REGIONAL PERSPECTIVES
53 CANCER CONTROL 2021
Addressing the need for palliative care
in Nepal - the building of a hospice
and palliative care education centre in
Kathmandu
Max Watson, Consultant, Palliative Medicine Western Trust, Director of Project ECHO at Hospice UK; Patricia
Newland, Executive Director, The Challenge Fund and Local Radio Presenter on Current Affairs, UK; Rajesh Gongol ,
Vice Chancellor, Patan Academy of Health Sciences, Founding President Hospice Nepal and Stuart Brown, Consultant,
Palliative Medicine, Waikato Hospital, New Zealand
N
epal is landlocked; located between India to the east,
south and west and the Tibet Autonomous Region of
China to the north. It has some of the most difficult
terrain in the world, with 75% of the country being covered by
mountains, meaning that access to the rural population to provide
palliative care guidance and medication is extremely difficult.
Nepal has a population of over 29 million people with
60% of the population under 30 years of age. The average
life expectancy has risen to 70 for men and 72 for women.
The Ministry of Health is responsible for the support and
administration of public health services including hospitals
and clinics. The Nepalese government has approved a strategic
plan for palliaitve care, but much work needs to be done to
achieve the goals of this plan.
The burden of noncommunicable diseases is rising and
patients with cardiovascular disease, cancer and respiratory
conditions being most in need of palliative care (1). Patients
with cancer have a high burden of symptoms such as pain,
breathlessness and nausea and vomiting. Two common cancers
in Nepal: oral cavity cancer and cancer of the cervix are known
to have particularly severe symptoms which are difficult to
alleviate (2).
Cancer incidence and survival rates in Nepal
Cancer incidence in Nepal is increasing and has become a
major public health problem. It is now recognized that more
attention should be paid to the need for palliative care - both
in urban areas such as Kathmandu, but also among rural and
remote communities. Lung cancer is the most common cancer
among males followed by stomach, colorectal and oral cavity
cancers. Among females, cervical cancer is the most common
cancer followed by breast, lung and gallbladder cancers.
Comparing palliative care in Nepal and the United
Kingdom
Dying in pain in Nepal is still a common occurance. In the
United Kingdom when a disease such as cancer is beyond
curative treatments, patients rightly expect at least to receive
effective pain relief, and many will be offered comprehensive
hospice care. However, in low- and middle-Income countries
(LMICs), such as Nepal, the great majority of terminally ill
patients have no access to pain relief medication and even
less access to hospice care. As a result, many patients endure
very painful deaths, causing both patients and their families
immense suffering (Table 2).
Sandwiched between India and China and with a population of over 29 million
people, a quarter of whom earn less than US$ 0.50 a day Nepal faces many
challenges not least in healthcare. There is little palliative care provision for adults
and children's palliative care is in the earliest stages of development. There is an
urgent need for more hospice beds in Kathmandu as well as the expansion of the
current palliative care outreach programmes into the rural regions of the country
where 80% of the population reside. The number of trained palliative care health
professionals is limited and key to the new hospice facility will be a state-of-the-art
education facility.
MAX WATSON PATRICIA NEWLAND
RAJESH GONGOL STUART BROWN