A little education on Spinal Cord Injuries (SCI)

Besides natural disasters such as earthquakes and landslides, you might wonder what are the primary causes of SCI in Nepal, how prevalent a spinal cord injury is in the country, and then what the various injury levels mean.

Causes of SCI in Nepal

Not a lot of formal research has been done in this area, but the following are generally considered to be the primary causes of spinal cord injuries here in Nepal.

Falls:  Falls are the #1 cause of spinal cord injury in Nepal.  You have to understand, keeping water buffalo and yaks fed every day can be a challenge for those living in mountainous regions.  Climbing trees is a quick and easy way to collect fodder for cattle. Over time, the greenery from the lower branches is harvested, necessitating a climb higher to new branches that tend to snap with the weight of even a small child.  No safety equipment is ever used – that is just unheard of.

Here's a photo of a women collecting fodder high up in a tree by the roadside.  There is a steep drop on the other side of the tree.  During Ram's Wheelchair Yaatra last year, he scolded this lady for such a dangerous activity and she did climb down fro m the tree once he warned her of the possible consequences of a fall. Notice the two trees behind her, with their branches already bare from previous fodder collections.  Photo credit SIRC.

Here’s a photo of a women collecting fodder high up in a tree by the roadside. There is a steep drop on the other side of the tree. During Ram’s Wheelchair Yaatra last year, he scolded this lady for such a dangerous activity and she did climb down from the tree once he warned her of the possible consequences of a fall. Notice the two trees behind her, with their branches already bare from previous fodder collections. Photo credit SIRC.

A second version of falls while collecting fodder, is when a person mis-steps on a steep embankment while collecting fodder from scrub bushes, and tumbling down the steep incline to their death, or severe spinal cord injury.

A third version is a fall from a roof.  Many Nepali rural homes are two-story with the animals quarters on the ground floor and the family living above.  The roof of the two-story house is used to dry red chillis, corn and other produce from their subsistence farm. Slipping off the roof while checking on the drying produce is a primary cause of SCI in Nepal.

A typical rural house in Nepal.  Two-story, note the trying chillis on the roof and the husks of corn drying on the upper level.  Photo credit Kate Coffey.

A typical rural house in Nepal. Two-story, note the trying chillis on the roof and the husks of corn drying on the upper level. Photo credit Alamy.

Bus accidents.  I’ve written before on the craziness of buses in Nepal – they are not regulated in any way, are privately run and the owner is only out to make money.  This results in drivers not being fully licensed and therefore not skilled to drive, buses are badly maintained (if not at all) and the buses are loaded with people, animals and cargo at every opportunity.  Add to this the state of the roads, many are unpaved and slippery in the dry dust or the wet muddy monsoon.  Taking a bus in Nepal is always a gamble.  Bus accidents account for the second largest cause of spinal cord injuries in Nepal.

It’s unclear where the safest seat is – on the roof or inside the bus.  Some say it is close to the driver – when you see him jump from the bus, you should follow too!  If the bus rolls and you are on the roof, you are a goner. If the bus shoots over the side of the cliff, then those on the roof have the best opportunity to jump off the roof before the bus careens down the embankment.

Motorbike Accidents.  No matter where in the world, you will always have young men going faster than they should on their motorbikes, weaving in and out of traffic.  The issue with safe driving in Nepal is that there is none.  On narrow roads it is common to a truck and a bus play bit of roulette, to see which vehicle will stop to allow the other pass by.  Add to that weaving motorbikes and it is a recipe for disaster.

Add a further complication where only the driver of the motorbike is required to wear a helmet, any passengers (there could be whole families on the motorbike) are not required to wear helmets.

Family of four on a motorbike where the driver is the only one wearing a helmet.  Photo credit The Himalayan.

Family of four on a motorbike where the driver is the only one wearing a helmet. Photo credit The Himalayan.

More recently, as more women ride motorbikes, there has been an increase in the number accidents involving women’s scarves being caught in passing traffic, resulting in the women being pulled off the bike and run over by the traffic behind.

