Surgery for Children with Disabilities in Nepal

by American Himalayan Foundation
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal
Surgery for Children with Disabilities in Nepal

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.

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Dr. Ashok Banskota knew he had to do something. It was 1985. He had returned home, a newly minted US-trained surgeon, and was deeply troubled by the extreme lack of orthopedic care for children in Nepal. In this land of few roads and many mountains, an untreated break or burn could easily disable a child and keep them from school and taking part in village life.

 

He was determined to make good care accessible to all children with physical disabilities regardless of their family’s financial situation and, volunteering his skills and time, opened a small clinic. In the years since, his vision propelled the building of a modern orthopedic Center — the Hospital and Rehabilitation Center for Disabled Children (HRDC) near Kathmandu, with a talented medical team to match.

 

The pandemic is still ravaging Nepal. Lockdowns, travel restrictions, and capacity limits have decreased the number of surgeries and patients overall. Even so, the HRDC medical team has continued to mend the bodies and spirits of Nepal’s children with skill and compassion. Here is a look at how they have been on the move in recent months — responding, adapting, innovating, and curing.

 

They implemented strict Covid-19 protocols immediately after the virus first reached Nepal: patients and visitors screened before entering, all children coming for inpatient treatment tested before admission, a quarantine ward, and the number of patients limited to half capacity. And so, during lockdowns, the hospital has continued to safely care for children in the middle of treatment who couldn’t safely be discharged.

 

Clubfoot is a common condition in Nepal that turns the foot inwards, making it difficult or impossible to walk. Left untreated, the foot stiffens, making it much more difficult to cure. The Ponseti method uses a series of plaster casts to gradually straighten the foot. It’s a huge step forward in correcting clubfoot faster and with less trauma. A child with clubfoot typically has their progressive casts applied at the hospital near Kathmandu. In the pandemic, however, HRDC teams decided to take the casts to the kids — via motorbike!

 

The medical team quickly also embraced telemedicine to provide continued guidance to parents, help children’s rehabilitation continue at home, and consult with field workers and staff at the satellite clinics on diagnosis and follow up treatment. Their five satellite clinics, mobile outreach camps, and 75 field workers are even more essential now, giving young patients the care, they so desperately need.

 

All this means they can reach more children in need and provide better care for their young patients who come to HRDC, broken in different ways, and walk out — yes, walk! — with their heads high into a future full of new possibilities.

Mobile Ponseti in action.
Mobile Ponseti in action.
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Good news! AHF has been awarded a grant from the USAID American Schools and Hospitals Abroad Initiative for HRDC to equip their new OR and patient ward with modernized and state of the art medical equipment. Below is the full press release.

WORLD LEADING TECHNOLOGY AND EQUIPMENT CAPABILITY IMPLEMENTED AT KAVREPALANCHOWK HOSPITAL

$500,000 Grant Enables Even Greater Healthcare Services for Children with Physical Disabilities

A $500,000 USAID grant provided through American Schools and Hospitals Abroad (ASHA), to the American Himalayan Foundation (AHF), to upgrade the hospital near Banepa, in the Kavrepalanchowk district, has been realized with the announcement that both a newly built 26-bed patient ward, and a newly built operating room, have been provided with world leading, state of the art medical technology and equipment.

The grant, under the USAID Surgical Innovation Project, was awarded in 2018 but the pandemic meant that the procurement and delivery of the equipment was delayed. As a result, the Hospital and Rehabilitation Center for Disabled Children (HRDC), a project which provides services for children with disabilities across Nepal, only received the first equipment shipment in late December 2020.

The first major piece of surgical equipment to arrive was an Intra Operative Nerve Monitoring System (IONM) for neuro and spine surgeries. The IONM allows surgeons to continuously monitor a child’s central nervous system during complex spine surgeries and where the nervous system is at risk of being damaged.

Key pieces of technology in the new operating theatre include: a portable ultrasound and x-ray equipment, an intubating fiber optic bronchoscope, and an anesthesia workstation. In total, 38 pieces of Operating Theatre equipment and almost 180 other necessary items, such as beds and patient lockers for the new ward, have been purchased under the grant.

Dr. Ashok Kumar Banskota, the founder and chairman of the Friends of Disabled, the NGO that runs HRDC, says the grant presented an excellent opportunity to modernize the hospital.

“Thanks to donors such as AHF, HRDC has been able to treat children at little or no cost to the families. This means that children in families who normally could not afford access to life changing surgeries and rehabilitation, can get the medical support they need.

“This is a truly transformative moment for the hospital. For the last 35 years, we have done our best to serve children, and their families, and have positively impacted the lives of nearly 100,000 children. We have done this using the equipment that we have had and focused on maintaining that equipment to the best of our ability. But now, with this grant from USAID/ASHA, we been able to upgrade our surgical and ward equipment to the most modern, most technically innovative and the safest equipment available in the medical world today,” he said. 

Erica Stone, President of the American Himalayan Foundation is also grateful to ASHA for their support. “HRDC has been one of our keystone projects for the past 30 years. Our donors are very supportive of HRDC and have assured us that our commitment to the 100,000 children we have treated and those who will follow will continue for many years to come. The ASHA grant for the purchase of equipment and furniture is an exemplary opportunity for HRDC to modernize, for which they are very grateful.  We at AHF thank USAID/ASHA for the opportunity for us to continue to share our cherished American values of inclusion, equality and environmental conservation.”

HRDC has performed more than 45,000 surgeries ranging from minor tendon releases to major spinal surgeries that take eight or more hours. In addition to surgery, the hospital also provides physiotherapy and manufactures its own assistive devices, such as calipers, orthotic shoes, and prosthetic limbs. In addition to the central facility at Banepa, HRDC operates four satellite clinics in Nepalgunj, Ithari, Lahan and Butwal, and has a team of 76 community-based rehabilitation workers who cover 30 districts across Nepal. It also operates mobile and surgical camps ensuring its services are brought to the most remote corners of the country.

