As regular readers to our website know, medical care is not free in Nepal. We have been shocked at the amount of money some of NHEDF’s patient’s families have had to pay for medical care. Nepal ranks as the 19th poorest country in the world and according to the World Bank is one of the least developed. Huge hospital bills start with the ambulance driver who get up to $200 commission (or a percentage of the hospital stay) for bringing a patient to a particular hospital. A visit to ICU can cost $375 a day (including discounts!) One of the patients at the Shelter had 50 days in ICU ! ($18, 750!)
Read these articles to begin to understand how some of NHEDF’s patients have medical bills that run into upwards of $30,000 and yet they have no hope of ever paying them back:
Imagine a sixteen year old Australian girl from a poor family who has badly broken legs as a result of an accident. She gets whisked by ambulance to a competent hospital where she is operated upon, has state of the art surgery with pins, plates and screws and all sorts of other hardware inserted to unite the fragments of broken bones. She returns from surgery with both legs in plaster. She can weight bear on her left leg but not the right. She is mobilised by the physiotherapist using crutches. All her medical expenses so far are covered by Medicare, our public health system. She goes home after seven days and returns to school. She makes a good recovery and within six months she is playing sport at school again and doing everything she normally does. A couple of years later she finishes school and gets a job.
Parbati was 16 when she was admitted to NHEDF in January 2017.She comes from the remote region of Doti in the far west of Nepal, was tending the family’s goats when she was caught in a landslide, struck by a tree and swept into a river. She was pulled out by villagers and sustained multiple fractures to her right leg. Her family could not afford medical treatment for her, but her community rallied around and helped financially, so she was admitted to a local hospital for wound dressings but the hospital had no facilities to do anything about her fractures.
After ten days the money the people in her village had collected for her had run out and Parbati’s father had to make a choice – she could either return home to their remote region with multiple fractures unable to walk or he could sell some land to keep Parbati in hospital and she could be brought to Kathmandu for treatment. Her father sold their property leaving only their earthquake damaged house.
Parbati was admitted to hospital in Kathmandu where she stayed for 300 days before being admitted to NHEDF. Since she has been at NHEDF she has now had seven surgeries including bone grafts and a bone marrow transplant which was unsuccessful and she had many complications.
During her time at NHEDF she has required ongoing nursing care for wound management, care of the external fixators and regular physiotherapy to decrease muscle wasting. She also has regular orthopaedic reviews, x-rays to assess the healing of the fractures, and ongoing surgeries. When the fractures are all healed the fixators will be removed and she will be able to weight bear. After further physio she will be able to go home!
The future for girls like Parbati is complex. If she loses her leg she is unlikely to get married in a place like Nepal. Her parents are elderly, and her family is poor. They have no electricity and their tiny house made of mud and stone was damaged by heavy monsoon rain. Parbati’s seventy year old father is taking care of her at NHEDF and her mother is now living with her elder daughter in another village.
The orthopaedic surgeon who was treating Parbati has since moved to another hospital and Samrat has so far been unable to find another surgeon to take over her care. The challenges of navigating the medical system in Nepal can test the patience of a Buddhist saint!
In Nepal, being disabled is like a curse from a previous life, because many people think that you must have done something really bad in your past life and because of that, you have either been born disabled, or become disabled, as you travel down the road that constitutes your life.
For young people experiencing disability, few of them will be able to find a partner. Occasionally women find husbands who are also disabled, or men have wives who leave them when they become disabled and vice versa. Most of the time, however, the harsh reality of disability in Nepal means you are on your own, and if you have no family to take care of you, you are also banished to a life of poverty.
Sometimes we get asked why NHEDF tries so hard to save a limb, but it is not just a limb, it is a life.
Keep this in mind when you read our patient stories, because every time NHEDF prevents someone from enduring significant disability, they change the future for someone who could otherwise be banished to a life of loneliness, isolation and poverty.
NHEDF’s Shelter is a place where patients can stay for a very long time! One of their patients has been there for over 2 years! NHEDF’s nurses become like family and Kusum and Kunga have commented on how “our patients share their different personal problems and we, by listening to them, forget our own problems, because our problems are nothing compared to theirs. We try hard to help them solve their problems whether it is through giving psychological support, physical support, some small financial support, encouragement or advice.”
NHEDF is very lucky to have such wonderful people working for them!
There is a saying which, as nurses, we are often reminded of, which goes “People will forget what you said; people will forget what you did, but people will never forget how you made them feel.” Thank you Kusum and Kunga for making a difference…
Roads to Rehab Nepal is extremely lucky because we have the support of the most fantastic physiotherapy practices in Canberra! Not only are they wonderful physios, but they are an outstandingly generous group of people, being Gold sponsors of Anjeela, NHEDF’s physiotherapist. They are also full of wonderful people like Therese, one of our Management Committee Members, and Kristine, Danielle and Ale who decided to ask for donations for their 40th birthdays instead of presents. In total $1203 was raised so NHEDF went Christmas shopping! The supplier below must have thought all his Christmasses had come at once too!
The Shelter now has a physio room with an ultrasound machine and gel, a hand gripper, gel balls, four pick-up walkers, a muscle stimulator and a quadriceps table, along with lots of other bits and pieces. Thank you so much Southside Physiotherapy and Sports Injury Centre http://www.southsidephysio.com.au/and Woden Integrated Physiotherapy http://www.wodenintegrated.com.au/
The team in Nepal and all their patients are very grateful and Anjeela also thinks all her Chrismasses have come at once too!
Samrat, NHEDF’s Director reports “Waiting hours in front of hospital out-patient’s department (OPD) has become part of our lives. The frustrating part is, you are never sure if you will get a chance to meet your doctor or not. The funny part is even the staff of that department do not know whether that doctor is coming or not but we are asked to wait till 12 pm anyway. If the doctor does not turn up then we have to come another day, maybe a week later
Is this how a hospital should be managed? We know doctors also have their personal lives to live and can take a day off but is it fair to ask your patient to keep on waiting for such a long time? For many of us life is like a time bomb which can take your life anytime. Every second counts, but who cares when life is so cheap in Nepal?”