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Physiotherapy Unit: An outreach for Children with Physical Disabilities; Prior and Subsequent (Updated: Dec 19)

Updated (1/1/2015) Our idea is a service targeted to those physically challenged children, with especial focus on parent-less kids and also to those who are on the verge of losing their parents. Physically challenged children are living their worst life even in big city areas, where they have access to all the facilities. The condition is poorer in villages. People with low earnings are always the disadvantaged group to access the health facilities. Hence they tend to hide their kids. But the situation seems worst among those kids who are orphans and who are at the high risk of losing their parents (especially mothers)

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Maternity issue is a big issue in Nepal. Many parents seemed unaware of the permanent disability that their babies might suffer if the expected mothers and infants are not properly cared.  The scenario is highly at risk especially in villages; even where they are located adjacent to big city areas.  Physiotherapy centers at hospitals and private clinics are providing services  which are beyond the reach of poor parents. The cost to reach the center and the charges need to pay for the treatment is out of reach for such families.

Physiotherapy unit can be established to reach the targeted community aims to reduce the disability on new babies and ease those babies who do not reach their developmental milestone due to disability.


Updated (18/12/2014)
Though Kavrepalanchowk district is adjacent to the capital city of Nepal, the district lacks proper health centers. Most population resides in the rural areas who still believe in Dhami and Jhakri (the traditional and spiritual way of treating the patients). There is a high need to alert these people about medical facilities to reduce the risk of health hazards.

Women in Nepal both in cities and in villages do their household activities in squatting position which is more common in village area like Kavre. Due to lack of awareness, women in villages during pregnancy and after delivery as well do their activities in the similar manner that includes heavy tasks as well. This is highly risk for the health of mother too. The risks include chronic knee and back pain and uterus prolapse. In this case, mothers can also be benefitted from Physiotherapy service.

Activities of the center:
At the very initial phase, we are focused on establishing Physiotherapy centre in Kavrepalanchowk district, because it can be established in low cost. During assessment and reassessment phase of physically challenged children prenatal, perinatal and post natal history of mothers will also be assessed which will be discussed with the doctors (obstetrics /gynecologist, pediatrics). After discussion, if doctor’s visit is required then it can be implemented even in short time. Either team of doctors visit the physiotherapy center in Kavre, or collective number of patients (both mothers and children) can be taken to the hospital which is not that far from Kavre.

Mobile camps can be organized by the team of doctors and other medical staffs of Vinayak Hospital and Maternity Home Pvt. Ltd targeting those women who need surgical intervention like in the case of uterus prolapse which is more common in the village women. The hospital has already done various camps for Vaginal Hysterectomy under the Ministry of Health of Nepal in all development regions of Nepal.

Every pregnant woman requires Folic Acid at least for the first three months to prevent from Neural Tube defect. Thus, the program provides Folic Acid to the needy women along with Vitamin B-Complex.

Simple Lab test for the pregnant women (CBC-Test) will be done in the center itself so that the medicine will be distributed properly to the needy.

Life in cities is very difficult due to the heavy load shedding. There are no proper room warmers. The situation is even worst in rural areas like Kavre. Infants are very prone to cold and are highly at the risk of different kinds of diseases and infections which mainly include chest infection. In such cases, the children are referred to Pediatricians. This prevents children from further complications.

Major Objectives:
  1. To initiate this program with less investment; Establishing Physiotherapy center collaborating with Vinayak Hospital and maternity home Pvt.Ltd.
  2. To give awareness about maternity health issues and disabilities so that a comfortable environment can be established between the disable child and family members
  3. To clear the fact that their children are not disabled but they are differently able.
  4. To introduce special education among physically challenged children by analyzing their IQ level
  5. To organize mobile camp as and when required.
  6. To Initate and Implement Children Developmental Screening Test. (below 5 years) Updated (6/1/2015)  (Pilot study in developmental screening test Updated (14/1/2015))

Physiotherapy center can be established
  1. To reduce the risk of disability in new born babies( for eg. Folic acid deficiency during pregnancy might cause neural tube defect(spina bifida) in new born babies,) proper counseling to the parents and the family members about the risk factors during prenatal, perinatal and postnatal.
  2. To help those children who do not reach their developmental milestones due to disability. (eg; cerebral palsy)Hospitals and private clinics do run some physiotherapy camps time and on focusing such community but the children if provided treatment regularly along with some training to their parents, their days would have been easy so far. Additionally, awareness programs on disability for expecting mothers/family should be provided such that mothers’ nutrition and care will be considered even more seriously.

Physiotherapy unit will work in three sections:
Awareness campaigns: Providing awareness programs for mothers/ expected mothers and their families with focus on disabilities on babies
Physiotherapy treatment including psychosocial support: Providing physiotherapy services with psychosocial support to the disabled children
Training to the family/guardians: Providing necessary training to the guardians of the disabled children


Field Visit (updated 25/12/2014)

The team visited “Bhumidanda” Village Development Committee (VDC) Panauti & its Health post for the idea exchange program. It was found that VDC and Health Post don’t have the exact number of physically challenged people in their village. Women group were also invited to attend the program. One of the participants in the women group revealed the fact that such physically challenged kids are locked inside the room. She gave an example of an autistic child being locked by her parents. She added people don’t want others to know that they have such children in their homes and said that it’s a burden to the entire family as they need to be provided a full time care taker. (They are totally dependent on others)

The village doesn’t have any such center where these kids/youths can be properly cared and trained to live their everyday life. One of the participants said, many people come time and on to see such children but they never do anything. So it would be great if there is such facility, where such differently able people can be admitted and trained for everyday activities.

