When a couple in Jajarkot, Nepal welcomed their first baby boy, Pascal, they couldn’t have been happier. Like most new parents, they experienced their fair share of worries. When they started noticing that their baby’s feet had some kind of abnormalities, they became increasingly concerned and worried that he may never be able to walk.
Neighbors and relatives would show sympathy to Pascal’s parents. But at times, they would blame his mother for his disability, stating that it was due to something bad she may have done in her previous life.
Pascal’s parents belong to a marginalized community who make clothes as a way to earn a daily living. When Pascal was two or three months old, he caught a viral flu and was taken to the nearby health post for treatment. While there, a health worker noticed that his feet did not look like they typically would at that age, but didn’t know what exactly was wrong. With a lack of knowledge on clubfoot, the health worker hesitated for proper counseling and sent the baby home after receiving treatment for the flu. Pascal’s parents thought that his feet might self-correct as he grew.
One day, a female community health volunteer met Pascal while visiting the community. When she noticed his feet, she recalled learning about clubfoot in an early detection training provided by Humanity & Inclusion, with support from USAID.
Shortly after, she identified Pascal as having bilateral clubfoot and helped counsel his parents, sharing with them, what she had learned from her training. That was the ray of hope Pascal’s parents needed.
With her expertise, she is helping them understand the importance of early detection, and referred him to a nearby health post where the trained health worker confirmed the case to be bilateral club foot.. “Thanks to early detection training, I was provided with the knowledge about clubfoot and when identified at an early and timely matter, a child’s feet can be corrected, ensuring a better quality of life,” the trained health worker says.
The child was then referred to the specialized center for intervention.
After getting to the specialized center, Pascal’s father saw many other children with clubfoot who were also undergoing treatment. Being able to talk with other parents gave him a better understanding of clubfoot and the importance of early intervention. After six-month-old Pascal was assessed by the specialist, he was fitted with a specialized plaster cast to help move the feet into proper alignment. After his cast was removed, his parents took him home.
Recently, Pascal has been provided with a brace to help ensure that his feet don’t revert back--protocol in managing cases like Pascal’s. Frequent check ins are also important factors during the rehabilitation phase. Parents are counseled to visit the center within three months after the final session of cast has been removed.
Pascal’s parents are very grateful for the early detection training that the Humanity & Inclusion health worker and female community health volunteers participated in. The skills that she and other staff learned from the training help ensure that more children like Pascal can live full, independent lives.
Through this pilot project funded by USAID, Humanity & Inclusion trained 159 health workers and 205 female community health volunteers to detect different types of disabilities on children five years old and younger.
Manju was born in Dadeldhura, a hilly district in far west Nepal. Her foot and toes on her lower right leg were not fully grown, which prohibited her from walking. Things were so difficult for Manju that she couldn’t even attend infant school like other children.
However, in 2014, at the age of four, she received a warm welcome at a local rehabilitation center, as well as her first artificial limb. With it, she was able to walk; and she enrolled in the local school.
Manju is one of the 18,000 Nepalis who are standing taller—and climbing higher— thanks to the generosity of the American people through USAID. Since her very first fitting, she has grown a lot, and USAID’s Strengthening Rehabilitation in District Environs (STRIDE) Activity, implemented by partner Humanity & Inclusion (HI), has already provided her with two replacement prosthetic legs.
For more than a decade in Nepal, HI has worked to build, strengthen and expand access to rehabilitation. And, since June 2019, this critical work has continued with a brand new project.
USAID’s STRIDE activity, managed by Humanity & Inclusion, partnering with local organizations, ended on January, 31, 2019, with a long list of successes. Since STRIDE’s launch in 2010, staff provided rehabilitation services to more than 52,000 Nepali people. Among them, more than 18,000 people learned to walk again using locally-manufactured assistive devices, which were based on appropriate technology. STRIDE also prepared and supported more than 4,000 people with disabilities as they entered the workforce and began earning decent wages. Along the way, STRIDE created a skilled team of rehabilitation professionals—which did not exist in Nepal before the project launched. And at the end of the project, STRIDE handed over five rehabilitation centers to Nepali stakeholders.
