Mobilising the community for the provision of palliative care in Nepal

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This article originally appeared in ehospice

Nepal has a population of 28 million with 87% of the population living in rural areas. These communities are often isolated and inaccessible because of the country’s mountainous terrain.

Based on the best available evidence, it is estimated that at least 112,000 people each year in Nepal will be in need of palliative care.

Whilst palliative care is developing in some urban centres, most rural areas are without any palliative care at all.

As a low-income country, healthcare resources in Nepal are over-stretched even in major cities, with people in remote areas often only receiving the most rudimentary healthcare.

Nepal is also experiencing a demographic shift as life expectancy increases with the successful control of infectious illnesses and improving maternal and child health.

The result is that there are increasing numbers of older people and people living with non-communicable diseases in the community.

As has been demonstrated in other areas in low and middle income countries – particularly Kerala in South India – empowering local communities to develop a vision for caring for their frail elderly and those with advanced illness is an important step in providing comprehensive palliative care.

Community empowerment is particularly vital in Nepal as the traditional extended family structure is weakened, with younger family members moving away to work in cities or overseas.

For a number of years, there has been a small palliative care service based at the Green Pastures Hospital in Pokhara.

The invitation to deliver a workshop emerged from the advocacy for palliative care undertaken by the Green Pastures Palliative Care Service.

Over 60 women of all ages from Pokhara and the surrounding area enthusiastically participated in learning about palliative care – why, what, where, for whom, how and when.

They were taught listening and communication skills and gained ‘hands-on’ experience in caring for someone who is bed bound, including: changing sheets, washing hair and positioning for maximum comfort.

The workshop was facilitated by two palliative care nurses, a counsellor and an Australian palliative care physician who lives in Nepal.

This workshop is just a start. We have a vision to develop this work further extending it to other community groups.

By adapting palliative care training materials, making them culturally appropriate and helping groups to organise themselves to provide care in the community, our aim is to develop ongoing support structures with long-term sustainability and a model which is appropriate for Nepal…read more

We strongly welcome any palliative care worker to share your experiences and stories with us. Please feel free to email Joyce at [email protected] your photos and and with a short description today!