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.

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