“We are immensely proud of STRIDE, and eager to cement its successes,” said Willy Bergogne, Country Director for HI Nepal. “Thanks to USAID, we’ve been able to dramatically improve people’s access to a range of rehabilitation services. Nepal has more highly skilled rehabilitation professionals and well-positioned rehabilitation centers. But, we need to ensure that these services are sustainable—and successful—in the long-term. This is the challenge we’ve set.”
Needs and Gaps
Many of our beneficiaries are living near the poverty line and cannot afford services or the assistive technologies offered by rehabilitation centers. In addition to these gaps, we know that long-term follow-up in remote communities remains a challenge.
What’s more, Nepalis are living longer than ever, though they face more non-communicable diseases, such as diabetes and cancer. These diseases increase the prevalence of disabilities and the need for physical rehabilitation services throughout a person’s life.
While rehabilitation needs are growing in Nepal, the capacity to address these needs remains limited. Physical rehabilitation services are mainly provided by local organizations, including the rehabilitation centers that formerly worked with STRIDE. This results in inadequate coverage to meet local needs and puts pressure on sustainability.
The Ministry of Health and Population acknowledged the growing needs of the Nepali people and the usefulness and importance of rehabilitation services as part of the continuum of care. The ministry included physical therapy as an essential health service in the National Health Sector Strategy 2015 – 2020 and allocated a budget for physical therapy for the first time. However, the public health system only recognizes physical therapy as an essential service; and it is mainly available in urban areas in tertiary level hospitals. The Government of Nepal’s budget for rehabilitation services only partially covers the provision of assistive devices and rehabilitation services.
The new Leprosy Control Disability Management Section (LCDMS), which is responsible for coordinating the Department of Health Services’ strategies on disability prevention, is a promising step toward a more comprehensive response. However, planning, administration, technical capacities, availability of rehabilitation professionals and resources allocated to fulfill the need of growing rehabilitation services are limited. Mechanisms and guidelines for monitoring, equitable access and use of quality services are also currently lacking.
The Path Forward
To fill these gaps, USAID’s physical rehabilitation activity will help to establish a sustainable, integrated, public-private rehabilitation system. The goal of this is to improve the mobility and functional independence of victims of conflict and others in need of rehabilitation services. The activity aims to strengthen the quality of rehabilitation services, increase access to rehabilitation services and strengthen the sustainability of private physical rehabilitation centers. This critical work, which will be implemented by HI, is made possible due to a $4 million grant made possible due to the support of the American people through USAID.
USAID’s physical rehabilitation activity will run through the end of 2024. During this time, the activity will help to establish a sustainable rehabilitation services system using the WHO Rehabilitation 2030 strategy as well as the WHO health system strengthening approach, which targets six core areas:
- Governance and leadership
- Health and rehabilitation human resources
- Rehabilitation information system development
- Medical and product technologies, including assistive products
- Finance, including health insurance and budgeting rehabilitation activities
- Service delivery, including private-public partnership
The steering committee for USAID’s physical rehabilitation activity, under the leadership of LCDMS, will help guide the process. Institutional and private actors will be crucial partners to ensure that this activity and its services remain relevant and appropriate.
HI will work with six local partners—the National Federation of Disabled Nepal, an umbrella organization of over 200 Disabled People’s Organizations in Nepal who will coordinate advocacy activities through local networks, and five physical rehabilitation centers (PRCs) previously supported by STRIDE to further enhance local capacities and model practices towards high quality, efficient, and comprehensive coverage in remote communities.
USAID’s physical rehabilitation activity team will closely work with the broader network of physical rehabilitation service providers and rehabilitation professional associations to have a sustainable system of rehabilitation services.
“The roots of the project are strong,” Bergogne adds. “Thanks to ongoing partnerships, and a drive to solidify Nepal’s rehabilitation sector, we can look forward to more smiles and tree climbing from children like Manju.”
