Developing Palliative Care in Nepal
"Even though I walk
through the darkest valley, [a]
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me."
Nepal is one of the poorest countries in the world and one of the least developed countries in Asia. Poverty and low development means that the country has high rates of malnutrition, childhood mortality and poor health, and much of this burden is concentrated in poor and rural communities, which account for 80% of the population.
EMMS International has been working in partnership with the International Nepal Fellowship (INF) on a number of health projects since 1992. Together, we have a track record of delivering lasting improvements to health and well-being. Your support has helped to improve the lives of mothers and their babies, local communities with low levels of healthcare, people that have suffered life-changing injuries and people living with leprosy and TB. We’re now working to improve care and support for people living with life-limiting illnesses.
We need to do this because in Nepal, as in other low-income countries, disease demographics are shifting towards non-communicable diseases (NCD’s) like cancer, asthma and diabetes, These now account for 60% of deaths in Nepal and as a result palliative care needs in Nepal are significant and growing.
Nobody should live in pain. We believe passionately that pain relief is a human right. Human Rights Watch have identified that people living without adequate pain relief for conditions such as cancer, have reported levels of pain and suffering equivalent to people that have been tortured. It shouldn’t have to be like this, and this is why we are working hard to ensure that effective and easily accessible medicines are an essential part of our palliative care response.
Recent research shows that in remote rural district hospitals, more people are presenting with advanced NCDs meaning the chance of cure is low. Lack of staff trained in palliative care means unnecessary and expensive referrals to city hospitals, even for incurable illness. Subsequently, patients and carers spending time far from home become poorer. Many spend their limited resources on private healthcare promising a cure. Evidence also shows that the poorest people spend the greatest percentage of their resources on healthcare (circa 10% of their total income) thereby exacerbating poverty.
Women and girls face a double burden, as families are less likely to care for or pay for healthcare for them, leaving them to suffer pain. Women and girls shoulder the bulk of caring for sick family members, disproportionately draining their energy and resources. Nepal’s 2015 constitution limits women’s inheritance rights to married women, but many women are often forced to forego their inheritance after their husband’s or father’s death. This can mean loss of their home, and poverty for them and their children, from which they may take over a generation to emerge.
We plan to change this bleak situation, and help the people of Nepal to improve their own palliative care and wider well-being. We will do this by helping people to understand their diagnoses, which treatments are worthwhile and when there is no cure. This will directly reduce poverty from futile health expenditure.
People will receive the pain relief they need through access to appropriate medicines, and an option of home-based care or care close to home. Families will be helped by not spending on unnecessary travel, and take fewer and smaller debts to fund healthcare. Married women will be helped to ensure that they are not dis-inherited, enabling them to feed their children, pay school fees and be free from violence.
We have begun this work by supporting the training of Nepal’s first palliative care nurse specialist, Nurse Manju, who will primarily focus on rural poor communities, as well as those suffering life limiting injuries and illnesses as a result of the 2015 earthquake. She will be working with local church volunteers to bring medicine and care, and God’s love and comfort, to sick people and their families.
We are also working with INF and the Nepal Association of Palliative Care to undertake a needs assessment for palliative care across the country. And we have hugely exciting plans to develop new services and innovative models of care with INF and other partners going forward.
Care cannot stop when there is no cure, and many people with life limiting illnesses can have the quality, and often the length, of their lives greatly improved by palliative care. We are determined to make sure that as many people as possible can get access to the medicines and care that they need, and that those left behind are not burdened with debts and additional poverty.
Nurse Manju and her colleagues need your support to carry on this essential work. As she puts it: “I help them live with dignity even though they are walking ‘through the valley of the shadow of death’”. Your friendship with sick people, their families and Nurse Manju will make all the difference, and help to bring health and hope across Nepal.