Mike Landry, affiliate DGHI faculty member and chief of Duke’s Doctor of Physical Therapy division, was in nearby Bangladesh when the Nepal earthquakes hit in April and May.
Within days, he got a call from Handicap International—a non-profit organization that runs programs in health, rehabilitation and social and economic integration—with a request to help Nepali physical therapists deal with earthquake-related injuries. He heeded the call and spent a week in Kathmandu’s National Trauma Centre, providing mentorship and support to the rehabilitation clinical staff, who were treating survivors with spinal cord injuries, traumatic brain injuries, amputations, multiple complex fractures and other serious injuries.
The dramatic surge of injured people from Kathmandu Valley—the epicenter of the earthquakes—quickly exceeded the capacity of the health infrastructure, which itself had sustained damage. Landry’s assistance during this time was critical because the delivery of humanitarian rehabilitation interventions by physical and occupational therapists not only improves individuals’ physical functioning, but also strengthens the overall health system by increasing the discharge rate of injured people, thereby enabling institutions to treat more patients.
Reflecting on this experience, Landry said, “I provided brief support, but the Nepalis are the true heroes. They’ve been working tirelessly, day in and day out, during extremely difficult circumstances.”
WHO Consultancy Brings Landry Back to Nepal
A few months later, Landry was back in Nepal, this time consulting with the World Health Organization (WHO). He’s working in WHO’s Nepal office in collaboration with Nepal’s Ministry of Health and Population and Leprosy Control Division to develop a national long-term disability prevention and rehabilitation policy and action plan.
The World Report on Disability projects that approximately 15 percent of the global population lives with some disability, but Landry estimates that in Nepal, this figure is between 20 and 30 percent of Nepal’s population, or 5-8 million people. Nearly 30 percent of Nepalis live in extreme poverty, which is correlated to higher levels of disability. And the earthquakes, as well as the recent decade-long civil war, have resulted in a significant increase in disability levels across the country.
As a result, Nepal has reached out to the global community though the WHO to request assistance in developing an effective, sustainable disability policy that will strengthen its health and social systems. Landry’s global health and policy experience, combined with his physical therapy expertise, made him an ideal candidate to contribute to this work.
Landry’s Work in Nepal Is Both Tactical and Strategic
As part of his three-month consultancy, which will continue into October, Landry is also working with the WHO to develop a standardized system of tracking post-disaster injuries across the country. Currently, all of the hospitals and non-government organizations (NGOs) involved in relief efforts collect different data, and sharing data across organizations has been a huge challenge. This project will result in a master data set that will be populated by data from many different agencies. Moving forward, Landry says, this framework and indicators must be ready for implementation immediately following any future disasters.
Landry, who has participated in many post-disaster and post-conflict emergency responses over the last 20 years, has also been attending to the day-to-day needs of injured survivors—from delivering emergency mobile medical kits by helicopter, to sorting and organizing donated rehabilitation equipment, to helping discharged survivors return to what used to be their homes. This experience, he says, has deepened his understanding of post-disaster patient needs and will help shape national policy recommendations for Nepal.
Putting Life as an Injured Earthquake Survivor into Perspective
Several factors converge to paint a bleak post-earthquake picture for injured survivors in Nepal.
As Landry and his colleagues point out in a recent American Journal of Public Health editorial, advances in emergency responses to disasters have enabled us to increase the number of lives saved. But this success leads to an increase in survivors with complex medical conditions—such as amputations, spinal cord injuries, brain injuries and psychosocial trauma—that require long-term medical and rehabilitative care. As a result, many of these survivors face significant lifelong disabilities.
According to Landry, it’s essential to consider the long-term functional abilities of critically injured patients and develop a plan for enabling these patients and their families to navigate their post-injury lives. However, addressing these needs is particularly challenging for low-income countries with limited resources, such as Nepal.
In fact, in the areas affected by the earthquakes—the poorest districts in Nepal—about 80 percent of the population lives in extreme poverty, subsisting on less than $2 USD per day. In addition to the physical struggles people with disabilities face, many of their homes were destroyed or partially destroyed, and despite millions of dollars in aid and development, many Nepali have not seen a direct outcome from these contributions and they don’t have the means to rebuild.
That’s why this work is so important to Landry. He cites Atul Gawande’s The Checklist Manifesto as a model that inspires him to help develop a plan complex enough to address the seemingly insurmountable challenges faced by people with disabilities in a post-disaster setting, yet simple enough to be transferrable to a wide range of countries and disaster scenarios.
Landry hopes that the strategies developed through his work with the WHO, like Gawande’s checklist, will save lives and help preserve quality of life among survivors. “One of my goals,” he said, “is to address the need at hand in Nepal but to also set in place strategies and ideologies that could be used in response to other disasters in other areas.”
After decades working at the crossroads of global health, disability and rehabilitation, Landry believes it’s no longer morally or ethically acceptable to consider only short-term humanitarian interventions. Rather, he says, “We must consider the consequences of our collective humanitarian action. We’ve become relatively successful at preserving lives following a disaster, and it’s now time to extend our commitment to meeting the complex needs of injured survivors.”
We’ve become relatively successful at preserving lives following a disaster, and it’s now time to extend our commitment to meeting the complex needs of injured survivors.Mike Landry, physical therapy and global health professor