It’s monsoon season in the Kutupalong refugee camp in southern Bangladesh. The ground is muddy and slippery. Seven-year-old Saiful steps cautiously along the path to school. “I’m afraid of falling with my artificial leg,” he says, surrounded by his school friends. Saiful and his family live in the Rohingya registered refugee camp in Kutupalong, Bangladesh. At age two, he lost his left leg due to a congenital malformation. With support from Humanity & Inclusion, he has been fitted with an artificial leg and can now walk and attend school.
“His right foot was deformed and turned inward,” his mother explains. “It got worse and became infected. They said it was osteomyelitis, inflammation of the bone marrow and bone. The doctors told us several times that it needed to be amputated. We just couldn’t imagine doing that.” Over the course of two years, Saiful visited hospitals in the region on more than ten occasions. Visit after visit, the advice was always the same: Saiful needed an amputation. His parents resisted and refused to authorize the operation. Saiful would keep his leg.
Saiful had to take antibiotics on a regular basis. Then one morning, he woke up and couldn’t move his legs or blink his eyes. He was rushed to Cox’s Bazar Hospital where he had his right leg amputated. “We were miserable and felt demoralized. Saiful did too. He became isolated, and didn’t want to go out for fear he would fall. And us, we were exhausted.”
In 2013, HI physical therapists met Saiful in the refugee camp. “He was shy and wasn’t moving around much,” explains Bayzed Hossain, HI’s disability officer in Bangladesh. “We’re working to ensure he attends rehabilitation sessions and does exercises to restore his flexibility and to firm up his limbs. We’ve also set up parallel bars close to his home so he can get regular exercise. And we’re training his parents to conduct physical therapy exercises between sessions. But most important of all, in 2015, at age six, Saiful got his first artificial leg and took his first steps.”
“We’d given up hope,” his father explains. “We thought Saiful would never walk again. His artificial leg changed everything. Our boy is now learning to walk and going to school. He made friends and he’s more confident now.”
It’s June 2016 and Saiful, 7, is writing on the blackboard. “Saiful is cheerful and fits in well,” his teacher explains. “He’s supported by a group of teachers who go around with him. We’ve made a few adjustments to make him more comfortable. HI trained us on how to include children with disabilities in the classroom as best as we can.”
Saiful also takes part in the sport and leisure activities organized by HI, which brings together more than 800 children with and without disabilities. “Khelain arto besi gom lage” – “I love to play!,” says Saiful.
Today, with support from Humanity & Inclusion, Saiful is more autonomous, better integrated, and attends school. His confidence has grown, but his situation is still complicated. “Saiful needs to improve his balance as he recently fell and burned himself,” Bayzed Hossain says. “He needs to firm up his limbs and become more flexible. And he’ll need a new artificial leg next year, as he continues to grow.”
Saiful returns home from school for the day. He’s getting ready to meet up with his friends to play marbles. Before he says goodbye, our team asks him what he’d like to do when he’s older. Saiful responds without missing a beat: “Ai dorwayrea asmane urium” – “When I grow up I’m going to fly!”
Sponsor a rehabilitation session for a child with a disability.
Nishan and Sonu are huddled together with their eyes glued to the screen of a mobile phone. They are chatting with their father in Qatar, where he works. The last time they saw him was a year ago. Their mother, Nira Rai, is next to them, working in the kitchen, which doubles as a bedroom. She washes the vegetables for dhal, a Nepalese lentil dish.
Nira Rai begins to share about the day her son’s life changed. “Nishan was five-years-old,” she explains. “He was coming home from school with his friends. On the road, they came across a truck. They were very excited. They rushed to the truck and clambered inside.
“That’s when Nishan fell out of the vehicle, but the truck was still moving. It was terrible. He was in so much pain he blacked out. I saw him the next day in the hospital and his leg was badly cut up. He was suffering a lot.”
For three days, the doctors did everything they could do to save his leg. But eventually, they decided he needed an amputation. "When Nishan realized he’d lost his left leg, he cried and cried. He was devastated. He asked me if he’d ever walk again. To reassure him, I promised he would. But I was far from sure.”
