From the Field: Empowering Physical Therapists and Wheelchair Users in Bhutan

Editor’s note: This post was adapted from a trip report written by HVO volunteer and leader Linda Wolff, MPT, summarizing her experience working as part of a team to deliver wheelchair service provision training to physical therapy providers in Thimphu, Bhutan. Read Ms. Wolff’s previous account of her experience delivering Part I of this training here.

In May 2016, I traveled to Thimphu, Bhutan as part of a team to deliver the World Health Organization (WHO)’s Wheelchair Service Provision Training Program. This past summer, I returned to Bhutan with my team to follow up on the training and achievements of 2016, and to deliver the WHO’s Wheelchair Service Training Package Intermediate Level Training (WSTP-i) to 13 physiotherapists and physiotherapy assistants.

The training team consisted of Jamie Noon, master trainer, Louisa Cotton, occupational therapist, Simon Gue, technical trainer, Karma Lhaki, Bhutanese pediatric physiotherapist, and me. Together, we delivered a total of three training courses throughout the months of June and July 2017.

First, Simon Gue conducted a Wheelchair Maintenance and Repair Training course. Four biomedical staff from throughout Bhutan and one physiotherapy technician from the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) participated in this course. Participants were trained to identify wheelchair parts, assemble wheelchairs, source wheelchair components locally, and repair wheelchairs. With the information learned and the tools provided, each individual returned to their department equipped to deliver wheelchair maintenance and repair.

Jamie Noon led the Intermediate Wheelchair Technical Training course concurrently with the maintenance and repair course. Participants in this course included four physiotherapists/physiotherapy technicians, one prosthetist/orthotist, and two parents of children with cerebral palsy. These participants learned how to design and fabricate postural supports and how to assemble intermediate wheelchairs.

The WSTP-i took place following the aforementioned courses, and was led by Jamie Noon, Louisa Cotton, Karma Lhaki and me. Six physiotherapists and five physiotherapy technicians participated, along with one prosthetist/orthotist, and one parent of a child with cerebral palsy. During this intensive course, participants learned how to interview and physically assess intermediate wheelchair users; how to select and prescribe the appropriate wheelchair and cushion; how to select, modify and fabricate the appropriate postural support devices; and how to fit the wheelchair user to the appropriate chair. Participants also learned basic care, maintenance and repair of intermediate wheelchairs.

Each team of two to three participants was paired with a wheelchair user, and by the end of the course each team had custom fit their client with an appropriate wheelchair with a seating system designed and fabricated to optimize their posture, comfort, and function. At the conclusion of the training, each team gave a presentation to the group so that all participants learned from one another’s experiences.

Wheelchair users who participated in the basic training course delivered in May 2016 and family members of children with disabilities came to help out with the intermediate training course! Their participation and contributions were valuable beyond words and these individuals will ultimately lead the way for all people with disabilities in Bhutan.

During the course, seven children and two adults were fit with intermediate/advanced seating systems and wheelchairs. The course participants worked incredibly hard, incorporating all they had learned to provide safe, comfortable and functional wheelchairs to these clients—a task that would have challenged even the most experienced practitioner. Most of the clients had never had a wheelchair before, and none of them had ever had a wheelchair that fit them or one that they could use outside.

As part of this project, an additional 220 wheelchairs and supportive seating systems were provided to Bhutanese children and adults through the support of HVO and with funding from USAID. There are now over 250 appropriate wheelchairs in Bhutan, and the Bhutanese government will begin to source these types of chairs. The National Referral Hospital in Thimphu has designated a building to serve as an Assistive Technology Centre, and the hospital’s Physiotherapy Department has committed to providing wheelchair services to clients two days per week. Trained staff in outlying district hospitals are also now able to provide wheelchair assessments, fittings and repairs.

As a result of this training, there is now a team of qualified practitioners in Bhutan who can safely and effectively provide basic and intermediate wheelchairs to children and adults with all types of diagnoses. With mobility comes participation in school, work, household chores, and spiritual and community activities. With mobility comes freedom, independence, and the ability to lead a productive and fulfilling life.

I look forward to continuing to empower physical therapy providers and wheelchair users in Bhutan through increased access to education and training!

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