Saurab Sharma is a physiotherapist who works in a clinical setting at Dhulikhel Hospital, Kathmandu University Hospital, and lectures at Kathmandu University School of Medical Sciences. I had the pleasure of meeting Saurab when he attended EP3, and PainAdelaide earlier this year and we’ve kept in touch. I asked Saurab if he might be interested in doing a bit of a Q&A for the ‘jam and he was happy to oblige.
Q: Saurab, tell me a little bit about where you work and the people you work with
A: Dhulikhel Hospital is located 30 kilometers east of Kathmandu. Although the distance appears to be short, we receive patients from very remote areas and the characteristics of these patients is very different. Most of these patients are from low socioeconomic status, have not been to school, and most of them would have visited traditional healers and tried all other ways of management before visiting the hospital. Most of them get themselves examined only if the problem is chronic, and very severe which does not resolve by any other methods of treatment.
Q: What are your interests as a physiotherapist?
A: My interests include management of musculoskeletal and neuropathic pain conditions. However, in the process of using evidence based management approaches to various painful conditions, I realized that the direct translation of evidence to practice in Nepalese population is extremely challenging.
Q: What are some of the challenges you face as a physiotherapist?
A: Some of the challenges include very low socioeconomic status, poor educational background (most of these patients are uneducated), traditional beliefs about the cause of pain, chronicity of pain, severity of the problems, including onset of deformities, and unavailability of pain related outcome measures in Nepali language. The difficult geography of the country and low socioeconomic status restrict the patients from coming back to the physiotherapists for the follow up despite of very low treatment cost (less than one dollar). Thus, planning the treatment of these patients is extremely difficult because of these factors. As the most frequent treatment approaches a physiotherapist uses are exercises, pain education and assurance, graded motor imagery etc all require a systematic approach to management and require multiple visits.
Imagine a patient coming to you with complex regional pain syndrome three months following open reduction and internal fixation for distal radius fracture and all you have is “half hour” to treat him. Physiotherapist should be a magician to treat the patient in single setting. Thus, the treatment of the patient is quite challenging.
Q: Have you noticed any unique aspects in regards to the experience and understanding of pain in Nepal?
A: While treating patients with painful conditions in Nepal for over seven years, I identified various trends in the pain behaviours among patients in Nepal. I noticed that some group of patients have less threshold for pain and better pain tolerance than other groups. I also noticed that some of these have very high catastrophizing and fear avoidance behavior than others. These variations seemed to be specific to ethnic groups, geographical location, and religion. This could be true for patients in other countries as well, however, I found this humongous variation in a small country such as Nepal quite unbelievable. Because of these variations, clinicians require completely different management strategies for these sub groups; while one group require more attention, assurance and analgesics and thus they take longer time to recover. I also suspects that these are the subgroups that are more prone for having persistent pain or chronic pain.
Q: How did you get interested in research?
A: After noticing these variations in pain, my interest grew in investigating this using rigorous research design. I am currently in the process of developing a pain quality tool based on different words patients in Nepal use to describe their painful states. Further, I am in process of translating various pain related outcome measures to Nepali language including measures for pain catastrophizing, pain intensity, pain interference, pain tolerance and pain behavior etc.
Q: What aspects of pain research are you interested in?
A: I am interested in looking at psychological factors that can contribute to ongoing pain such as sleep disturbances, depression, optimism, resilience, behavioral activation and inhibition system. I am also interested in comparing these psychosocial aspects of pain among patients in Nepal with those living in the developed nations. By developing a sound understanding of pain science and with a keen interest in developing pain knowledge and management for developing country such as Nepal, I collaborated with Dr Mark P Jensen, Professor of Psychology in University of Washington, Seattle. This collaborative research protocol earned an International Association for Study of Pain Collaborative Research Grant for 2015.
Q: You’re also involved in promoting and developing physiotherapy in Nepal, can you tell me a bit about this.
A: I am a member of the physiotherapy subject committee member at Nepal Health Professional Council and an advisor to Nepal Physiotherapy Association. My goal is to help improve the standards of physiotherapy practice in the country with my colleagues by revising the code of ethics and introducing a license examination for physiotherapists in the country. Through the association, I am also actively involved in the ongoing professional development programs for physiotherapists in Nepal by organizing courses, workshops and conference. As the organizing secretariat for Nepal Physiotherapy Conference last year (NEPTACON-2014) which was a grand success, my colleagues and I brought together 14 experts in the field of physiotherapy from eight different countries, and had more than 300 participants from all over the world. The conference also included five pre and post conference workshops from these experts.
My thanks again to Saurab for taking the time to share his experiences.
You can find Saurab on Twitter as @link_physio and he has a blog at linkphysio.com – a “novel initiative to improve evidence based practice, share recent knowledge with physiotherapists, physiotherapy students in Nepal, and other developing countries.”