Really, any kind of an accident on a motorbike in Nepal results in serious injury and often death.   It’s why it ranks so high on the causes of SCIs in Nepal.

Prevalence

With minimal formal research, it is hard to state hard and fast statistics on which segment of the population are the primary sufferers of spinal cord injuries.  I can only tell you what SIRC observes as they take the patient’s background upon arrival at the Centre for rehabilitation.

Females usually present at the Centre as a result of falls from trees, roofs and cliffs.  Why?  In rural villages where every family is economically weak, the male head of the household works as a day laborer and takes jobs as he finds them so that the family earns money to buy food they cannot grow themselves and pay the bills.  Provision of food is left to the females in the household, including very young girls age 10+ who more often than not, are no longer at school but instead helping with her younger siblings and the chores around the farm.  This includes collecting fodder for water buffalo in trees and down steep cliff-faces, resulting in devastating falls.

Males up to the age of 30 usually present at the Centre as a result of motorbike accidents.  Many of these young men are educated, have a good life ahead of them, are often recently married with young children.  Males are traditionally the head of the household, with responsibilities for their parents as well as their sisters and their own young family.  Not being able to adequately provide for his extended family is shameful.  No longer being able to father children is dishonourable.  Any form of disability in Nepal is viewed with disgust, suicide is prevalent.  The mental health of young men with a spinal cord injury is always of concern.

Injuries or death as a result of bus accidents do not discriminate across the sexes, but it does concentrate on the poor, uneducated and rural peoples.  Most middle and upper classes have private cars with drivers to get around.  Only the poor travel on public buses, they have no other means of transport except to walk.  Most will have already walked up to a day or two along trails to get to the roadhead, to then connect with a passing bus.  Nothing is ever easy in Nepal.

Levels of Injury Explained

Maggie Muldoon, Overseas Programme Manager for Livability International shared this chart which gives some thought provoking facts on SCI.  The stats are based on those in the UK, but it still gives you a sense of the impact of a spinal cord injury.  And it explains the various levels of injury that can occur and what areas of the body are affected.  Double click the photo to enlarge it.

Maggie SCI explained chart

Maggie also shared this video with me.  Thanks Maggie!

Laxmi and Anita are featured, both were beneficiaries of rehabilitation at SIRC and the video documents how they were spinally injured and what their life is like now.  I found it interesting to see what life is like not only for Anita in her village, but also insights into a rural life lived in Nepal.  And it pleased me to see Laxmi make it on her own as a person confined to a wheelchair in Kathmandu.  Esha Thapa, SIRC Executive Director along with Suresh Poudel, SIRC Head of Social Services also speak to SCI.

It’s nearly 17 minutes long but worth a look, so if you do not have time now, come back to it when you do.  Click here to view the video.

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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3 Responses to A little education on Spinal Cord Injuries (SCI)

  1. Jeanine says:

    Hi Kate,

    Interesting information. A bit of info about another type of issue that is not well known but that can result in an incomplete spinal cord injury if not dealt with quickly. It’s called cauda equina syndrome (CES). The cauda equina is the bundle of nerves that come out near the base of the spinal column. If the cauda equina is compressed and the source of the compression not removed, permanent damage can occur. The longer the compression, the greater the damage to the nerves of the legs, feet, bladder and bowel. We in Canada are lucky in that CES is classified as a spinal cord injury and we can therefore access provincial services such as those from GF Strong in BC. Do the wonderful folks at SIRC help people recovering / rehabbing from CES?

    • Kate Coffey says:

      I will have to check with my medical colleagues on this one Jeanine, stay tuned.

    • Kate Coffey says:

      Hi Jeanine, apologies for the delay in replying.

      SIRC has confirmed they have been treating patients with cauda equina syndrome (CES) since SIRC opened it’s doors in 2002, and they do consider this as a spinal cord injury. So it looks like SIRC follows Canada’s classification.

      Great question, thanks for raising it!

      Kate

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