Nepal: Overcoming the inevitability of handicaps

In some villages in the steep Nepalese mountains, physical disabilities are seen as an inevitable punishment of the gods. These beliefs are the first barrier to integrating children with physical disabilities within their own families and in the community. Their access to care and treatment is limited, as well as to schooling. Today, one million Nepalese suffer from physical disabilities and 30% of these handicaps could be avoided. According to Terre des hommes (Tdh), one external cause promotes the formation of handicaps: malnutrition, brought about by the poverty suffered by so many Nepalese.

Tdh and the national association Friends of the Disabled built a rehabilitation hospital for physically handicapped children in the Banepa region. Since 1993, this medical centre has been enabling youngsters to receive high quality medical treatment adapted to their needs. The centre’s staff also offers social support by helping their families and communities to accept them and to reintegrate them, in school as well. It is a sad fact that 85% of the children looked after in 26 districts of Nepal are excluded from the school system and so from their own peer groups.

Involving the family and the community

The rehabilitation of disabled children is most effective when the family and the community are involved. The project therefore integrated this family and social dimension into its rehabilitation programme. During the whole of the monitoring time, members of the family and the handicapped youngster are instructed about post-treatment care. Then they are advised on how to adapt their living surroundings to meet the specific needs of the youngster. At the same time the general public is made aware of child rights and of the prevention of handicaps, caused in particular by unsuitable food. Skills and knowledge are in this way transferred from the health centre to the homes and villages where the physically handicapped live. In order to guarantee that treatment is followed and to make sure of correct handling, doctors regularly visit their patients at home.

Widening access to treatment and healthcare

Three outstations of the hospital for the rehabilitation of disabled children have been set up in the Baglung, Banke and Sunsari districts to carry out mainly orthopaedic surgery. The hospital and rehabilitation services have thus improved their access at a regional level. These outstations improve treatment monitoring and the progress of rehabilitation on the one hand, and on the other, facilitate setting up rehabilitation camps in the more remote villages. The involvement of the communities and their awareness to the problems of handicaps has led to an improvement in identifying children and looking after them by the most appropriate services.

Up to date this project has made it possible for 2285 children to benefit from reconstructive surgery, and artificial limbs were fitted to 2300 children. At the end of the project in 2013, more than 17,000 physically disabled youngsters will have benefitted from social rehabilitation services on a community basis through follow-up and home visits, and more than 7000 of them will have received physiotherapy so as to become independent in everyday life. The great majority of these youngsters will be able to be integrated in school more easily, as has already been the case for 3555 children.