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.