The work side of things – an update

It’s been a flurry of activity these past few weeks at SIRC.  For me I have been building out the implementation plan for the now approved deliverables that were presented to the Board on December 29th, 2013.  This is in advance of the interns we hope to secure mid February 2014.  Simon G will be happy, I am using his template of many moons ago, colour coded and all!

Esha and I also met with Kumar – the Intern Coordinator at ACE School of Management – the most prestigious management school in Kathmandu.  No matter that SIRC has never thought to secure MBA/management interns or that SIRC is probably not viewed as a salubrious placement as compared to let’s say Coca Cola.  He liked us!  We talked about our strategic plan, the specific objectives we wish to focus on over the coming months, the role an intern would play in meeting these objectives and the part they would play in completing something tangible and valuable to SIRC.

We initially were looking for two MBA interns with a marketing focus and then Kumar mentioned he had a few good students whose focus was Human Resource Management.  One of our objectives is to implement a performance management system as well as establish a succession plan but we thought we would focus on that later this year.  However if the potential interns in the current program are recommended, we decided there and then to also hire an HRM intern too.

While on campus, we sat in on some student presentations and got to ask a few questions (which surprised the students but they managed themselves very well!).  The students are underway with their exams now so we should receive resumes from interested students by the end of this week, and commence our interviews as soon as their exams are over.  We are dead pleased this has come off,  SIRC already has many interns from nursing, physiotherapy and medical doctors but Esha had never really considered interns from a management program.   I am thrilled I stuck to my guns and pursued the notion of having Nepalese business interns work with us.  Many told me it was not possible, glad I could prove them wrong.  Personally I am also delighted to be able to coach and mentor Nepalese interns, start to build capacity in the business world in Nepal.  I hope I am up to it!

Esha, Prakash and Udaya have been very busy working on a few other initiatives.  My part is to review, make comments and suggestions and hope I have interpreted things correctly. The primary focus since the beginning of January has been on providing key information to Livability Ireland in support of a grant application to Irish Aid.  The key focus of this proposal is “To strengthen the Nepal Health care system to ensure that people with SCI and other disabilities can access the healthcare and rehabilitation services they need”. More specifically, it will focus on the enactment of the appropriate legislation in Nepal, as well as the development of training programs that will lead to professional designations.

Livability Ireland see SIRC as being one of the key partners with which to make this happen  in Nepal and have secured partners in Ireland to facilitate this:  the (Irish) National Health Training Centre (NHTC) and the (Irish) National Council for Health Research.  We at SIRC are very fortunate to have such an amazing partnership with Livability Ireland who are credited to have contributed directly to the evolution of SIRC as an institution over the last 13 years.

My role in this proposal was to gather recent stats on SCI in Nepal (SCI = spinal cord injury) and review & provide comments on each of the drafts.  The application was submitted last Thursday so fingers crossed we are successful!

Pressure sores are difficult to prevent for SCI patients, primarily due to their inability to move, and in developing countries, their protein-deficient diets and lack of tools such as air mattresses that prevent pressures sores in the first place.  They occur due to pressure on the soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Many of our patients arrive at SIRC with high-grade pressure sores and it can be a challenge get them to heal.  Before patients complete their rehabilitation at SIRC, the staff ensures all pressure sores are healed before the patient is discharged.

Surgical intervention may be needed to remove damaged or dead skin, and in more serious cases, plastic surgery is required to graft skin to the area where the pressure sore was.  So serious stuff.  Note to any medical folks reading this, apologies if I have misstated anything, I have much to learn on the medical side of things.

Since the first week in January 2014, we have been fortunate to have commenced a program where plastic surgeons from the Kathmandu Hospital, come to SIRC every two weeks to assess patients with pressure sores, and if needed perform surgery by local anesthetic in our small “operating theatre” at the SIRC facility.  If a full anesthetic is required, the patient is transferred to the Kathmandu Hospital.  The Hospital are also using this experience as a training opportunity for their surgical interns so this arrangement is beneficial to both parties.

