Partnering to Deliver Palliative Care in Nepal

Two Worlds Cancer Collaboration (TWCC) over the past 20 years has been involved in a number of various initiatives in Nepal from cervical screening to palliative care, by means of educational and financial support.  We are now embarking on an innovative program of integrating these initiatives into one ’scaled up’ program that will allow maximum benefit to much greater populations throughout Nepal.  TWCC works in partnership with care providers in Nepal as we strive to build local capacity and sustainable programs with the ultimate goal of helping alleviate pain, distress and suffering due to life-limiting diseases, and to improve quality of life for patients and families experiencing terminal illness and bereavement.  

 Almost 80% of Nepal’s population live in rural/remote areas.  Most cancer/palliative care services are available only in the larger cities (e.g. Kathmandu, Pokhara, Bharatpur, Bhaktapur).  In rural/remote areas of Nepal, access to cancer/palliative care services is extremely limited and requires patients and families to travel long distances over difficult terrain, often resulting in late diagnosis, unnecessary pain and suffering, and limited control of symptoms.  The Closing the Circle Program will help provide services throughout Nepal, including rural/remote areas.  

 The COVID pandemic has added additional challenges as already scarce resources continue to be stretched to the limit in Nepal.  One of our most recent initiatives is to provide education/support through the use of the Project ECHO (Extension for Community Based Outcomes) education model which is ZOOM based and allows us to share knowledge and collaboratively discuss complex cases regardless of distance, geography, travel or convenience, and facilitate multiple education sessions with local healthcare providers across Nepal.  

 The ‘Closing the Circle Program’ is comprised of the following key initiatives:

• Cancer prevention through education, esp. regarding risk factors (smoking, alcohol/substance misuse, importance of vaccinations) 
• Screening & early detection, esp. for cervical and oral cavity cancer
• Education & training through fellowship programs, esp. related to cancer/palliative care and oral cavity cancer screening
• Rural/Remote outreach & expansion of pain and palliative care services to those areas of Nepal where services are currently very limited or non-existent
• Purchase of equipment and facility improvement to facilitate provision of cancer and palliative care throughout Nepal
• Purchase of medications, most notably Morphine, to help alleviate pain and distress

 By bringing together these elements, we will ‘Close the Circle’, creating a model program that can be replicated elsewhere.  

 The time is right to move forward with these initiatives!  This past year, Dr. Bishnu Paudel, a medical oncologist, has been appointed as Executive Director, Bhaktapur Cancer Care Hospital, Nepal with responsibility for the coordination and implementation of population-based cancer control, including a government approved national palliative care program for Nepal.  TWCC has a strong, long-standing relationship with Dr. Bishnu and he and his colleagues in Nepal are very keen and ready to move these initiatives forward.  

 After months of visits to different hospitals, Preem (above) was diagnosed with late-stage, male breast cancer. He and his family lived in a remote region of Nepal with no access to healthcare without a days of travel. The months of hospital visits and tests exhausted the family's finances leading them to sell their farm to pay for treatment. Eventually he was referred for palliative care  at a hospice in Thankot – 15 kms west of Kathmandu.  Preems' circumstances are common in Nepal

 Please help us ‘Close the Circle’.  Your funding support is needed!