January/February 2004
Page 3
A Brief Report Of Stoma Activities And Achievements In Nepal
By Shanti Bajracharya, E.T.
Introduction
Nepal is a landlocked country, sandwiched between India and China. It rises from the Gangetic Plains to the northern border along Himalayan mountaintops that include beautiful Annapurna, Kanchanjunga, Dhaulagiri and Mount Everest, the highest mountain in the world at 29,022 feet. The capital city is Kathmandu.
A population of 23.5 million mainly work on the land as farmers and labourers with an annual income of $US220.00. Approximately 80% of the population is Hindu with the remainder Buddhist, Christian and other. Life expectancy for men and women is 56 years.
Condition of Ostomies in Nepal
Stoma care in Nepal faces a number of problems due to the poor health service or facilities. I mentioned above that Nepal is a hilly region with poor transportation facilities. People with ostomies have to walk 2 or 3 days to see me. The economic status of Nepalese people is also not good. Most ostomates are uneducated.
Nepal is a socio-culturally diverse nation. There are many problems in Nepalese society, which creates a cultural barrier for ostomates to go to temples and worship. They feel awkward attending social programs and parties, mainly because they think they are not normal. The bag leaks and the content is outside the body. Unfortunately I am the only E.T. nurse in Nepal.
It is not possible for Nepalese who are ostomy patients to afford bags. People who can see me are getting bags from Friends of Ostomates Worldwide (FOW). This program is a great help for poor ostomates.
Nepal Ostomy Association
Nepal Ostomy Association has been established in Nepal comprising 17 members, which consists of ostomates and senior surgeons. However, we are not yet able to obtain registration with the government of Nepal, because of political instability.
The Work
- Counselling pre-operative and post-operative patients.
- About how to apply bags.
- About life style.
- Special support for Ostomates
Education about Stoma Care
Since 3 years back I have been conducting classes on stoma care for about 4 hours for Nursing campus students of final year and nursing staff of different hospital. I hope they will be able to work in different parts of the country so they can teach a little about stoma care. This includes:
- Pre-operative information to the patient.
- Review of anatomy or physiology about gastrointestinal tract and urinary system.
- Making the stoma.
- Post-operative care and information about stoma clinic.
- Psychological considerations for post-operative stoma patients.
- Irrigation.
Stoma Clinic Report
I prepared two Stoma nurses who also took practical training in the Stoma Clinic. One from the same hospital where I work, the other from a hospital in another city which is called Bir Hospital. They want to run a Stoma Clinic so I am in process of establishing one there.
Ostomates here are growing more and more day-by-day. Since 1997 patient flow is like a pyramid. This the report since I started the Stoma Clinic till now:
1997 - 7 patients per month
1998 - 14 patients per month
2000 - 28 patients per month
2002 - 35 patients per month
2003 - 40 - 45 patients per month
The clinic is run once a month, starting with 7 patients, now it is 40 - 45, an increase of 600%.
Professional Difficulties in the Stoma Field
- Financial constraints.
- People are uneducated or unaware of the stoma problem.
- Surgeons are not aware about ostomates - How do patients manage this?
- Where do they get bags?
- Are the bags they use optimum for the stoma they have?
- How are they living their life with ostomies?
- How do they adjust in society?
- Government is not taking responsibility.
- There is no training school for specialized course.
- Geographical constraints.
- Cultural barrier.
Ostomy Bag Production
I am also trying to make simple ostomy bags here in Nepal with the help of one German man, Dilman. We have already made some samples and distributed them to about 40 ostomates. I hope this bag can be made by ostomates themselves, too.
Source: IOA Today - October 2003, via Inside Out On-line Jan/Feb 2004.
Return to This Issue Index
Return to Inside Out Home Page
Return to WOA Home Page