Let us think about prevention also.

This is the photograph of the private local mill in Baitadi district of Nepal which is on the way to Darchula district. This is the place where generally women from nearby and adjacent community usually come to grind their wheat, paddy and maize. You can see a  belt exposed near by the funnel shaped input section (from where grain is poured for the grinding). Luckily I meet with the operator of this mill and had few exchange of words with him. At the course of exchange, I request him to share any incidence of work related accident that he came across there. He told that in last 10 years of time he had seen three women whose hand was totally crushed while pouring grains. He also told that Nepalese women generally wear Dothi ( it’s similar to sari)  in village, the ending free portion of the Dothi usually hangs at the back side of the shoulder level. Therefore, sometimes running belt suddenly catches the hanged portion of the Dothi pulling the upper extremity under the machine. He also told that women who faced the incidence were Amputed later. After returning back from the trip, i requested my mother to share whether she knows similar tragic incidence of the people when she used to be at village 10 years back. She also revealed that she closely knows four people who were the injured on such mill. Out of four, one woman unfortunately loosed her life as her long hair( Nepalese women usually prefer having long hairs) was caught by the running belt of the mill and remaining 3 were Amputed. Similarly she also shared that except these 4 incidences, she had heard many like such.

We can see this type of mills on every community of the country and there is no option for the people other than these mills for the grinding of their grains. But what strikes on my mind is at least those women  could have been prevented from being disable or losing the precious life if they were aware about the precautionary measures to be taken. I do not have exact figures of such incidence on the other part of the country but i can say this is as the hidden prevalence which should be further explored for the design of some pertinent precautionary measures.

Therefore, it’s my humble request to all the readers, to consider this fact seriously (who knows we or our family members or relative can be a victim one day of such incidence) and  explore the nature of similar prevalence in your community. Please share your findings and then it’s we who should start for what we can contribute to prevent unwanted traumas and deaths in our community.

My observation and derived feelings

Hello,

Sorry for the delay updates. As a part of my usual work, i have been deadly busy visiting the several districts around the country. Kanchanpur, Dadeldhura, Baitadi, Darchula, Banke, Morang, Sunsari, Sarlahai, Bara, Dang, Salyan and Rukum are the district that i have visited on last 6 months. Though hectic, it was a absolutely golden opportunity for me to accomplish the mission assigned as a part of my usual work in one perspective while on another part it was an exposure for me to understand the living situation, topography, health system and challenges of the population residing at these districts. I have meet and accompanied by the several physiotherapist in these visits which was a plus point for me to better understand and analyze the situation from the window of physical therapy.

Speaking from the physical therapy perspective, every human being needs to work to secure earnings to run their life. For this, they need to do activities throughout the life course. None of the work or activities is simple or stress less. Stress can be physical, mental or both. What i see is most of the population in Nepal faces the physical stress at the course of commencing activities to secure their earning. In my observation what i found is mostly the female population of the country more prone for the work related physical stress. Some of the typical examples of daily activities that i observed on the women are over attainment of continuous squatting posture for all household work like cooking, cleaning, washing and so on. Similarly strenuous work like chopping the firewood with an axe, carrying heavy loads of firewood from jungle, carrying heavy loads of grains on back uphill and downhill, pushing a local grinding instrument called DIKKI and JATHO and so on are few of the usual daily activities of Nepalese women. Yes, no doubt, without these activities, it’s hard to run the families as these activities are directly related to the income or food and which is a prime need of a life. If we look from other perspective, the male dominant society of Nepal can be one of the factor among several that women are considered as the sole goal owner of stressful household activities and men remain out of the house for earning. The solution for this inequality is never ending until and unless the the population is jointly quenched with some important prerequisites of development like education, health, employments and good governance at least. Though there are attempts of securing the development by both state and non-state actors, what i observed is lack of coordinated joint sequential approach. For example, for the general population, it becomes very difficult to understand about how to take care of their health without basic education at the beginning. Population can’t follow the health instructions if they do not know how to read or write. Similarly, vocational training without the proper visibility of the employment is also a very futile example. Here, what i want to express is that the development is a sequential process of its prerequisites; hence it should be followed by both state and non-state actors’ one by one. Similarly  it's very important to include the ideas from community right from the planning phase of the developmental intervention.Otherwise a huge funding being utilized in this sector may act just like just pouring water on sand.

Again speaking from the physical therapy perspective, i see huge number of the population prone for the physical distress. It can be one of the reason why population living in rural Nepal are more diagnosed with early degenerative joint diseases, pelvic organ prolapse , ultimately leading to chronic disability. There is a tendency of the most of Nepalese population to seek treatment at the last or chronic stage of the diseases and by that time diseases leads to the non affordability of higher medical intervention as most of the chronic condition is not addressed on the community level health service providers. So the best step here can be the prevention, but the physical therapist who are the sole goal owners for the prevention or limitation of degenerative condition, pelvic organ prolapse and other chronic disabling condition are not available on primary health care system of Nepal. Exercises and activity modification (activities done on correct postures) are very simple and easy ways that physical therapist can teach the population in community. 

As the number of physical therapist are very less in country, what i think is, state should start mobilizing at least one physiotherapist in a district at first followed by mobilization of physiotherapist in each primary health care center as the number goes up gradually. The simple physical therapy screening and follow up skills should be transferred to female community health volunteer available in each community of Nepal who can address the minor issue in community itself and refer the major cases to the physiotherapist at the institutional level. Above mentioned health issues only provides the glimpse where physiotherapist has a major role. There are many other public health issues in Nepal where there is an important role of physiotherapist, especially on the prevention part.