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Teams to Nepal

Team 15 vist, March 2015

Team 15 was invited by Tansen Mission Hospital to provide a week-long rehab nursing training program to allow their nurses to better care for patients with complex rehab needs. NepalAbility provides funding for the neuro-rehabilitation program at Tansen Hospital. The funding allows patients with stroke, brain injury and spinal cord injury to receive extended rehab treatment, and we wanted to equip the nurses to support these patients during their stay. Team 15 included two experienced Canadian rehab nurses who provided the core content and invaluable practical experience for the week-long nursing workshops. The rest of the team supported the workshops, as well as worked with staff from our own areas. There has been some turnover in the staff at Tansen Hospital, so this was an opportunity to support and build new relationships.

We ended our trip with a visit to Pokhara and Green Pastures Hospital & Rehabilitation Centre. They too have been undergoing some changes, and this spring was not a good time for NepalAbility to provide workshops. We met with the staff and hospital superintendent to talk about how NepalAbility can support Green Pastures Hospital in the future.

Team 15 included three members from Edmonton: Dr. Shaun Gray (physiatrist), Lorna Richmond and Mary Mark (rehab nurses), and two from Toronto: Edith Ng (occupational therapist) and Carol Scovil (rehab engineer).

Team 14 visited Nepal in the Spring of 2014.

Karen Penwell, Physiotherapist
Karen Penwell is a physiotherapist working in rehabilitation at the Dr. Leonard A. Miller Centre in St. John's, NL. She graduated from Dalhousie University, Halifax, NS with a Bachelor of Science (Physiotherapy) in 2004 and has spent over seven years working as part of an interdisciplinary rehab team, treating patients and families living with stroke, brain injury, and spinal cord injury. In 2013, she travelled to Haiti with Team Broken Earth, a volunteer task force of nurses, physician, and one physiotherapist. While there, she worked with Haitian physiotherapy technicians in Port aux Prince, and supported hands on training with local rehab staff.
She has a great desire to offer continuing education opportunities, and integrate the evidence-based practice. Karen is a member of the Global Health Division of the Canadian Physiotherapy Association and is registered with the Newfoundland and Labrador College of Physiotherapists.

Sherry Lythgoe, Physiotherapist
Sherry Lythgoe is a physiotherapist from St. John’s, Newfoundland. She graduated from Memorial University with a BSc in Biology in 2006, and completed a MSc in Physiotherapy at Dalhousie University in 2008. Since graduation she has worked with adult populations in various practice setting, including acute care, inpatient and outpatient neurological rehab, and outpatient orthopedics.
She has a strong passion for volunteerism and her profession and is thrilled to be a part of NepalAbility’s 14th team to Nepal.

Nora Cullen, Chair NepalAbility
Dr. Nora Cullen is a specialist in Physical Medicine and Rehabilitation and Chief of Staff at West Park Healthcare Centre. Since 2006 she has been a founding member and Chair of NepalAbility. Together with Angie Andreoli, Edith Ng and the help of many other professionals, they have built an organization that is a driving force of rehab in Nepal. She completed medical school in 1994, followed by residency at the University of Toronto and a clinical fellowship at the Rehabilitation Institute of Michigan, Wayne State University in 1999. She works clinically with adults who have sustained a brain injury, assisting them with re-integration into the community. She is an Associate Professor at the University of Toronto where she teaches medical students, residents and fellows. Her research interests involve long term outcome measurement following brain injury and the interventions that impact on those outcomes. Her passions include improving the quality of life of people who have had a life altering disability.


Team 12, April 2013

Team 12 built on relationships and opportunities from previous visits and provided continuing education and hands-on training to local rehab staff in Nepal. They spent a week at Green Pastures Hospital & Rehabilitation Centre and presented a workshop on interprofessional approaches to behavioural challenges & opportunities in supporting patients coping with disability. They then had several days to work alongside staff on specific cases, and do practical skills training. They also supported spinal cord injury rehab improvements at Green Pastures Hospital - they have just received three years of funding to increase their SCI rehab capacity.

