23rd ASCoN Conference and the theme
The 23rd ASCoN was held in Nepal from 23-25 November 2024. This was the fourth time Nepal hosted the conference. The conference was co-hosted by Epidemiology and Disease Control Division (EDCD)/ Department of Health Services (DoHS)/ Ministry of Health and Population (MOHP) and the ASCoN founding member Spinal Injury Sangh Nepal (SISN). The conference had multidisciplinary workshops, scientific sessions, paper and poster presentations, exhibitions, and sport events. The theme of this conference was “Knowledge, Exchange and Technologies for Decentralized SCI Care”.
The conference especially focused on strengthening:
- Specialized SCI services
- Primary health SCI services
- Rehabilitation nursing
- Community outreach and long-term health maintenance support
- Innovative technologies
- Wheelchair sports
Participants
We had around 311 participants from 18 countries this year. The participants consisted of PMR doctors, spine surgeons, neuro doctors, ortho doctors, nurses, physiotherapists, occupational therapists, psychologists, social workers, persons with spinal cord injury, prosthetists and orthotist, vocational trainers, researchers, evaluators, policymakers, representatives of international organizations, Disabled People’s Organizations, development practitioners, officials from local, provincial and federal governments.
Partnership
SISN and EDCD held four preparatory meetings prior to the conference to organize the program. The meetings were led by Dr. Yadu Chandra Ghimire, Director of EDCD and was coordinated by Ms. Nistha Shrestha from LCDMS. During these discussions, it was agreed that the inaugural ceremony would be overseen by EDCD. It was agreed that the team would approach Honorable Minister Pradip Paudel and other senior representatives from the Ministry of Health and Population (MoHP) for the inaugural ceremony.
Key sessions, including “Rehabilitation 2030” and “Challenges and Opportunities to Establish Comprehensive Rehabilitation Services in Asia,” were planned during the meetings. Additionally, it was decided that SISN would be responsible for managing the technical aspects of the conference and EDCD would take a lead in writing emails/letters and coordinating with the stakeholders working in the rehabilitation sector in Nepal for the program. PRA and USAID joined as supporters, as rehabilitation in Nepal is one of their key activities.
Program Details
Day 1 and 2 of the conference was held in Kamalmani Theatre, Patan Dhoka while the day 3 and post conference workshops were held in Spinal Injury Rehabilitation Centre, Kavre.
Day 1:
The day started with welcome remarks by Ms Esha Thapa, ASCoN Chair 2024 and keynote speech by Stephen Muldoon, the founding member of ASCoN.
The inaugural ceremony was graced by Honorable Minister Pradip Paudel and other senior representatives from the Ministry of Health and Population (MoHP). The Minister highlighted that the Conference will act as a catalyst for change and will strengthen long term collaboration and public-private partnerships aimed at increasing access to quality SCI and rehabilitation services across Nepal.
A plenary session on “Rehabilitation 2030” happened on day 1 as well. EDCD along with other distinguished speakers provided an overview of the Rehabilitation Sector in Nepal. Advocacy, planning and implementation using ISCoS and WHO Tools and Resources were also discussed in the session.
Various multidisciplinary sessions like Community integration – Aftercare and Long-term health maintenance for people with SCI, Occupational therapy and Assistive Technology, Physical Medicine and Rehabilitation and Nursing Care enriched the learning and sharing experience of Day 1. The wheelchair basketball game was also the highlight of the day. The day concluded with the meeting of ASCoN Executive Committee members.
Transforming policy into action: Rehabilitation 2030
This session was moderated by Esha Thapa, Executive Director of SISN. Dr. Raju Dhakal, Medical Director of SISN, discussed the needs, opportunities, and challenges regarding rehabilitation in Nepal. He talked about the relevance of WHO Rehabilitation 2030 and in the context of Nepal.
Dr. Rabindra Banskota, Chief of LCDMS presented the policies that have been made and implemented in Nepal. He highlighted that work is ongoing to finalise the National Rehabilitation Strategic plan which will shape and guide the strengthening of the rehabilitation sector in the coming years.
Prof. Dr. James Middleton, President Elect of the International Spinal Cord Society (ISCoS), presented on the work of ISCoS in areas such as education, research, publications and injury prevention. He described the ongoing work within ISCoS to develop the ISCoS SCI Standards Toolkit and how this resource could be used for advocacy, planning, and implementation of SCI rehabilitation services.
The last speaker Stephen Muldoon through his 3 decades of experience in the rehabilitation sector shared about the work of the WHO- World Rehabilitation Alliance and its role in advocating for increased investment in workforce development, research, rehabilitation in Primary Health Care and rehabilitation in emergencies. He spoke about the relevance of WRA within the context of Nepal and other countries in Asia .
Overall the session highlighted how we can strengthen rehabilitation in the health systems with a specific focus on complex conditions like spinal cord injury as per the WHO 2030 agenda. The government of Nepal envisions having provincial level rehabilitation centers in different parts of Nepal and in doing so enabling increased access to essential rehabilitation across Nepal. The session highlighted that expansion and strengthening of rehabilitation services in all parts of Nepal will only be possible through collaboration and partnership with all key stakeholders. Resources such as the ISCoS SCI Standards Toolkit can be utilized to inform the planning of SCI of evidence based services both at an institutional level and at a National Level. Centers such as SIRC can provide technical partnerships to support the decentralization of rehabilitation services at the provincial level with support from partners working in this sector.
