A family doctor in Nepal

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Former GF Strong hospitalist Dr. Joanna Mereu holds a special place in her heart for the Nepalese Spinal Cord Collaboration (SpiNepal). This charitable organization works closely with Nepal’s specialized spinal injury unit, the Spinal Injury Rehabilitation Centre (SIRC), near Kathmandu. Inspired by SpiNepal’s founders (Dr. Peter Wing, retired spine surgeon, and his wife, retired physiatrist Dr. Claire Weeks), Dr. Mereu worked in Nepal this past spring. She spoke at GF Strong about her experiences as part of the VPSA’s November Unique Lives in Medicine series.

“The work Peter and Claire have started with SpiNepal is the reason I’m involved,” said Dr. Mereu. “Through their sponsorship, Dr. Raju Dhakal, Nepal’s one and only physiatrist who works at SIRC, had the opportunity to come and train at GF Strong, which is where I met him. Raju is such an inspiration. He grew up with polio and managed to become a physician. He feels it is his duty to be an advocate for those who are disabled in Nepal… physical disabilities are low on his government’s scale of priorities.”

Dr. Mereu talked of several factors that contribute to spinal cord injuries in Nepal. These include: the method of transporting cargo on people’s backs using wide fabric straps anchored to foreheads; falls from trees and cliffs while trying to find food to feed animals; falls from buildings where upper floors are not fitted with railings or are under construction; falls from overcrowded bus roofs onto potholed roads; motor vehicle accidents; and two major earthquakes in 2015. Falls are the major cause of spinal cord injury in the country; they account for 64 per cent of injuries.

During her most recent trip to Nepal, Dr. Mereu made numerous remote home visits to spinal cord patients.

“On my first day, I visited three patients,” she recalled, “including one we had to hike about an hour and a half to reach. Two had been hurt during earthquakes; and one was housebound with a terrible wheelchair. Yet another had a large pressure ulcer that ended up requiring surgery.”

Dr. Mereu also went on team rounds at SIRC, in which—unlike here—all staff participate. By the time rounds are done, all the work has been completed or delegated.

“Though doctors and staff provide the professional and technical care, family members do everything else including feeding their loved one,” she explained. “Patients pay for everything (e.g., pills, food, and care); nothing is free. Those who have a bit more money are charged a little more to offset the costs for the lower-income patients. No one had a problem with that; it’s a very communal society.”

Our VPSA Unique Lives in Medicine luncheons are an opportunity for members to connect and share their passion. It was clear from her energy and how many physicians lingered after her presentation that Dr. Mereu cares deeply about the work and the people and friends she made while in Nepal. No one would be surprised to see her there again.

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