Early in 2014 Hands Across Borders (HAB) plans were made for a fourth visit to Nepal.

For this project three new therapists were available: Ms Tanja Bakker and Ms Guusje Besteman from Westfriesgasthuis (Hoorn) and Ms Gertie Berghuis from Bernhoven (Oss-Uden). Ton Schreuders (ErasmusMC, Hand en Pols Revalidatie Nederland) and Wim Brandsma were also available, together with Dr Wim Theuvenet (Gelre Apeldoorn). The later two have lived and worked in Nepal for may years, mainly involved in the leprosy work.

We planned to accept the invitation by Dr Indra Napit (see below) for the Surgical Workshop at Anandaban, to follow up on previous visits at Dulikhel University (GP outreaches, flexor tendon repair protocol) in combination with the invitation to speak at the Physiotherapy Congress NEPTACON 2014, and in Pokhara, as was requested earlier by Mr. Subash Gautam, Physiotherapist at Manipal Teaching Hospital, to assists in a program for children with CP. Dr. Indra B. Napit, Orthopedic & Reconstructive Surgeon, Medical Director, Anandaban Hospital, The Leprosy Mission, Kathmandu, Nepal wrote to us about possible assistance of HAB in the International Reconstructive Surgery Workshop Anandaban he had planned. In the invitation he wrote: “This time we will include the Surgeons and Physiotherapist/OT as we will focus on the reconstructive surgery of Eyes, Hands and Feet in Leprosy and Rehabilitation. We will also focus on Common Hand problems like tendon transfers, Dupuytren’s contracture etc. We are practicing Early Mobilization Protocol at Anandaban since last few years with the guidance from Hands Across Border (HAB) from Netherlands. A team of Physiotherapist and Occupational Therapists from HAB, Netherlands will join us to facilitate the rehabilitation session. The experienced surgeons from different countries will facilitate the surgical session. The date were November 09 -14, 2014.”

All members of HAB (5 therapist and Dr Wim Theuvenet) planned to be at Anandaban at the opening. Sunday the Surgical workshop started with speeches by local VIPs and Dr Indra Pradit as medical director of the ALP and also Dr Wim Theuvenet as former director of the ALP and Wim Brandsma involved in research in treatment of leprosy. Surgeons and therapist form different countries attended this workshop; Nepal, India, Bangladesh and Myanmar. Ton, Wim B and Wim T had several teaching sessions on general subjects and leprosy related. In the afternoon surgeons did surgery and therapists had there own sessions. Tanja, Guusje and Gertie also presented on amputation and stump care (picture right) , wrist problems and cases studies. Dr Indra has been conducting a research on early mobilization after tendon transfers, the idea he said he got from our last visit to Anandaban.

Final day surgeons and therapists were thanked the faculty for organizing and colleagues expressed there gratitude to have learned so many things during the 6 day workshop. Tanja, Guusje and Gertie left for Pokhara during the first week for the CP sessions at the Manipal Teaching Hospital. Unfortunately this was cancelled and they visited Green Pastures Leprosy Hospital and spent time with the PT and OTs. During this time we also got new form Dulikhel that they were too busy with the NEPTA congress and canceled the planned sessions with PT students and CP children. Fortunately, Wim Brandsma was able to contact Dr. Shankar Rai, plastic surgeon at the Kathmandu Model Hospital. The three therapists time to see patients, make splints and teach about several subjects.

HAB members made contact with dr. Kirshana (plastic surgeon ) and PT Ms Monika. They mainly (80%) have poor patients who can not afford to pay for the treatment Many related contractures due to burns. Patients with complex injuries were seen. Two hand therapy books were donated.

Dr Skankar wrote: Dear friends, It was really nice to see you in our new hospital. I am sorry that I could not be there during the lectures since I was working in one of our peripheral sites but I enjoyed very much talking to three of you yesterday though briefly. We hope you and your more friends will be kind to visit us again in the future to teach our team. Also talk to your hand surgeons, burn surgeons, cleft surgeons, plastic surgeons, anesthetists, critical care specialists to visit us and teach us. Even nurses can help us to improve our nursing care. Please, take it seriously. With warm regards, Shankar.

During the second week Ton went to Dulikhel where everybody was running around to get things done for the 7th NEPTA congress at the Kathmandu University School of Medical Sciences , Kavre , Nepal. He was asked to present on the “Evidence of management of the stiff hand”. Some of the contact persons (Smita k.c lecturer/ KUSMS, Ms Ranjeeta, Mr. Saurab Sharma) came to see him to apologize for the “chaos” and the last minute cancelation of the HAB activities. The two day congress was attended by over 300 therapists mainly from Nepal and many from India. Several invited speakers were present from Australia, America and India. The president of the NEPTA conges, Mr Saurab Sharma wrote afterwards: I have no words to thank you for being so nice and flexible throughout the conference and also after it. There were many things which did not go according to the plan or as I had wished for, and I am very happy that you adjusted according to situation. I also apologize for the chaos at times, including the number of certificates you were asked to sign. The conference wouldn’t have been possible without your support. Thank you again. I wish to have a better planned and organized conference after this. I will request for your support in the future as well. I am looking forward to meeting you soon again.