In 2012, Nira Rai met with a social worker from a Community Based Rehabilitation Center in Biratnagar, eastern Nepal, which is supported by Humanity & Inclusion. There, Nishan began his first rehabilitation session.
“We gave Nishan a prosthesis and helped him learn how to walk again,” explains Bharati Dev, a physical therapist with HI. “We also taught his family how to do the exercises with him at home. And as Nishan grew taller, we lengthened his prosthesis.
“In 2017, there were major floods across the whole district. The rehabilitation center was under water, and his prosthesis was damaged, so we had to stop his care. When we resumed our activities, in 2018, we gave Nishan a second prosthesis.
“Every three months, Nishan visits the center. He needs to be closely monitored because his prosthesis hurts him sometimes due to the poor condition of his stump. It can get infected very quickly,” Dev adds.
"Since he was fitted with his prosthesis, Nishan is more self-reliant,” his mother says with a smile. “After his accident, his friends laughed at him. He was depressed and withdrawn. Today, Nishan is very active. He plays a lot with his friends and his sister. And he loves badminton.”
Nishan, who is now 14, goes to the Himalaya Secondary School in Damak, five minutes from home. He likes learning English, doing crossword puzzles, and using the computer. He has a close circle of friends and helps his mother in the kitchen. His dream? “I want to go to China,” he says. “It’s a big country. I’ve heard a lot about it. And then, I would like to see my father again.”
Many thanks to the American people, through USAID, for supporting this project.
On April 25, 2015, the earth shook in Nepal, killing more than 8,000 people and injuring 22,000. Already present in the field, Humanity & Inclusion launched an immediate response in aid of those affected, providing assistance to more than 19,000 people.
"Following the earthquake, HI helped many victims with fractures or musculoskeletal pain and longer-term injuries such as amputations and spinal cord injuries,” explains Willy Bergogne, Humanity & Inclusion’s director in Nepal. “We formed new partnerships with government authorities to ensure access to rehabilitation care for people living in remote and hard-to-reach districts.
"Four years on and conditions are more stable for many patients, but we continue to provide rehabilitation care to those in need."
Since April 2015, our team has run more than 42,000 rehabilitation and psychological support sessions for more than 19,000 people and supplied 7,000 prostheses and orthotic devices to people with injuries. HI has also distributed more than 4,300 kits containing tents and cooking supplies to more than 2,200 families.
Transporting aid to remote villages
Humanity & Inclusion’s logistics team organized the storage and transport of more than 5,400 tons of humanitarian equipment to remote villages. In the Winter of 2015, our teams handed out warm clothes and blankets to more than 9,000 people.
Supporting the most vulnerable
More than 1,500 earthquake-affected households have been given financial support to set up new business activities such as goat breeding and small stores. Our organization also enabled the most vulnerable people to access additional humanitarian services, such as education and healthcare supplied by other organizations.
In addition, our teams raised the awareness of more than 3,000 people to ensure the most vulnerable individuals are taken account in natural disaster risk management. We want to ensure that no one is forgotten.
Humanity & Inclusion has a team of 80 people in Nepal. We support seven rehabilitation centers in the country, help earthquake casualties earn a living, and makes sure children with disabilities have access to school. Currently, HI is assisting victims of the recent March 2019 tornado.
Photo: Sudan Rimal, a physical therapist with HI, spends the day at a park in Nepal with earthquake survivors Nirmala and Khendo.
On March 31, a violent tornado struck the Bara and Parsa districts in southern Nepal, killing nearly 30 people and injuring more than 600 others. Officials estimate that more than 1,500 households were affected.
To support the victims of the storm, Humanity & Inclusion is distributing mobility devices–crutches, wheelchairs, and walkers–and providing rehabilitation care to those injured. These activities are in collaboration with our partner rehabilitation center, the National Disabled Fund and Nepal Physiotherapy Association (NEPTA).
