Print Edition - 2015-05-30  |  On Saturday

Artificial extensions

- Manish Gautam
Artificial extensions

May 29, 2015-

Dani Thapa’s right leg is now half as long as her left, but Thapa does not want to believe that one of her legs is gone. A mother of a two-and-half-year old daughter, Thapa, 25, and her girl survived despite being inside Dharahara when it collapsed on April 25. She was taken out of the rubble immediately and hurried to the Trauma Centre at Bir Hospital, and by the time doctors attended to her, she was literally covered in blood; her daughter escaped unscathed. A few days later, doctors operated on her leg and severed the portion beneath her right knee.

A month after the catastrophe, as Thapa lies on a bed on the fourth floor of the Trauma Centre, her right rests as a stump wrapped in bandages. What remains of her leg is being cleaned and freshly dressed to avoid infection. One month into her hospital stay, she still looks shocked and worried, though.

What Thapa needs and her husband Saroj KC wants for her, as is the case with the majority of the people who have had to undergo amputations in the earthquake’s aftermath, is a prosthetic leg to at least get moving again. She will, however, need six months to one year before her body gets used to the appendage.

Inside one of the chambers of the rehabilitation centre at the National Disability Fund, a distinct sharp smell like that in an emergency ward in hospitals lingers in the air. Many units of medical equipment are affixed to the tables here and drilling machines and adhesive jars are strewn all around. A man standing near one of the tables holds a hard whitish mould and covers it with a wheat-coloured, soft, squelchy rubber sheet. The wooden surface affixed to the wall has pliers, vise-grips, screwdrivers, clamps and other tools hanging from it; the area almost resembles a workspace in a garage.

This chamber houses the equipment that will be needed to create an artificial limb for people like Thapa to get walking again, almost like they used to before April 25.

The rehab centre focuses on working with limb amputees, and anyone who has lost a limb is given priority over other patients. During counselling sessions, a physiotherapist talks to the patients about the nature of their injury, and discusses ways to ease their life and how to learn to cope with their injuries. After the session, an assessment of their limbs is conducted in a nearby room. If Thapa were to come to the centre, following the counselling, the staff here would first familiarise her with mock limbs made from plaster casts. The health personnel would then closely examine and measure both her thighs and then produce a plaster cast specifically for her. That cast would then have gypsum powder added to it, and it would be turned into a perfect hardened limb structure. This mould would then be subjected to a series of chemical reactions until it got a hard-limb-like-structure, where the inner portion would covered by the wheat-coloured soft, squelchy rubber sheet—to provide comfort to the owner of the limb. A process such as this takes two weeks.

The cost of these prosthetic limbs ranges from some Rs 20,000 to Rs 100,000, but the NDF provides them at a subsidised rate. The organisation has come up with a sliding-scale fee, with four categories: at one end of the scale are the prices for those people who can afford to pay the full amount, while on other end, people who do not have the wherewithal are given the prosthetic limbs free of cost.

And more people may soon be able to avail of the service. According to Dhan Bahadur Tamang, secretary of the Ministry of Women, Children and Social Welfare, his ministry will earmark additional funds for the NDF and people who were injured in the earthquake and need artificial limbs and assistive devices will be provided the equipment free of cost. “These people should furnish the government-approved certificate that recognises them as having been injured in the earthquake before they can avail of the services,” says Tamang.

 

Once the prosthetic limbs are fitted on the injured, it’s time to get them used to their new limbs. They are asked to walk on a short ramp with metal-frame supports on either side. Once they can make it through this section, they are asked to walk on mock stairs, slopes and rough surfaces. If there are any corrections to be made to the devices, it will be done during the transition period of 15 days to a month, when people like Thapa will familiarise themselves with their device.

 “People might feel uneasy with the devices in the beginning, but they will gradually accept them as a part of their life,” says Ashish Dhungana, Rehabiliation Manager at the centre.

According to Handicap International, an international non-governmental organisation working on disabilities, over 30 percent of the people injured in the recent quakes need permanent rehabilitation; furthermore, 60 percent of the injured have wounds that might not heal, which if not treated could result in disabilities too.

The data from Handicap International—collated from a random survey done among 600 injured people in the Trauma Centre, Tribhuvan University Teaching Hospital, Patan Hospital and Bhaktapur Hospital—shows that 30 percent of the people have suffered head and spinal injuries or have had to have their limbs amputated. The report also says that 60 percent of the patients could become permanently disabled due to infections and failure to get follow-up treatment.

“There have been quite a lot of amputations conducted in the aftermath of the earthquake and we are trying to reach all the people who need prosthetics and orthotics support,” says Sarah Blin, Country Director of Handicap International Nepal. Blin, who has earlier worked in disaster-hit areas, says that in Haiti, her team had to perform further amputations on people whose limbs had already been amputated—before they could be fitted with the devices. She says she is encouraged with the way the Nepali medical personnel are conducting themselves.

A rough estimate shows that there are about 60 orthotists and prosthetists in Nepal, and they should be able to meet the demand for the devices in the country.

What worries experts is that people in the rural areas who have been severely injured and have lost their limbs might never have access to their services if they are not tracked down properly soon.

In Kathmandu, two organisations—the NDF and Nepal Army—produce the artificial limbs while there are five such organisations in each of the country’s developmental regions.

Nepal has the experts it needs, but Dani Thapa and her husband are worried that once the attention shifts from the earthquake’s aftermath, they might not get the care and support needed.

Published: 30-05-2015 07:42

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