Pat and I recently visited Nepal to do some trekking but also to explore the possibility of working there.
Nepal is an amazing place where there is great poverty on a personal level but also huge national debt. Almost all things Australians take for granted in every day life is either absent or is a very low standard. Nepal is a Hindu country with its own blend of Hinduism and Buddhism perhaps related to the fact that Buddha was born in Nepal and Hindus in Nepal believe that Buddha was one of the reincarnations of one of the main Hindu gods.
The United Missions to Nepal incorporating over 39 foreign Christian agencies has been well established for some time and obviously has a significant role in health and community services. We visited the BP Koirala Memorial Cancer hospital, Patan hospital and the United Missions to Nepal and visited the only old people's home in Kathmandu, which is a focus of a Rotary Club project.
The BP Koirala Memorial hospital is in the southern lowland of Ramshahpath some four hours drive from Kathmandu. It has been built with Chinese funding and consists of a number of brand new multi-story buildings with guarded perimeter. It awaits instillation of diagnostic equipment, which along with the staffing and running costs is to be funded by the Nepalese government. We were told that this is to become the national centre for cancer and that it would be operational from April 1999. Ajani Kumar Jha who visited Peter MacCallum Institute in Melbourne has gone to India for three years to train as a radiotherapist with a view to working in this hospital.
Pat and I met the chairman of the governing body Ganga P Uprety, Dr Hari Dhakal, a pathologist in charge of the hospital and Dr Bidur Osti, Executive Director at a combined meeting in Kathmandu. All emphasised their intention of this cancer hospital to develop palliative care services and emphasised a strong desire for volunteer help from Australian palliative care specialists.
Pat and I saw the plans of the hospital, which included an administration block, wards, radiotherapy, pharmacy, pathology departments as well as a hostel for non-inpatients. Executives talked of a plan for a hospice but this was not included in that presented to us. The hospital will have 100 beds and will see about 300 outpatients a day. They are asking for help with teaching and setting up a continuous palliative care service and are willing to provide help with visas, transport, accommodation and meals but are unable to pay salaries. There was a hint that existing medical and nursing staff will be largely unaware of what palliative care is and does and it was not clear to me who was going to be educated in palliative care. The hospital was described as being 'semi-government' servicing the whole of Nepal and perhaps northern India but there was no definite connection with the university.
Patan hospital is in Kathmandu and the Medical Director is Dr Mark Zimmerman an American who arranged for us to have a comprehensive tour of the hospital which has been in existence since 1982 largely through the effort of United Missions to Nepal. There is now a board of management involving that body, representatives from the government and the community. I noted that the Nepalese government is only responsible for two percent of the running costs of the hospital, the remainder comes from private patient fees, United Missions and donations. In four years time the United Mission involvement will be withdrawn and the hospital is hoping to raise funds from its private beds to subsidise the remainder. It consists of 200 beds (27 private) and sees about 250,000 outpatients per year. There is a low-key community outreach program. We saw medical, surgical, paediatric, obstetric and gynae wards as well as a new small ICU and operating theatres and a small path lab. Just outside the main hospital is a day birthing centre, which copes with 12 deliveries a day. There are plans for an orthopaedic ward. It was obvious that the hospital is struggling to meet the demands for acute services with a much lesser involvement with advanced diseases and no palliative care in the planning for the next three years. Mark Zimmerman pointed out that the situation might change as the hospital develops.
Dr David Weakliam is the new Director of the United Mission to Nepal which has been working in Nepal for over 40 years to serve the people in the development of their capacities to build a better future for their families, their communities and the nation. It consists of over 39 Christian organisations from 18 countries working with the people in Nepal in health services, industrial development, education services and rural development in over 35 projects. Again, most of the medical and nursing services have been developed towards trying to match the need for acute services and community health projects. There are no immediate plans for the development of palliative care services in associated hospitals or in the community but David Weakliam pointed out that at some stage United Mission will give this consideration and then he will be looking for help ion education and planning from palliative care specialists.
Sally Smith is Director of the Sakriya Unit and working with United Mission to Nepal organising HIV/AIDS services with the main emphasis being on education and prevention. She is also thinking about palliative care service planning and development but as yet these are in the early stages. It is likely that she will be coordinator for these services within the United Mission to Nepal.
Nepal is a small country wedged between the old Tibet and India with a population of over 20 million coming from lowland, jungle, rich agricultural land in the south to hills and central valleys which contain most of the major cities and then onto the Himalayan mountain ranges. The people are very friendly and we felt very safe even in the major cities. It is well worth a visit but be prepared for anything.