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Fifteen year old Zheng Haiyan of Mongolia, pictured
in the center and right with Dr. Villavicencio and Dr. Odom, recently underwent
surgery for her scoliosis. Dr. Odom, who has performed multiple scoliosis surgeries
in tandem with ATNI, and Dr. Villavicencio traveled from the USA to collaborate
with a team of Chinese doctors and nurses:
Pictured with his father, Zhao Haixiao also needs surgery for his scoliosis
but requires a more involved procedure than what is currently offered in China.
As a candidate for surgery in Denver, Zhao must first get a passport before
making the journey. In cases like Zhao's, diplomatic issues prove unbearably
slow when urgent healthcare is needed:
All Together Now International has been helping for several years to fund
Nepal's first and only spinal surgical center for children, the Hospital
and Rehabilitation Centre for Disabled Children (HRDC), located near Kathmandu
in Banepa, Kavre, Nepal. Through the generosity of many ATNI donors, HRDC
has been able to meet its projected costs for 2004, and to continue the
spine program activities into 2005.
HRDC's objective is to identify spine problems early during
childhood, and to institute effective management plans for these young
patients. The Centre's efforts are focused on very poor children, most
of whom are less than 16 years old. In addition to dealing with the spinal
disease processes occurring in their bodies, these children also deal
with severe socioeconomic disadvantages and the social stigma that accompanies
all of this.
The HRDC spine program involves center based screening, case selection,
patient management including operative and non-operative treatment, a
special spine clinic for surgical intervention when necessary, and requisite
patient follow-up. Additionally, HRDC operates 50 mobile clinics each
year that travel to remote parts of Nepal. Also, a school screening program has been implemented to look
for cases for early intervention and to explore the epidemiology of spine
problems in Nepal.
HRDC has made great strides in the recognition and intervention of spinal
disorders in Nepal. During the last four years, more than 100 children have been
treated with spine problems, ten schools have been screened, with a total
of 9.397 students being evaluated. Some specific patient examples are
the following. Tsering, a four-year old boy who stood only two feet tall
due to kyphosis, was treated with surgical intervention which stopped
the progression of the disease which would have lead to paralysis. Kamal
Jit Tamang, a twelve-year old suffering from tuberculosis of the spine
causing paraplegia, was also treated with surgical intervention and is
expected to be walking normally soon. Eleven-year old Priyanka Thakur
from India had surgery to correct congenital scoliosis of the thoracic-lumbar
region. Her postoperative and recovery periods have gone well. Priyanka's
case is an example of HRDC's policy to accept and treat patients irrespective
of national boundary.
School
screening for scoliosis brings hospital service awareness to new communities,
meaning that patients with disabilities other then spinal are now more
likely to use HRDC. The management team at HRDC oversees a
continuing program aimed at enhancing the skills of staff members both at
the paramedical and surgeon level. A major challenge at HRDC is to
treat in a very cost effective way a highly complex disease
process when it has progressed to an advanced stage. This, of
course, is what makes screening and early detection so crucial.
ATNI advisory council member and orthopedic surgeon, Dave
Spiegel, MD, also a member of Orthopaedics Overseas, travels to HRDC
annually. He spends several months teaching and enhancing the skills
of the excellent and dedicated hospital staff.
The spine program has accomplished many goals and has shown promising
results. However, HRDC aspires to reach and treat more children by: developing
programs to continue spinal screening, introducing new screening methods,
training CBR (community based rehabilitation) workers, recruiting spinal
registrars, enhancing the skills of all the staff, and acquiring new equipment
and instruments.
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