Day 2:
On the Day 2 of the conference there was a panel discussion on “Challenges and Opportunities to Establish Comprehensive Rehabilitation Services in Asia”. EDCD also participated in the panel discussion representing Nepal. The panelists came from Nepal, Ireland, Malaysia, Bangladesh, Sri Lanka and Australia. 12 national and international delegates presented their paper to compete for ASCoN Best Paper Award. The day was also enriched by the parallel sessions on ISCoS Database Base Project (IDaP), Sexual Health and Reproduction after Spinal cord injury, Neuro-urological Aspect of SCI and Physiotherapy in SCI.
The official closing ceremony was organized towards the end of the day. SISN handed over the baton to India. ASCoN 2025 will be held in Chennai, India.
The 3 ASCoN awards were also announced during the ceremony. Prakriti Khatri from Nepal won the Best Paper Award for her paper titled “Psychometric properties of the Nepali version of Spinal Cord Independence Measure Self-Report”. Likewise, Thitirat Kusol from Thailand won the Best Poster Award for her paper titled “Inaccuracy of Urine Volume Measurement: A comparison study between urine in urine bag and volumetric flask”. The ASCoN Star Award was presented to Ms Esha Thapa, Executive Director of SISN for her relentless efforts and invaluable contributions toward improving the lives of persons with spinal cord injuries in Nepal and beyond.
One of the key highlights of Day 2 was the launch of the Nepal PMR Society.
Panel Discussion on Challenges and opportunities to establish comprehensive rehabilitation services in Asia
This panel discussion was moderated by Mr Stephen Muldoon, a consultant who has been working in the rehabilitation sector in Asia for almost 3 decades. The panelists included Prof. Dr. James Middleton from Australia, Dr. Dinesh Kafle from Nepal, Dr. Nazirah Hasnan from Malaysia, Dr. Fazlul Haque from Bangladesh, Dr. Narendra Pinto from Sri-Lanka and Ms. Nistha Shrestha from Nepal, representing the Ministry of Health.
Key points that arose from the interactive discussion among the Panellists and Q&A from the participants included:
- SCI is a complex condition requiring medical care and rehabilitation across the continuum of care – pre-hospital/acute care/rehabilitation/community integration/long term health maintenance. It was felt imperative that clear referral pathways need to be strengthened between service providers across the SCI care and rehabilitation pathway.
- It was highlighted that there have been many advances in SCI management in areas of acute care and rehabilitation. However, follow up of patients and long term health maintenance support for people with SCI living in the community needs to be strengthened.
- The importance of the integration of rehabilitation into government health and social care plans was emphasised. It was highlighted that Nepal has completed a National Rehabilitation Situational Analysis and that work is ongoing to finalise a National Rehabilitation Strategic plan.
- The importance of awareness and advocacy on the causes of conditions such as SCI was emphasised. It is imperative that service providers are in a position to demonstrate the life changing impact of healthcare and rehabilitation services for people with SCI and other conditions.
- It was highlighted that conditions such as SCI require specialised multidisciplinary care and rehab over a 2-3 month period and there is often a lack of rehabilitation beds across the country.
- Financing SCI care remains a major challenge, and mechanisms need to be found to fund comprehensive rehabilitation services. Key to this in the coming years will be the development of public-private partnerships.
- It was highlighted that bodies such as ASCoN have an important role to play and provide a platform for cross regional learning, exchange and networking.
Day 3:
Seven multidisciplinary workshops were organized at Spinal Injury Rehabilitation Centre on the third day. Around 150 resource persons and participants were present at the centre for the workshops.
Day 4:
Two main post conference programs were organised on Day 4. One focused on SCI Nursing Management where Dr Apichana from Thailand and a support team from Indonesia trained 36 nurses from various hospitals in Nepal. The other session was on the ISCoS SCI Standards Toolkit. Experts from Ireland, UK, Australia, Nepal, Netherlands and Italy participated in the session. EDCD representatives were also present in the session.
Conclusion
The 23rd Asian Spinal Cord Network (ASCoN) Conference 2024 in Kathmandu, Nepal, successfully provided a platform for knowledge exchange, collaboration, and innovation in decentralized spinal cord injury (SCI) care. Bringing together 311 participants from 18 countries, the event showcased a multidisciplinary approach, addressing crucial aspects such as specialized SCI services, primary health care, rehabilitation nursing, community outreach, and the integration of innovative technologies.
The conference played a pivotal role in supporting the overall development of Nepal and the broader Asian region by emphasizing the importance of inclusive healthcare systems. By strengthening human resource capacity, promoting innovative practices, and fostering collaboration among stakeholders, the event directly contributes to improving healthcare accessibility and quality. These efforts align with broader development goals, such as reducing health inequities, promoting social inclusion, and enhancing the productivity and well-being of persons with SCI.
With enriching workshops, impactful presentations, and engaging discussions, the conference highlighted the importance of collaboration between governments, healthcare professionals, and organizations. The active participation of stakeholders, including policymakers, medical professionals, and persons with SCI, highlighted the collective commitment to driving systemic improvements that benefit individuals and communities alike. The knowledge shared, partnerships forged, and policies discussed during the conference will undoubtedly catalyze progress toward an inclusive, accessible, and sustainable future for SCI management, contributing significantly to the holistic development of Nepal and Asia as a whole.