Lament of Psychiatric in Nepal:

An alternative to mental health care
E kantipur MAR 19 - 2012
Many of my patients come to see me with complaints of pains and aches in their bodies. Careful history-taking, examinations, along with other necessary investigations usually help me come to a diagnosis. But then there are those patients who have vague, non-localised pains, and who don’t fit into any organic diagnosis. In these cases, I refer them to my psychiatrist colleagues for an opinion. Invariably, these patients are labeled as suffering from depression and go on to receive psychiatric treatment. Mildly depressed individuals do well with counseling and medication, but the moderate and more severely depressed individuals generally need longer and more intensive treatment.
There are often patients who require regular counseling, apart from being prescribed medication. Unfortunately, many of them live far away from urban areas and do not have easy access to psychiatrists, compelling them to give up on their treatment after a couple of sessions; logistically and financially, it is not possible for them to continue. In Nepal psychiatrists are a rather rare breed of specialists—there are just a little over 50 catering to patients in the entire country. The patient load is such that they just don’t have the time to counsel at length the way they would prefer.
Poverty and lack of education among the vast majority of our patients are also reasons why they may not receive any reassuring counseling from family members and proper treatment. This is why Mr KBC from Ramechhap district, who initially came to see me for vague body pains, could not follow up his treatment with a psychiatrist. In the UK, social workers reach out to the needy in their own communities and help them along in their treatment when they fail to come back for a follow-up. The Nepali state has no such provisions. In KBC’s case, as professional counseling was not possible and his family was not of much help either, he turned to religion for relief. Although he’d been born a Hindu, there wasn’t a single temple in his VDC or priests to counsel him in his time of need, which led him to seek support from a church in his village, one that had opened its doors 10 years ago with donations from foreign sources.
This highly-organised Christian institution gave him the support and counseling he desperately needed. He converted to Christianity, as have 300 others in the last 10 years from the adjacent three VDCs with a collective population of 30,000. KBC became better and left medication. He eventually relapsed, however, and returned to us and was promptly referred to a psychiatrist.
Depression is a huge problem in our country, as it is all over the world. From the seventh position a little more than a decade ago, in 2020 it is expected to climb to the position of second leading contributor to global burden of disease in the world. Our history of violent conflict in the recent past, widespread poverty. and societal inequalities—these could all be responsible for the high prevalence of depression. The prevalence, based on a small community survey done in Kathmandu 25-30 years ago was 15 percent, but this figure may be much higher today. And possibly as an outcome of the government’s inability to provide us with solutions to the many mental health problems existing in Nepali society, we are now witnessing the proliferation of churches all over the country as a result of steady inflow of foreign money from Christian donor agencies. These churches have taken up the role of counseling these poor patients who have been failed by their state and their own society.
Christian organisations have a history of providing good education (St Xavier’s school, for example) and health services (Shanta Bhawan ie the current
Patan Hospital, for instance), and have now extended their support to the mental health arena too. These churches do well because they are usually dedicated, extremely well-organised, well-versed in local societal problems and very result-oriented: traits I would actually like to see in our state actors if health care in our country is to be taken forwards.
Nepal is chock-full of complainers. We complain all the time of the perpetual problems of bad governance, poverty, injustice and inequality, but when it comes to putting in the effort to find a way out, we become passive. If our political leaders have consistently failed to place us in the path of peace, stability and prosperity, it would be logical to seek alternatives ourselves. Maybe we could ask the Christian proselytisers to give us some pointers on how to move forward. They have the required qualities and a track record of being able to deliver their target objectives.
I am certain they would be happy to help us, if we ask them.
Dr Lakhey is the Professor of Orthopaedics and an Orthopaedic Surgeon at the Kathmandu Medical CollegeMarch 19, 2012 ekantipur