The team then went to Tansen Mission Hospital, and repeated the workshop there, as well as provided training around stroke rehab, respiratory physiotherapy, and homelessness and psychiatric challenges.
They also continued to support the neuro-rehab staff and department funded by NepalAbility at Tansen Hospital. It is great to continue to share skills and develop relationships with health care professionals and hospitals in Nepal.

Team 12 included Dr. Nora Cullen (Physiatrist), Carol Scovil (rehab engineer), Anthea Nardi and Fahreen Ladak (physiotherapists), Anita Gupta (psychologist) and Tracy Martin (social worker)

Team 11, November 2012
Our 11th team to Nepal focussed primarily on supporting the newly launched rehabilitation strategy, a joint initiative between NepalAbility and Tansen Mission Hospital. The neurorehabilitation arm of this strategy involves salary support for a physiotherapist and physiotherapy assistant dedicated to providing assessment, treatment and education to patients and families who have injured their brain and spinal cord. Team 11 offered support in the area of team processes, program evaluation, and specific assessment and treatment approaches to an expanded team that also included occupational therapists (OT), nurses, spiritual care workers and physicians. As part of our ongoing fundraising campaign, this team also filmed a short video.

Team 11 included Edith Ng (OT), James Bardy (OT) and Angie Andreoli (PT). Marvan Kwan is our director of photography.

Team #10, May 2012
In May, NepalAbility sent its 10th interprofessional team to Nepal. This was also NepalAbility’s first international team as we welcomed Cathy Bucolo, a Speech Language Pathologist from Australia. At Tansen Mission Hospital, our focus was on providing education in the area of cognition after sustaining a brain injury. We emphasized the use of assessment tools and ongoing follow-up using an interprofessional approach. Our team led interactive workshops with Nepali clinicians, including physicians, nurses and therapists that emphasized introducing standardized measures tools, and the importance of addressing cognition in treatment. We also discussed the long-term impact of impaired cognition and opportunities to educate patients and families as they transitioned home. Our goal was to build on themes presented by earlier NepalAbility teams, and to introduce more complex themes including reinforcing the importance of early referrals to the newly formed rehabilitation team. In Pokhara, our focus shifted to the area of cerebral palsy from a case management and interprofessional perspective. The group led a full day interactive workshop with the interprofessional team from Green Pastures Hospital and Rehabilitation Centre. Using small groups and case studies, this workshop highlighted the maximization of function, positioning techniques, prevention of secondary complications, and specific treatment approaches. The intent of this workshop was to build on the Nepali team’s strong foundation in order to further prepare them for an upcoming camp for patients and families living with cerebral palsy. Dr. Nora Cullen, Physiatrist led the NepalAbility team, which included Cathy Bucolo, Speech Language Pathologist, Reena Punani, Occupational Therpaist, and Anthea Nardi, Physiotherapist.

Team #9, November 2011
In November 2011, NepalAbility sent its 9th interprofessional team to Nepal! We are excited to be providing education and practice focusing on the areas of home modification, community participation, pressure ulcer management and neurodevelopmental treatment approaches for incomplete spinal cord injury and stroke recovery management. We were able to network with past NepalAbility teams and with our colleagues in Nepal regarding a unified approach to home modifications. We also built on the rehab education provided to date by linking it all together with education and a problem solving approach to community participation. We focussed on strategies to achieve social, cognitive, emotional and physical well-being following injury. In addition, reviewed and provided more education and follow up in the area of pressure ulcer management and the use of computerized pressure mapping systems for people in wheelchairs. Finally, we offered workshops to enhance practice in the area of neurodevelopmental treatment/ facilitation strategies. We finished our trip by sponsoring and key noting a rehabilitation conference at the Spinal Cord Injury Center (SIRC) in Kathmandu. This team was led by Carol Scovil (Rehab Engineer) and includes Jamie Young (Physiotherapist), Pauline Courcy (Registered Nurse) and Sylvia Haycock (Occupational Therapist).

