Dear DPT faculty, staff, students and friends,  

I know that I’ve have not been in touch with any updates, so I thought that maybe I should send a little update a few weeks before I’m back at Duke (by the way, my first day back is Monday Oct 26).

Before leaving Durham I was really well intentioned to be sending you periodic updates, but to be honest, it has been a hard assignment here for many reasons.  Life can be  very, very difficult here in Nepal, and the spring earthquakes were follow by months of worrisome aftershocks and heavy monsoon rains. The rain and the quakes seem to have stopped for the moment, but the geological predictions is that the the earthquakes from 6-months ago are really just a precursor and that the build-up of pressure beneath Nepal will unleash again soon.  It seems that we are always on edge, and any little tremor sends shock waves…it only happened a few times that building were evacuated while trembling…and that was plenty for me.   

Anyhow, even beyond the after-shocks, there has been a lot of political activity while I have been here…the country passed a new constitution recently (there was an interim constitution since 2009 when the 10-year civil war needed), but there are about 100 ethnic groups here in Nepal (such as the famed Sherpa’s who live mostly around Everest) and not all were pleased with the outcome.  So, lots of bloodshed along the southern border with India known as the Terai, for about 2 months.  This placed severe restriction on our ability to move about the country (UN vehicles are often targeted in these types of circumstances), and then more recently there has been a blockade at the border with India preventing all types of fuel (petrol, diesel, kerosene, etc…) from entering the country.  On a normal day 300 fuel trucks enter from India.  Over the last month, about 300 trucks in total have entered…and so we now live under acute fuel crisis, and people are stockpiling.  I realize that I am giving you a bit of a ‘bleak’ picture here…but this is reality for me, and all of us here in Nepal at the moment.  Life is often a hard grind, but the Nepali pride and spirit is something to behold.  I am looking forward to my talk on November 2nd that Chad Cook and the DPT executive have arranged: I have some stories, pictures and videos that I am anxious to share with you all.  I’ll warn you…and I may have mentioned this before to some of you, but there are many story from my travels (including here in Nepal) that I will share, but there are some stories and experiences which are so deeply moving, personal, and haunting that I have difficulty sharing.  I save these only for my wife, usually late at night over a shockingly strong gin & tonic.

My early days here in Nepal (July and August) were filled mostly by rounding on injured patients in hospital or field sites.  Rehabilitation capacity here is growing, but gaps remain…especially in terms of follow up with people post surgery, removal of external fixators, etc… I was also heavily involved in delivering medical camp kits (MCKs) by UN helicopters to remote villages above 6,000 meters, and distributing rehabilitation equipment that were donated to Nepal.  I’ll be honest, these first few months took me back to my younger years as a humanitarian aid worker and physio in different parts of the Former Yugoslavia, and Guatemala.  However, overtime my activities and responsibilities transitioned more toward policy work with the Nepal Ministry of Health and Population and developing a national strategy on what will be called “National Plan on Disability Prevention and Rehabilitation.”   Given the political conflict and crisis that has occurred in the last month, our plans are delayed, and we’ll not achieve our outcomes by next week….so even when I return home I will likely be involved (in some capacity) with WHO in Nepal. 

I am so excited that this coming Monday.  I will be speaking on behalf of WHO at the opening of a ‘step down facility’ where we collaborated with the International Organization for Migration (IOM) in a village called Chautara.  A step down facility here is a temporary in-patinet facility for people injured by the quake who are medically stable enough to be discharged from hospital, but do not have the factional capacity/ability to go back home (if their home is still standing).  There will be a heavy focus on rehabilitation and functional restoration, and we’ve developed standardized protocols and will be using standardized outcomes measures (like the WHODAS 2.0) to measure and evaluate progress, but to trigger rapid patient discharge so that we can treat the maximum number of people in the shortest possible time frame .  I’m also very proud to say that we have recruited one of the alumni of the Duke-Bergen (Norway) summer institute initiative to come to Nepal and lead the clinical service delivery of the step-down facility, and we know that he’ll do a wonderful job (actually he will be the first PT that IOM has ever hired..they are not a rehabilitation NGO, but have recognized the need to address the needs of people with disabilities I disaster settings as part of their core work).  At the step-down facility, we will set the standard on how to do a ‘step-down’ facility well, and this process will become part ofWHO’s basic package of disaster relief for the future.

Anyhow, just a quick update, and to wish you all well from here in Kathmandu.  I took a photo on my way back from WHO office this evening (see attached).  Now that the monsoon season is over… the sky has turned from all shades of grey, to beautiful shades of blue.  In the photo you will see In the distance, way in the distance, a glimpse of the world’s highest peak – Mt. Everest (called Sagarmatha in Nepali).  It is an absolutely awesome and majestic view, one that no picture or video can truly capture.  As I took this picture, it was as though the ‘Sun went down looking like the eye of God’ …and for me, after more than 3 months here, that was a very good thing.

Bye for now, and looking forward to seeing you all soon!

Mike