Updated (31/12/2014)
Assessment Form (Cerebral Palsy)

                                                                                                                         Date of assessment: 30th Dec 2014
1. Personal Data

Name/Sex: Mission Moktan
Date of Birth/Age:  Dec 14 2011/ 3 years 16 days
Weight of the baby: 2.1 kg Weight during birth (at present 7 kg)
Permanent Address: Sindhuli

Medical Diagnosis, established by: CP (diplegic)/ Malnutrition
Schooling: No
Nationality: Nepali
 
Family
            Father’s name/Job: Milan Moktan/  Service holder
            Mother’s name/Job: Sarita Pokharel/ Agriculture
           
2. Anamnesis
Chief Complaints
        Parent/Caregiver: (His  mother herself is a caregiver, according to her)

1. Gross motor function
  • Not able to hold head and trunk position for longer time
  • Not able to sit, stand , crawl, cruise
  • No proper activities in prone  position 
  • 2. Not able to speak, although he reacts in some of the words
History:
 
Prenatal:
According to his mother, she had routine check up in the health post and also in the hospital. She visited health post for four times; on 4th month, 6th month, 8th month and 9th month respectively. On her 4th month visit, she was given Folic Acid and was told that, the medicine will expire in a month. So she could consume folic acid for a month only. This is one of the main reason for the malnutrition of her baby.
For the fifth time she visited Sithauli Hospital. The hospital declared as Intra-uterine death of the baby and was referred to Janakpur Hospital. Janakpur Hospital did her USG and found out that the condition of her baby was good.  However, She was recommended to stay in hospital for a week but due to her weak financial condition, she returned back to her home.
 
Perinatal:
According to his mother, the baby was delivered at home with the assistance of her mother and mother in law. He was 2.1 kg at his birth (She said, they had weighing machine at home)
 
Postnatal:
According to his mother, after one and half month of his birth, Mission had fever and was taken to private clinic. He was diagnosed as pneumonia and a week of antibiotics dose recovered his fever.
 
How/ when where first symptoms recognized:
 
According to his mother, when he was six months, his mother noticed that the baby couldn’t hold his head and trunk properly. It was also noticed that he couldn’t roll from supine to prone and prone to supine. But the mother neglected the condition. On 9th month, she visited Ayurvedic Hospital (Homeopaethic), which prescribed some medicines that helped to increase his weight 2 kg more, keeping his weight on 11 kg. But gradually his weight reduced.
 
At the age of 3 years, he was brought at Vinayak Hospital and Maternity Home Pvt.Ltd. He was diagnosed as a child suffering from Cerebral Palsy (CP) with Malnutrition. Proper Nurition to the child was advised and he was referred to Physiotherapy department.
 
Other diseases:                        None
Technical Aids:                        None 
Social interaction:                     Good (he understands what he is told)
                          
 
Scoring Keys
0 = not able
1 = maximum help
2 = moderate help
3 = mild help
4 = independent
Activity Daily Living
 
           Toilet:                            0
            Eating/drinking:              0
            Dressing:                       0                     
            Personal Hygiene:          0
            Mobility In/Around Home:0
            Aids:                              0
 (Totally dependent)
 Need for assistance (expectations): he needs 24 hours caretaker.
 
He is undergoing physiotherapy treatment and awareness program is provided to his parents.
 

Who will benefit from this idea and where are they located?

Specifically, expected mothers and babies equal to or less than age 5 from the low income families will be benefited from this idea. But in general overall community of Panauti Kavre district of Nepal will be benefited.

How could you test this idea in a quick and low-cost way right now?

Tests can be done in a low cost way with the children who are taking irregular treatment from hospitals and private clinics. Consultation with medical doctors and physiotherapist will help to provide the service at ease. (Updated 18/12/2014)There are different methods to test our idea in a low cost way. Data will be collected from the municipality of the targeted community which will help to reach towards the specified groups. Since our organization has a reputed name in the district, municipalities will help us disseminating our programs in the community. This will help us in conducting Focused group discussion. Focused group discussion on “AAMA SAMUHA” (mother’s group) will be done to find out the maternal health conditions of women. The survey will be done by our own research team. Furthermore, we have a staff that is familiar to the targeted area that will definitely help us in reaching our goals in the very initial phase of our idea.

What kind of help would you need to make your idea real?

Since this is all about collaboration, my idea too can be successful with collaboration. Understanding the disability and the problems facing by the disabled child and their low income families would be the greatest help at the initial phase. Further more we need Expert’s advice on the same.(updated 18/12/2014) Advice from Field Expert would be an added benefit for us. Refining the data will be another help and when executed this idea will not only help those targeted children live their day to day life easily but also the families and other families who may be at risk of disability.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

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its very nice you have thought of disabled children! Amazing! really good idea! Congratulations!

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