Nepal – patients required to bring caregiver with them to hospital

Nepal – patients required to bring caregiver with them to hospital

Life & Death Matters Post

In academia students are often asked to reflect “in practice” and reflect “on practice”.  Sometimes, when I am in the midst of an experience it is difficult to comment on it… it is too close, and words fail me.  While in Nepal, not only was it an incredible experience, and so stimulating to meet such warm and kind people, but I had a difficult time understanding and sorting through the finer details of things.  There were pieces that I could not post because I was not sure I was correct in my assessments, or in my understanding.

Mostly I was inspired by the beautiful people, the genuine caring, and the intelligent and well educated nurses.  I was thrilled to be there, at the invitation of Dr Robin Love, to adapt the ‘Essentials in Hospice Palliative Care’ resources for the developing countries.  It was so much easier to make some of the changes when I was in this setting.  Not only was I more focused, but I was also able to hear the concerns and witness the realities of their caregiving.

Perhaps the most startling revelation was the requirement that all patients must have a family member to care for them while in hospital. As I consider this request, I can not help but consider how this would impact all those involved, I wonder how many people are not able to come to hospital because they do not have a caregiver, and consider those who leave their homes, jobs and children in order to provide care.   Then I picture the caregivers who sleep on the floor beside the bed, wash their clothes and hang them outside to dry, and are required to purchase and bring to the hospital all medications that are not stocked and supplied by the hospital.

In Canada we are challenged to provide good care for patients. Staff shortages are stressful for both patients and nurses.  I wonder if the time will ever come when patients will be told to bring their own caregivers with them to the hospital…



5 Responses

  1. Hi Kath , just checked your blog.You have assessed correctly in a very short period of time spent in Nepal.The visitors are the must at the hospital along with the patient and they are the care takers most of the time.They are always having a vital role from the day of admission to the day of discharge.They bring them food, wash clothes, buy medicine, take them to the bathrooms and many more.Only few people who don’t have their relatives come alone and you can really imagine what its gonna be a patient without a visitor.Nurses do care for them but its never going to happen like a visitor or relatives.And most of the patients are forced to be discharged or leave hospital because the relatives have so much of work pending or missed.The family member are so concerned when the patient is going to be discharged starting from the day of admission.I wonder when its gonna be like family member drop the patients to the hospital and nurses gonna take full care of them.

    1. Srijan,
      Many of the stats were presented during the conference “The future of palliative care in Nepal”. (I hope that i credited them correctly!)
      Wonderful to see the nationals and the visitors gather to discuss this, and to hear the presentations of the Nepalese people who had such great content to share.

  2. Hi Kath, your assesments are quite right. But there are some other things that are missing… that is understanding the culture.Is it law, rules or what that a patient have to bring the caregiver to the hospital with them.Its culture, we live in joint family , a very social life, a close bond with family. In western culture we wont find people living up to 3 generation together. Sorry if I am wrong…. another fact is that Nepal as a developing country… a role of nurse could not be possible same as you define in western ethics, a holistic care… The load of patient is so high that a nurse hardly have time to talk to patient.The main job of nurse … what I been seeing…medication,vital sign, follow doctors order… lack of nursing care… not their fault anyway. So, most of the care is done by family………………….

    1. PRavita,

      Thank you so much for your comment!

      I do not consider this an issue of “fault” but rather, that it is different in NEpal, and it is something that I can learn from, and that perhaps all countries can learn from. The reality in Canada is also that the nurses do not have excess time – and there are too many times when patient care is not provided in a manner that is acceptable to the patient, the nurse, the family…. Including families more may be something that we need to learn from Nepal and other developing countries.

      As you mention, people do not often live together in multigeneration family units. So, if the nurses are not able to provide care, then WHO would a patient bring with them? This is a challenge we face. I wonder if there are people in Nepal who also face this challenge, and how this is addressed for those whose family are working or who do not have family.

      And, in Canada and the USA, one of the things that requires so much of nursing time and energy is the requirement to complete a LOT of paper work. And though the intent behind the paper work is supposed to be to improve quality of care, it may also be for legal protection issues. The paper work can decrease the time with patients and consequently may decrease quality of care.

      Culturally, although many families help with caregiving… I wonder how we could include those families who want to be included, in a way that allows the family the opportunity to provide care using the resources in the hospital, the supportive presence of nursing. This might not only benefit patients, but also family and nursing, and other patients. Not sure how this would be integrated without causing families to feel burdened, or resentful, and address the challenge of rising patient load.

      What do you think Pravita? Other thoughts?

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Courtney Murrell is a PSW who works in hospice palliative care.

When she is not at work, she is spending time with her family, going on hikes or writing. Courtney is a lifelong learner and loves to share her passion for writing as a wellness practice.

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