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Addressing the need for palliative care

in Nepal - the building of a hospice

and palliative care education centre in


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


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


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.




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