"Our priority is to provide appropriate rehabilitation care to the injured in order to prevent them from developing a long-term disability and to enable them to regain their quality of life," explains Willy Bergogne, Humanity & Inclusion’s director in Nepal.
Humanity & Inclusion in Nepal
Humanity & Inclusion has been present in Nepal since 2000. Our team took immediate action to help victims of the earthquake that hit Nepal on April 25, 2015. We continue to deliver rehabilitation sessions and provide walking aids in the seven districts. In addition, our programs have diversified with additional focus on health and access to services such as inclusive livelihoods, inclusive education and community based disaster risk management. Learn more about the work we do in Nepal.
When a 7.8-magnitude earthquake struck Nepal on April 25, 2015, Ngima Sherpa followed the terrifying headlines from her home in Jackson Heights, New York. Alongside her sister and mother, she says she cried and prayed. But then, Ngima recalls, her nursing skills kicked in: “It wasn’t good to be sad. We had to do something.”
As an active member of the Nepalese American Nurses Association (NANA), she had a group of colleagues who were keen to help. They were also adamant that any money sent to Nepal would support professionals who were directly helping Nepalis with injuries—especially nurses.
The next day, Ngima grabbed a folding table, a little brown collection box, and posters calling for donations. She set up a stand on the sidewalk, along the path to her child’s school.
Her perspective on the New York spirit changed within moments. “Everyone came,” she says. “They were all ready to help Nepal: the Indians, the Pakistanis, white people, black people, senior citizens, students. It was overwhelming.”
By the third day, NANA had collected about $20,000, as well as enough medical supplies to fill an office. And on May 3, 2015, a handful of nurses traveled to Kathmandu to deliver relevant supplies directly to the professionals they knew they could trust: Nepalese nurses. “We went to every hospital, and left a bag of supplies,” she says. Additional supplies were used to stock two shelters in New York.
The only catch? The Association of about 300 nurses in the U.S. didn’t yet have a place in Nepal to donate the funds they’d raised. And before long, their fundraising results had almost doubled. So, in 2017, Ngima took her family to Nepal, where she set aside time to find a charity that she felt she could trust.
She began to find her match in western Nepal, when a Belgian physical therapist sat next to her on a bus. “He had worked with Humanity & Inclusion (then Handicap International) for years,” she says. “He told me there were a lot of people who needed prostheses.”
Back at her computer, she sent an email to Willy Bergogne, the director of Humanity & Inclusion’s Nepal program, and the wheels started turning. “I felt, ‘this is it,’” she says. “We won’t find a better project than this.”
So far, the generous grant to Humanity & Inclusion has benefited 34 people who lost limbs from the 2015 Nepal quake. These individuals had originally received rehabilitation and artificial limbs at the National Disabled Fund, a Kathmandu-based rehabilitation center set up by Humanity & Inclusion with support from USAID. Three years on from the earthquake, many people’s artificial limbs had worn down from so much use on Nepal’s uneven roads. HI’s younger beneficiaries simply grew, and were ready for replacements.
“We are thankful to NANA for their great support to reach out to almost all the Nepal quake impacted amputees,” says Willy Bergogne, the director of Humanity & Inclusion’s Nepal program. “We’ve been able to replace their prostheses at the right time, enabling the beneficiaries to walk confidently.”
“Ngima Sherpa and NANA are incredible for supporting the critical work of their fellow nurses in Nepal, and for considering the long-term needs of the people whose lives changed so drastically on April 25,” says Jeff Meer, U.S. executive director of Humanity & Inclusion. “By setting up that folding table in Jackson Heights, Ngima, her colleagues at NANA, and their generous neighbors will have helped dozens of people maintain their independence and mobility in Nepal. I cannot think of a better way for these committed professionals to promote, advocate and protect the health, safety and rights of the people of Nepal.”
Sunita Bhandari of NANA visits NDF, a Kathmandu-based rehabilitation center that is supported by Humanity & Inclusion in Nepal.
