Dr. Bibek Banskota approaches his work with a philosophy of compassion—a philosophy he learned from his father.

Dr. Bibek Banskota is a pediatric orthopedic surgeon in Nepal. He currently serves as the executive director of the Hospital and Rehabilitation Center for Disabled Children (HRDC), MiracleFeet’s partner in providing clubfoot treatment in Nepal. Their main hospital is located outside of Kathmandu. Dr. Banskota attended undergraduate school in neighboring India before pursuing medical training in the UK, Nepal, the US (where he was a research fellow at the Children’s Hospital of Philadelphia), and Switzerland. He returned to Nepal to work alongside his father, Dr. Ashok Banskota, to continue the HRDC founding mission: to provide treatment to physically disabled children from underprivileged backgrounds. 

Every year, their team treats over 20,000 children with physical disabilities, including about 500 with clubfoot. HRDC also boasts an enormous field program staffed by community-based satellite workers who traverse the country seeking children in need of rehabilitations services. Most of the patients they treat in a normal year are recruited through this extensive outreach. Thanks to the broad network of satellite clinics, patients from 77 districts of Nepal can access care, not just those living near the main hospital.

“Invest in a child and their whole life is ahead of them for them to invest in society.”

The hurdles children with disabilities face in Nepal, a low-income country with a challenging geographical landscape, are enormous, and COVID has made these difficulties especially pronounced.

“There are three main barriers to accessing care. There’s not a hospital nearby: physical barrier. The family doesn’t have enough money to pay for treatment: financial barrier. The family doesn’t know that the problem is treatable: cultural barrier. Our program is modeled to overcome these barriers,” says Dr. Banskota.

Of course, he and his staff approached COVID with the same philosophy of empathy. “I thought: COVID has impacted my life so much, I can only imagine how it’s impacted the children we treat whose lives are already very, very difficult.” The majority of children at HRDC come from very low-income families and often don’t have enough to eat during normal times. Now with the far-reaching impacts of COVID compounding disadvantages, their hardships only increased. “That kind of thinking led us to decide not to close the hospital for even one day.” Instead, Dr. Banskota and his staff modified their approach so they could continue safely providing care.

“When you think of a family who has a disabled child but does not have enough to eat, the child’s disability rarely makes it to the priority list, and we are very aware of that.”

HRDC provided PPE to staff (protective gear, surgical masks, and visors) and masks to patients and family members. They distributed hygiene kits which included soap, sanitizers, extra masks, and information about simple measures to prevent contracting COVID-19. They rearranged waiting rooms and enrollment areas to facilitate physical distancing. And they decreased patient appointments significantly only seeing 30 patients a day, as opposed to the typical 80 a day. They also instituted telemedicine services which helped the doctors stay in touch with patients and families despite movement restrictions. And even when restrictions were loosened, telemedicine made it easier to reach children living in remote, hard to reach areas.

“All these new barriers make things more challenging and complicated, but that’s why we are here. We are very optimistic.”

Even before COVID, Dr. Banskota’s optimism and unfailing compassion guided his philosophy about treating disabled children. As he sees it, there are several factors that prevent children from fulling participating in society: lack of education, disability, socioeconomic constraints, and often–especially in LMICs–gender.

Take 9-year-old Ashika, he says. She was born in India, only 30 miles from one of the HRDC satellite clinics, and lived in isolation until a family member learned from a volunteer health worker that her condition could be treated. She has all the factors preventing her from equitably participating in her society: a girl born into a poor family with a disability that prevented her from attending school. Even though her treatment journey will be more complicated since she’s older, it will open up doors for her and lift many of the barriers that have held her back. 

“We look at a disability treatment as an investment in the future. It has ripple effect into the family, into the community. It really opens up a lot of doors for the children, and they can look forward to a life that has a lot of hope and dignity.”

After treatment, HRDC staff help children enroll in or return to school and provide some with vocational training. One training program called Primary Rehabilitation Therapy Training (PRT), recruits young adults interested in a medical career to promote and share accurate information within their communities about clubfoot identification and treatment availability. So far, the program has trained over 600 youth ambassadors.

Dr. Banskota has extensive experience treating older children, like Ashika, who have often gone most of their life without the care they need. He approaches these cases with consideration for the trauma inherent in these young lives.

An early adaptor and advocate of the Ponseti Method, Dr. Banskota’s father, alongside Dr. David Spiegel from Philadelphia, introduced Ponseti in Nepal. Before, the majority of children born with clubfoot who received medical attention—in Nepal and globally—were treated surgically. HRDC conducts an annual Ponseti refresher course that is mandatory for all providers at the hospital and satellite clinics. Many medical and paramedical workers from different parts of the country attend as well.

In working with older, walking-age children, Dr. Banskota says that using the Ponseti Method often reduces the magnitude of surgery required, and can even be used as a definitive treatment modality in flexible feet. In a low-resource setting, late presentation of clubfoot is generally more complicated and more expensive to treat but has a high success rate. Of course, there are some outliers: children with very rigid feet and children who present at 12, 13, 14 years old. “For the majority of these cases, you can either reduce the magnitude of surgery by using the Ponseti Method or use Ponseti as a full treatment option.” HRDC has now published papers in internationally renowned journals in these areas.

“Getting the feet straight is just the beginning. Maybe for the doctor it’s an endpoint, but for the child, it’s the beginning of a new, wonderful life.”

Efforts are also being made outside the hospital walls to raise awareness about clubfoot and to spread the word about treatment. TV and social media are powerful tools, but inaccessible for many families in remote areas, so Dr. Banskota and his team rely on more traditional advocacy materials: flyers, community announcements, and word of mouth.

Nepal boasts a dramatic landscape which makes for a beautiful setting for the HRDC hospital, but also makes reaching children in need of treatment challenging. Often, on outreach visits, the staff must brave muddy, deeply rutted roads or even hike steep hillsides in remote areas where roads are not ubiquitous.

“I‘ll never forget one visit to an East Nepal Clinic. Once the roads ran out, we had to walk for about two hours to the treatment camp, and I asked this little child in a school uniform, ‘How many hours did you walk to get here?’ and this kid told me he walked for eight hours to get to our clinic. He left very early in the morning and reached us in the late afternoon. He had a pocket with rice, and that was his only meal for the day.”

Dr. Banskota’s passion for work and the compassion for the patient is reflected on the entire institution. The model, the dedication, the training, the focus on transforming young lives.

“When kids come here, the first thing they do is make friends. It’s really wonderful to see. It changes their mindset, and then they start smiling. They get enough to eat, they get a warm bed, and then they get treated.”

“It’s beautiful to see a child walking for the first time in their lives. It’s an unforgettable feeling.”