Dr. Banskota’s work at HRDC has received international recognition with a World of Children Award in 2011, the Star Impact Award in 2014, and the World of Children Alumni award in 2016.

HRDC Medical Director, Dr. Bibek Banskota explains his organization’s philosophy. “Our mission is to ensure children with physical disabilities reach their full potential by providing medical interventions with rehabilitation and at the same time removing barriers to cultural inclusion.

“We don’t just treat the disability, we care for the patient as a person, and we extend our care to their families and communities. We search out children with disabilities during our mobile camps, provide them with first-world standard care and facilities, stay with them until they have reached their maximum potential and assist them to reintegrate into society.

“This means ensuring they know how to access government benefits for people with disabilities, or meeting with school communities so they can better understand the child’s need and situation. This often includes myth-busting about the nature of physical disabilities and persuading schools to spend money on disabled-friendly infrastructure such as wheelchair ramps and modifying toilet blocks.

“The grant from USAID/ASHA through AHF is a godsend. Already our surgeons are singing the praises of the pieces of equipment we have already received. The IONM dramatically reduces the risk to these children’s central nervous systems during already complex operations,” he said.

The USAID grant is designed to support the development of the American values of equal and inclusive access to quality health care, surgical risk reduction, gender equality, environmentally sound medical waste management, and best practices in financial and procurement management.

USAID/ASHA-funded equipment, delivered!
USAID/ASHA-funded equipment, delivered!

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“You see these children transform when they come here. When they get some love, when they get their dignity and hope back, they start smiling again. That is what inspires all of us.” - Dr. Bibek Banskota

Children lie quietly in their beds, bandaged, some with external fixators or casts. The postop ward is spotless and airy, and the kids sit up and put their hands together in namaste to greet the doctors who stop at each bed with a smile and an encouraging word. The children smile back. They feel taken care of and heard. Here they have learned that their disability is not karma or shame. They will heal, learn to walk, play, and go to school – isolated no longer from family and community.

But this is not the story for all children in Nepal. Thousands still go untreated. They might live in a remote village with no hospital nearby. Or if there is a hospital, the family may be too poor to afford treatment or may hold on to superstitious beliefs. Then what? The children suffer and become outcasts.

The Hospital and Rehabilitation Center for Disabled Children was established to end the heartbreaks of untreated breaks and burns or birth defects. With gentle expertise and open arms, they make modern medicine available, affordable, and acceptable for all children.

Their patients are sons and daughters of laborers and farmers who earn just a few dollars a day. But no child is turned away for lack of funds, thanks to you and founder Dr. Ashok Banskota’s unquenchable vision to heal Nepal’s poorest children. Over three decades, nearly 100,000 of them have emerged form the hospital to a happier life.

And the work continues. Every year, HRDC field teams discover new patients through mobile camps that reach into the most remote corners of the country. If the kids can’t get to the hospital, the hospital gets to them.

Education and outreach are also integral to the hospital’s ethos – raising awareness about disabilities, showing children nothing is “wrong” with them, and fighting social stigma. In a classroom on site, kids can even keep learning while they recover.

At HRDC the staff all know that expertise alone is not enough. The hospital is built on a foundation of compassion and the wisdom that love heals.

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Dr. Ashok Banskota and his son, Dr. Bibek Banskota
Dr. Ashok Banskota and his son, Dr. Bibek Banskota

Recently, we were fortunate to spend some Zoom time with Dr. Ashok and Dr. Bibek Banskota, the doctors who run the Hospital and Rehabilitation Center for Disabled Children (HRDC). Every year, they heal thousands of children from poor families all over Nepal, boys and girls with untreated injuries or congenital disabilities who would otherwise face a lifetime of suffering. Through unparalleled skill and compassion, they help mend both physical and psychological scars. New patients are often surprised to meet other children like themselves and are encouraged to dream big. HRDC also offers counseling for patients and their families and works to promote inclusion and end discrimination in their communities.

Although the world has sheltered and slowed, the Banskotas, along with the staff of HRDC, are continuing to treat children and planning how to continue in the “new normal”. Here is a summary of our call highlighting their work.

Since April, HRDC has only been able to treat 73 patients at the hospital – as many as would be seen in 3 weeks in normal times. They expect to conduct 20 surgeries a week for now, increase as it becomes safe, and are taking all the safety precautions: quarantining, testing (same day results), beds 6ft apart, masks, fever checks, frequent handwashing, giving treatment with a screen separating the patient and staff, and a whole host of other protocols. AHF’s contribution of PPE supplies has meant there is enough for the staff, patients, and caretakers. The virtual clinics and mobile camps they have conducted around the country have been very helpful, and we expect those and their satellite clinics to continue to play a big role in treatment and outreach.

HRDC has had to make some cutbacks, which were done by creating a rotating roster for staff in a fair, transparent, and compassionate manner. Their team has been very resourceful during this difficult time and even began growing their own vegetables on the hospital grounds to supplement the kitchen.

All of this is possible because of you. The months to come will bring more uncertainty, but we and HRDC are dedicated to helping these children live full, pain-free lives, and we aren’t going anywhere. On behalf of the many young people touched by your kindness, thank you.

Mobile Clinics - The new normal!
Mobile Clinics - The new normal!
Thank you from the HRDC Staff
Thank you from the HRDC Staff

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American Himalayan Foundation

Location: San Francisco, CA - USA
Website:
Project Leader:
Sarah Bakker
San Francisco, CA United States
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