Afraid I had nothing to do with this arrangement, but I credit SIRC’s  burgeoning reputation in SCI rehabilitation and the increase of awareness of SCI as a disability as the key reasons Kathmandu Hospital reached out to SIRC.

The third big thing underway at the moment is an initiative to outsource SIRC’s medical doctor role.  SIRC has found it increasingly difficult to hire and retain medical doctors who will be at the centre to perform the day to day assessments of patients.  Why?  Primarily due to lower than usual salary for medical doctors and our location (1.5 – 2 hours from Kathmandu).

The resignation of our medical doctor last Monday prompted us to rethink how we continue to provide this service. By the end of the week and after a conversation by a SIRC board member with the management of Dhulikhil Hospital, a proposal is now underway for Dhulikhil Hospital to provide medical doctor expertise on a daily basis for the next 5 years.  This will be achieved by establishing a rota to allow doctors to spend 6 days a week 9am to 4pm for a 3-month period at SIRC, gaining SCI experience.  The rota will allow for transition from one doctor to another every 3 months so that the patients are not affected.

Dhulikhil is about 9km east of Bhainsepati (where SIRC is located) and the doctors will make their own way to SIRC.  This arrangement will cost SIRC a little more than what we currently pay the incumbent but it will be worth it.  It’s because Dhulikhil Hospital will be responsible for ensuring there is a replacement if the doctor is sick or on leave.  On call doctors will continue to be provided by Scheer Memorial Hospital in Banepa, just 4km away. In addition, Dhulikhil Hospital will also send an orthopedic surgeon and urologist every two weeks (no charge) to regularly assess our patients.  Again this provides these medical professionals with exposure to SCI.

This greatly rounds out the medical care that we can provide consistently to our patients …. consistently being the operative word.   It’s always the challenge when the team is small, providing 24/7 service.

Although Nepal has a reputation for bureaucracy and delays in getting anything started, I was astounded to see how quickly this arrangement came together.  It’s like this at SIRC, it may not be like that in other places. Maybe I just lucked out and am working with “can-do” types of people who, when a decision is made, they set to immediately and make it happen.  Remember the Admin team at SIRC are just a team of 3, they get a lot done for such a small team.  

I also see this with Lok and his brothers who seem to own half the street that I live on. In the last 6 weeks that I have been here, the extension to the celebration/event facility has literally gone from four bare walls to a completed building where they have already had their first few events.  So I guess it depends who you work with.

This is a long posting, maybe I should make more frequent updates on the work side of things. I’ll do that from now on I promise.  Feel free to ask questions!

About Kate Coffey

After 25+ years in the investment management industry, I packed in my job and spent 2014 living and working in Nepal and Bangladesh, and visited some other places in between. It took me on a journey I did not expect, had me fall in love with Nepal and it's people, and become inspired at the work of Spinal Injury Rehabilitation Centre (SIRC) located 2 hours east of Kathmandu in the Sanga foothills. Since 2014, I have continued my warm relationship with SIRC and worked closely with my friends there in the aftermath of the 2015 earthquakes to date. This blog initially started out as a travelogue of sorts to keep friends and family worldwide updated while I was off on my travels in 2014. Since then it has morphed into a life story of the many places I have lived and worked and of the wonderful people I have met along the way. I hope you enjoy.
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4 Responses to The work side of things – an update

  1. Grace Coffey says:

    Go team SIRC! Kate, It must be great to be working with such a great bunch of people – continued success to all for future goals! gx

  2. Katherine says:

    Great report Kate. The people-in-the-know at SIRC probably know this but in case they don’t …. There is a plastic surgery hospital about 20 minutes east of Boudha. It is a German-Nepali operation (I may be wrong on the German bit!) I took one of the boys from Child Haven there for a small procedure. They do facial plastic surgery for people who have burns and other problems. Sorry I can’t be more precise about the name and where it is. We took one of those crammed ‘buses’ from Boudha and it seemed to be straight east!

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