23 December 2017 started as just another day for Premi*, aged 17, living in remote and hilly Okhaldhunga with her family. It was early Saturday morning, time to feed 8 hungry goats, 2 cows and a buffalo. In winter, grass is less plentiful, so she climbed a tree to cut fresh leaves. The branch she was standing on broke, and she fell. Regaining consciousness, she could not move or feel her legs. She had fractured her spine, damaging her spinal cord. Four days later, borrowed money paid for a jeep to take her the day’s journey to Okhaldhunga Community Hospital (OCH). After three months of recovery at OCH paid for by selling the animals along with help from the Medical Assistance Fund at OCH, the next challenge was rehabilitation. Several months at the Spinal Cord Injuries Rehabilitation Centre (SIRC) near Kathmandu with her mother, gave her the therapy to strengthen her arms and trunk so she could move herself from bed to wheelchair. She also learned about pressure care and doing daily activities. For two years all was fine back home. Then, another tragedy struck. Her asthmatic mother contracted pneumonia. They planned to go to hospital the next morning, but her mother died that night. Premi was devastated. She had lost her mother, her main carer. She became depressed and stopped caring for herself. Large pressure sores developed on her hips, buttocks and legs.
In this extremely fragile state, our Community Based Rehabilitation team found her at home during their baseline survey in August 2020, six months after her mother died. They arranged transfer to OCH where her wounds were cleaned and debrided**. Too deep to heal on their own, she spent a year in Sushma Koirala Memorial Hospital near Kathmandu for skin flap surgery, this time with her younger brother as carer. Meanwhile, her father had begun daily labour work building houses and renting a small room near OCH. She returned to OCH for a month of therapy, then moved into the rented room with her family in February 2022. Soon after, another setback. She developed a fever and stopped doing her pressure care. Within days she had re-ulcered on her right hip and was referred to Sushma Koirala to close the wounds through plastic surgery. She returned to OCH in November via SIRC after counselling and refresher training in self-care.
Now, five years since her injury, she is doing well! She only spends short periods in her chair because her skin is fragile. She is working hard on her strength and is determined to prevent any more pressure sores. She has a vision to run a wholesale shop near the hospital. With the support of CBR and her family, this can become a reality. Pray for Premi and her family. They need resilience for the days ahead. Look out for an update in the future.
* Name changed
** debris or infected/dead tissue was removed from the wound.
CLARE GRIMBLE
Physiotherapist
Community Based Rehabilitation
