Nepal

Thanks to the presenters at the INCTR “Expanding Palliative Care in Nepal”  April 7,8, 2012 in Kathmandu for teaching me about Nepal! If any information is incorrect, please comment or email me.

Nepal:

• Population 29.3 million
• Percent of people with running water 2.8%
• Unemployment rate 46%
• Young population – 20 years Median age
• Gross national income per capita USD 1,120.
• Half of the population live on less than US$1 per day.
• 38% of the population live below the poverty line.
• Illiteracy is very high: 40% of men and 75% of women not able to read or write.
• Approximately 40% of people can access health care in less than ½ hour travel.
• 80% of population lives rural.  After they access the hospital once or twice, they often do not bother to return. The distance is too far, and they have expended all family finances.
• Patients with cancer who are terminal at time of diagnosis – 69%
• There are approximately 2 beds per 10,000 people
• Most common cancers, men, lung, larynx, stomach…
• Most common cancer, women, lung, cervix, breast, stomach…

Dr Bishnu Padel on Opioid availability for palliative care

• 2003, 6 countries consumed  about 80% of opioid.
• Developing countries, 80% of the world population used only a small percent of opioids.
• 200 years after discovery of MS, oral MS was finally approved for Nepal… Dec 29, 2004
• Oral Morphine available in 2005, but the supply was irregular
• Why: supply, policies, regulations, paperwork,
• Together, it made it very difficult to access Morphine.
• Nepalese started making Morphine October 2009
• And MS tabs in 2011. Now Nepal has access to Immediate release, slow release, injectable, and oral syrup…
• Now, there is an increased consumption… but still only  0.1898 mg per capita…
• Most hospices and hospitals have a supply of MS, but many rural areas do not!

Global issue!

• 80% of the world lacks access to essential pain medications.
• 15% of the world consumers 94% of global Morphine.
• Morphine is the cheapest of all opioids.

Statistics indicate a need to increase global awareness and continue to advocate for global access to Morphine.

It is an exciting time to be in Nepal.  For those who have been here over the past ten years, there is remarkable growth and development in the field of palliative care.

Presentations by the Nepalese nationals were inspiring.  Fabulous presentations about including palliative care in core medical and nursing curriculum .

Hospice beds are increasing in number. curently five hospices, Some hospices have visiting teams.  Others have day care. ALl have inpatient beds.