Team #8 - March 2011
In spring 2011, NepalAbility sent its 8th interprofessional team to Nepal. The March team consisted of Angie Andreoli (physiotherapist), James Bardy (occupational therapist), and Rebecca Stewart (speech language pathologist). This team had three main goals. The first was to focus on the psychosocial, cognitive and mental health needs of patients and families following neurological illness or injury. The second was to build on the great work of Team #7 who wrote a proposal for a rehabilitation strategy at Tansen Mission Hospital in collaboration with the hospital’s clinicians and leaders. The next steps were to support the learning needs of these groups as they work to implement this exciting new program. At Green Pastures Hospital in Pokhara we followed up on the pressure mapping system that was donated by Team #7, as well as continued to build on their interprofessional goals and education needs. And third, we continued to focus on family education as patients and families transition from the hospital back to their homes, including community visits to under-serviced areas in collaboration with the OTs and PTs at both hospitals.

Team #7 – November 2010
Our 7th team was comprised of Dr. Nora Cullen (physiatrist), Beth Keidann (nurse), Fahreen Ladak (physiotherapist), and Edith Ng (occupational therapist). During the final week of October the team offered 5 workshops at Tansen Mission Hospital (TMH) in the area of spinal cord injury classification and functional implications, bladder and bowel management, and autonomic dysreflexia, all with an emphasis on interprofessional care. Two community visits and clinical consultation on specific cases were also completed. This consultation involved helping the TMH therapists to design and create therapy tools from locally available and affordable materials for patients and families as they transition home. Planning discussions were also held with the clinicians and leaders for the development of a rehabilitation program which NepalAbility would help co-fund with the the generous assistance of our donors. The following week was spent in Pokhara. We offered two full day workshops at Green Pastures Hospital and Rehabilitation Centre (GPHRC) on wound and pressure ulcer management. Clinicians from a variety of local and more remote organizations along the continuum of care attended these workshops. Thanks to our donors, we were able to provide GPHRC with a pressure mapping system to support their efforts to help their patients in preventing pressure ulcers, both within the hospital and when they return home. Education on the use of the pressure mapping system was also provided. The visit concluded with an invitation to present at the Spinal Cord Injury Conference in Kathmandu, that focused again on interprofessional pressure ulcer management.

Team #6 - May 2010
In May 2010, NepalAbility has been invited to present hands-on workshops on wheelchairs and postural seating at a national SCI conference hosted by Green Pastures Hospital and Rehabilitation Centre in Pokhara. These workshops are offered in affiliation with the Asia Spinal Cord Network (ASCoN), and aim to build on the momentum created by the recent international conference hosted in Kathmandu, Nepal last year. There is a real desire among local healthcare professionals to improve the rehab outcomes for SCI clients, where currently a quarter die within 2 years of discharge from rehabilitation, and most have extremely limited home and community re-integration. The visit will also continue to support interprofessional rehab services at Tansen Mission Hospital, including education and support to the new Occupational Therapy department there. The May team consists of Shaun Gray (Physiatrist), and Lynn Davies (OT), and Carol Scovil (Rehab Engineer).

Team #5 - November 2009
Our fifth team to Nepal consists of some familiar faces including Angie Andreoli, (PT), Nora Cullen, (Physiatrist), Cathie Percival (SW), and Catriona Steele (SLP and scientist), along with her daughter Madeline. This team built on the work of previous teams and focused on the prevention and management of neurological impairments, with particular emphasis on spinal cord injury. Our work again took us to Tansen Mission Hospital and Green Pastures Hospital and Rehabilitation Centre. At TMH for the very first time, both the OT and one of the PTs conducted their a joint home assessment of a woman with a spinal cord injury living in a remote hill village. The team also invited to present at the 8th Annual International Spinal Cord Injury Conference (ASCoN) in Kathmandu on our work on an interprofessional approach to sexuality education for patients and families following neurological injury. In conjunction with the conference, we also toured and met with the therapists at Spinal Cord Injury Rehabilitation Centre, outside of Kathmandu.