"When the water shook" is a series of short videos that follows 10-year-old Nirmala from Nepal. The series includes five short films that feature Nirmala's life: the earthquake, rehabilitation with Humanity & Inclusion, her life at school, and much more. Watch her videos and share her incredible story with your friends!
The earthquake which hit the country on April 25, 2015 killed more than 8,000 people and injured 22,000, including Nirmala. In this episode, she recalls the moment the earthquake struck Nepal and what it felt like to wake up with a missing leg.
Life with a disability
Immediately after losing her leg, Nirmala met Sudan Rimal, one of Humanity & Inclusion's physical therapists. He helped her regain strength through physical therapy and supported her as she took her first steps with her new prosthetic.
In Nepal, disability is primarily considered a social issue. It is rarely addressed as a public health issue or taken into account in education, health, and economic development. An estimated 78% of children with disabilities are excluded from school and only 1% of population of people with disabilities has access to decent, waged employment.
Why Nirmala loves school
Today, Nirmala is enrolled in a boarding school in Kathmandu, thanks to support from Humanity & Inclusion. She shares her room with Khendo, her best friend, who was also injured in the earthquake.
The inseparable duo
Although they lived miles apart, the earthquake brought Nirmala and Khendo together. On that dark day in April, both girls lost a leg after being buried under rubble. A helicopter airlifted Khendo to the hospital where doctors amputated her leg. Soon after, she met Nirmala in Kathmandu and they've been inseparable ever since.
During the holidays, Nirmala returns to her parents' home to visit. Her father works in a textile factory and her mother looks after children. Thanks to the rehabilitation care provided by Humanity & Inclusion, today, Nirmala stands tall.
Ensure children like Nirmala can stand tall after a disaster.
Paving the way for working women in Nepal
Kamala Tamata has made a life for herself, and now she is paying it forward.
When she was less than a year old, Kamala acquired polio, which severely damaged her left foot. Doctors suggested amputating, but her mother wouldn’t let them. Still, walking was extremely difficult for her, and as she grew, other children made fun of her. She and her parents thought her future was limited.
That all changed when she met a community disability worker with Humanity & Inclusion in the Kailali district in southwest Nepal. Thanks to a USAID grant and HI donors, Kamala received a brace for her foot and physical therapy to help her walk. She expressed an interest in being a tailor, so she participated in sewing classes and received support finding her first job.
Today, she works in a dress shop and teaches classes to other women, including some with disabilities. She is also a leader with the disabled persons’ organization in her community. Her monthly wage is enough to support herself and her family. She is even able to put some money away in a savings cooperative.
“The support I received has made all the difference,” she said. “Now that I can walk and work, I don’t feel like I have a disability.”
The Humanity & Inclusion team in Nepal provides support to people with disabilities so they can find meaningful, waged jobs. In addition, we work with employers so they can better understand disability and how to recruit and retain employees with disabilities by providing the tools they need to succeed.
When Dharma Devkota was five months old, she was burned so badly that both of her legs had to be amputated. At the time of her accident, she and her family were living in the western hilly district of Surkhet. After her injury, they moved to Kailali, a district in western Terai.
For years, Dharma was carried to school by her mother, and sometimes by her father. In rural Nepal, children generally start school when they are four or five-years-old. Dharma started when she was eight, and would sometimes miss class when her mother became busy with household chores or agricultural activities.
That is, until she met the Community Disability Worker (CDW) through USAID’s STRIDE project. HI’s partner organization visited Dharma at her home and explained the process of being fit for artificial legs. “I did not believe that my daughter could walk and be independent,” Ranga Devi, Dharma’s mother said. “And I never imagined that she could cycle.”
Today, at the age of 18, Dharma is strong and independent with support from her second set of artificial legs. “She is a girl with strong determination,” her mother adds. “She learned how to cycle in the period of a week.”
Dharma attends school regularly, and travels to and from by bike. Her two brothers help care for her and help her study for school exams. She reads at a 9th grade level and dreams of someday becoming a nurse. “Now I never have to miss my classes and I can go to school regularly,” she says. Her mother adds: “Since she has become regular at school, she has improved her position in class.”