But then they come to HRDC, where their physical and emotional wounds are healed, and their lives are completely transformed.

AHF and Dr. Ashok Banskota have a 34-year partnership, and in those three decades HRDC has grown under his leadership from a tiny clinic to a modern 100-bed children’s orthopedic hospital. Now his son, Dr. Bibek Banskota, leads the team of compassionate and skilled doctors and nurses who care for these kids every day with the same dedication.

Dr. Bibek says he knows the children they treat have regained hope and dignity when they start smiling. Today, HRDC’s community-based rehabilitation brings their trademark care and expertise to children in some of Nepal’s most far-flung corners. Through 34 years and over 110,000 transformed young lives, HRDC continues to be one of the most inspirational places you could ever visit.

Links:

• Learn more about AHF
• Learn more about HRDC
• Sign up for AHF's email list

There are three components to HRDC's model of compassionate care. They can be boiled down to  three S's: surgeries, school, and superheroes. 

1.) Surgeries: HRDC is known for providing free and affordable orthopedic surgeries to children living with disabilities or are suferring injries. All this life changing work is carried out in six operation theatres at HRDC's Banepa hospital. These theaters are also used for both inpatient and outpatient services. Outside of the realm of surgery, HRDC's in house prosthesis/orthosis workshop is a state of the art environment where recovering children can be fitted for their future prosthetics that will help them walk again. It is a truly special place, and they even have radiology and pathology services. For post surgery, there is also the cerebreal palsy clinic and physical therapy. This is a place where a child-centric staff priortizes their patients whole body needs. 

2.) School: Before even going into the educational needs of the patients; HRDC is also recognized for being a place where surgeons early in their career and education can receive highly specialized training. While the medical residents at HRDC learn, the recovering kids are given the opportunity to not fall behind in their education. Since many children come to HRDC from remote areas and many undergo protracted treatment, the average length of hospital stay is about three weeks. However, children must stay at HRDC for months with more serious procedures. This causes a significant gap in their already limited access to education. They started the "HRDC School" began in 2014 to provide continuing education to admitted children. 794 children benefited from HRDC school in 2021-2022. Not only do these kids benefit, they have a lot of fun and love it. 

3.) Superheroes: Beyond the walls of the hospital and classroom, HRDC also runs three satellite clinics and conducted a total of 85 mobile care clinics in 2021-2022. These caregivers are bringing their work into marginalized and hard to reach communities that makes a world of difference. It also keeps care consistent for former HRDC patients who need some level of aftercare from their procedures.They also assess, identify, consult, motivate and refer children for rehabilitation through outreach camps. After initial treatment, tthere are systematic follow-ups of the children with physical disabilities for continued primary rehabilitation therapy and social inclusion to improve their quality of life. All of them are superheroes, the kids especially.

What makes HRDC's work so special is that it does not start with surgery or end with surgery. It is the catalyst for these sensitive young people to learn, grow, play, and develop in their place with the support of the family and community at large and subsequently integrate into the mainstream community, including the schooling system. Each part is as unique and important as the other, just like them. 

A broken bone shouldn’t decide a child’s fate. But in Nepal, treatment is often out of reach, and even a simple injury or illness can turn into a lifetime of disability, shame, and suffering. Fortunately, the Hospital and Rehabilitation Center for Disabled Children (HRDC) is here to change that.

At HRDC, they care for the whole child, from surgery and physical therapy to custom prosthetics and healing emotional wounds — all at little to no cost to the family. Their skill, compassion, and dedication to helping poor disabled children is legendary.

Over the past 37 years, the lives of over 100,000 Nepali children have been transformed here. And this year, HRDC wants to double the number of surgeries they perform, so even more children can finally receive the life-changing care they desperately need.

HRDC gives us renewed purpose in why we do what we do. Seeing the children, meeting their families, hearing their stories, and feeling the genuine and deep commitment of the staff is truly humbling.

Heera’s Story

Heera, whose name means “diamond” in Nepali, was born with Spina Bifida, a serious neurological disorder. Her parents were desperate to help their young daughter and went into debt in search of treatment for her – they even sold their land – but nothing worked.

Six years later, they learned about HRDC from a former patient in a nearby village. But by then, Heera had developed a life-threatening bone infection in her left foot, and the medical team had no option but to amputate part of her lower left leg. She spent several months in HRDC’s skilled and compassionate care, including having a custom prosthesis made and learning how to use it.

Her parents are so grateful and relieved. Heera herself is all smiles, happy to be back in school, and wants to be a teacher when she grows up.

Like her name, Heera’s story is a shining example of HRDC’s dedication to Nepal’s poorest disabled children and to their motto: “love heals.” Every child healed, every life changed, is a triumph. Please join us.

It started small, an almost chance meeting with a young Nepali surgeon, recently returned from an orthopedic residency in the U.S., at his clinic. He had a modest request (an autoclave) and a bold vision: good medical care for all children with physical disabilities in Nepal. So began our partnership.

The father and son team of Dr. Ashok and Dr. Bibek Banskota are beyond inspiring. Dr. Ashok Banskota built HRDC from the ground up with his uncompromising belief in providing quality care for poor disabled children, and his son Bibek has stepped in and seamlessly amplified his father’s vision. Together they have transformed the lives of 100,000 children.  

Their dedication to living up to their motto “enabling abilities” for kids is legendary. From correcting poorly healed fractures to straightening club feet, they give every child their best, regardless of the family’s ability to pay. Care is designed to heal that whole child, from surgery to physical therapy and beyond-there is even a school onsite for recovering patients. When getting children to the hospital was a barrier during the early part of the pandemic, HRDC teams began going to the patients, with satellite clinics, outreach camps, and staff who sometimes arrive by motorcycle.

A visit to HRDC is truly humbling. Being in the presence of the Drs. Banskota is a lesson in compassionate care and motivation, followed with the right actions. And if you visit the hospital on Wednesday around lunch time, never turn down an invitation to the best dal bhat from the hospital kitchen, vegetables courtesy of their new organic garden.

Since that first autoclave 30 years ago, AHF has been a steadfast partner of HRDC. We helped build their 100-bed hospital, encourage growth and innovation, support surgery and rehabilitative care for thousands of children every year, and will continue to champion this healing work for many years to come.