Team #4 – March 2009

Team #4 focused once again on Tansen Mission Hospital and Green Pastures Rehabilitation hospital in March 2009. In Tansen, presentations, both didactic and hands-on were given to several groups, including physiotherapy staff on NDT/Bobath approach to neurological care; medical staff on the rehabilitation management of neurological injury; and nursing staff and students on the rehab management of neurological injury with workshops on positioning, transfers, and splinting and positioning. Follow-up community visits were also made to three patients and families in their homes. In Pokhara, workshops were given to an interprofessional group of rehabilitation staff on wheelchairs and seating, and as well as on team goal setting.Specifically, presentations were provided to rehab workers/team members on sexuality following neurological injury. The wheelchair and seating workshop was repeated. Team #4 consisted of Dr. Shaun Gray (physiatrist), Erica Gray (OT student) , Sylvia Haycock (OT), Carolina Kwok (PT), and Dr. Joy Wee (physiatrist).

Team #3 – September 2008

Team #3 included Returning Clinicians Angie Andreoli (PT), Nora Cullen (physiatrist), Edith Ng (OT), and new member Christine Tang.
Christine graduated from the University of Toronto in 1998. She is a plastic surgeon based our of Etobicoke General Hospital. Chris specializes in breast, cosmetic, and general plastic surgery. Her loves are operating, travel, cooking, and trying different food, in that order!

Team #2 – October 2007

Joy Wee
Joy is a physiatrist (rehabilitation medicine specialist) who has been engaged in community based rehabilitation training and evaluation, and international rehabilitation teaching since 2001. She is currently in the Department of Physical Medicine & Rehabilitation at Queen’s University. She has ongoing communication with the past and current medical directors since doing a research project at Green Pastures Hospital and Rehabilitation Centre in 2003. She joined NepalAbility in 2007, and is on the Research Committee. She would like to see governments become more actively engaged in inclusion of persons with disability in all aspects of society.

Carol Mulder

Lesley Ruttan
Lesley is a psychologist practicing in the areas of Clinical Neuropsychology and Clinical Psychology. She works at Toronto Rehab on the Neurorehab program and in private practice. She joined NepalAbility after attending a presentation by Team I documenting their 2006 Nepal experience. She is very much looking forward to contributing to the group’s educational and research efforts.

Catriona Steele
Catriona Steele is a speech-language pathologist and director of the Swallowing Rehabilitation Research Laboratory at the Toronto Rehabilitation Institute. She is interested in exploring the experiences of Nepali people living with disability and in promoting the early identification and management of swallowing difficulties in individuals who have sustained neurological injuries.

Team #1 – November 2006

Angie Andreoli
Angie is a physiotherapist and researcher at Toronto Rehab. She has been a part of NepalAbility since its inception and is thrilled to contribute as vice-chair of the group. She brings with her with a keen interest in global development and combining her clinical, education and research experience to help build a sustainable program of service in Nepal.

Nora Cullen
Nora Cullen is a physiatrist (rehabilitation medicine specialist) who treats patients with disabilities as part of an interprofessional team. She did her medical training at the University of Toronto and now teaches at the same Faculty enjoying work with medical students, residents and fellows as an assistant professor. Since being at Toronto Rehab, she has had the opportunity to travel to many parts of the globe but none have captured her interest like the people and beauty of Nepal.

Zubeen Dharshi
Zubeen is a speech language pathologist who works with people who have sustained a brain injury in adult life. Her contributions towards introducing Nepali health care professionals to basic swallowing impairments was an important first step in building capacity in this new area.

Edith Ng
Edith is an occupational therapist at Toronto Rehab. She graduated in 1996 from Queen’s University and has developed a special interest in international rehabilitation. She has traveled to Nepal and Haiti to provide teaching and consultation as part of interprofesional teams. As the education committee chair and treasurer of NepalAbility, she is integral to NepalAbility's success and enhancing the quality of life of those living with disabilities in Nepal.


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