The day before I left Nepal, I had the pleasure of meeting with Dr. Ganesh Koirala at Hospice Nepal in Patan. Dr. Ganesh gave me a warm welcome, invited me into his office, and offered me tea.
Hospice Nepal is the third hospice I have visited on this trip. They all seemed to have one thing in common: lack of access. Each place had way more patients who needed palliative care services than they could accomodate for. Most hospices are located in large cities, leaving a disparity for those who live in rural settings.
There are only four hospice organizations in Nepal. Hospice Nepal is the oldest, and has eight inpatient beds in addition to a home care service that covers 30 kilometers. Dr. Ganesh is the only provider available to see these patients, and he travels to their homes by motorbike.
Dr. Ganesh told me that only 2-3% of cancer patients die on hospice in Nepal, and 50% die without any type of medical service at all. Most people don’t die in the best way they could.
Being halfway through my trip, I started to reflect on all of the experiences that came before this. I was reminded one of my first blog posts about my trip in which I described an encounter with someone who basically told me the only reason to be in hospice is for the money.
When I talked Dr. Ganesh, I knew this wasn’t true. He doesn’t have hot water or internet in his house. His wife and children live in a village far from the city because even as a physician, he can not afford his childrens’ education in Kathmandu. It’s not about money, power, or prestige. Like so many others I’ve met on this trip, he truly believes in what he is doing.
I live in a place where I can pursue my passion for hospice while being paid a fair wage. Unfortunately many jobs that involve caring for others are underappreciated and underpaid in all parts of the world. Many of those who care for the most vulnerable struggle to provide for themselves, and this is not limited to end of life care.
Nepal is a poor country, with yet another corrupt government. All of their healthcare sects struggle to maintain funding. With limited resources, palliative care is not seen as a priority. I think that attitude transcends cultures, and it needs to change.
Our society values youth over old age, curative over palliative, and profits over people. Hospice and palliative care services are expanding around the globe, but we still have a lot of work to do in helping people to recognize that they are just as important as traditional medical treatments.
Many people fear hospice, or don’t understand its benefits. Hospice reduces suffering, cuts costs, and actually lengthens life by an average of thirty days. At the heart of hospice is the patient, their family, and their goals. Hospice proves that even at the end, there is hope. Hope not for more time, but for better time. Dr. Ganesh fights to improve the time patients have left, and so will I.