1

OTs have an important role in reducing the impact of trauma, illness and impairment on disability

and social exclusion. Whilst the people of Nepal experience some of the greatest burden of

disability in the world, with only 8 OTs in the country we estimate there is only one OT for

every 1/2 million disabled people. At UiH we are facilitating a debate concerning how we, with

other key stakeholders, can promote the OT profession, build capacity in the OT profession and

ultimately develop opportunities to train Nepali OTs.

Planting the seeds for Occupational Therapy training in Nepal

I N S I D E T H I S

I S S U E :

Planting the

seeds for

Occupational

Therapy training

in Nepal

1

Bringing Art

therapy to

inpatient

psychiatric care

2

School

counselling: a

form of talking

therapy in high

demand across

South Asia

3

Building local

capacity for

mental health

and emotional

support in Ilam,

4

Sri Lanka:

programmes

temporarily

suspended

6

Challenges of

working high up

in the Himalayas

7

M A Y 2 0 1 9 V O L U M E I V , I S S U E I I

Quarterly Newsletter

Global Health

Above: Marjorie Gardner (UiH UK), Luvana Shrestha (UiH Nepal ) and Dr Pradip Singh (NMC) at a mapping and

needs analysis workshop of the current OT services in Nepal, with members of ANOT (Association of Nepalese

Occupational Therapists). Kathmandu, March 2019. Credit: UiH

2

Bringing Art therapy to inpatient psychiatric care: the

impressions of Nepali Art Therapist Lajja Dixit

“A journey of a thousand miles begins with the first step… is very apt for my expedition of introducing

Art Therapy in Nepal. The road has been exhausting but not impossible. My exploration now has

found a stationary point at Nepal Medical College Teaching Hospital (NMC) where I have had the

opportunity to reach out to more people in need of the support I can give, through Unity in Health

Nepal.

As with the start of anything new, there are difficulties and obstructions, which with a cool head and an

honest heart can be dealt with. For instance, I have had some situations and difficulties while beginning

my work at NMC. Art Therapy was new to the doctors and Nurses alike, in the psychiatric ward, they

did not know what to expect and how it actually worked, but as days passed and they saw how it

could be of use, they realized the essence of Art Therapy for treating patients.

Then, minor issues, such as, a stinking toilet next to the art room, made working with patients difficult.

It was more distracting for me and made focusing on work much harder. Talking about it with the

Head Nurse and then requesting the cleaning lady, politely, quickly made the issue disappear.

As I looked at patients and made files for each case, soon I realized that it was all in vain, since there

were no doctors coming in, to look at them and give their feedbacks, opinions about or act on my

findings. This was discouraging. But after talking to Dr. Pradip, the HoD, this obstacle was overcome as

he started sending other doctors to get the Art Therapy analysis from me about the patients or he

would normally come, sit, discuss and collect information, himself.

To start with, nurses felt I was an alien invader into their territory, as their rest room was taken and

converted into a comfort room. So, getting them to feel part of the Art Therapy process, took a while

and now, having the nurses involved has made things, healthier. The nurses recommend and suggest

which patients I see on which days. They give me information about which patients are interested in

sitting down for a session. This way, I do not have to any more, go around the wards asking and

looking for patients.

Work does not always come with problems; it comes with light warm moments too. Like the times, the

patients do not want to draw or sit for sessions but just want to come to the room because it is

relaxing and peaceful. Hence, the name – ‘Comfort Room’. Some come, just to look at drawings, so for

them I have books. Also, I am now trying to introduce music to the background, to make the ambiance

tranquil, but the use of gadgets like laptops and mobile phones draws unnecessary attention from the

patients. Therefore, a slight delay there due to my lack of knowledge in the technicalities of technology.

Besides, having outside people come and work in the wards is a big challenge because people refuse to

come and work in the psychiatric centers. It was clearly seen in the case of the wall sticker people.

They came once then they never showed up.

Finally, there is the commute to the hospital and back. The biggest hurdle, but one that can only be

overcome by the passion I carry for working in this field and the satisfaction I get when

patients recuperate, this reward is priceless. “

Lajja Dixit,

Art Therapist, NMC/UiH Nepal, April 2019

Above: Lajja Dixit, Art Therapist.

Below: Lajja discussing the

benefits of art therapy with the

NMC’s multidisciplinary team .

Credit: UiH

Transforming an old, dark and damp

storage room into the new psychiatric

unit “comfort room”. Middle: art

materials; Lajja discussing patient

reports with Dr Pradip and Head of

Nursing Bimala Koirala. Credit: UiH

“The nurses

recommend and

suggest which patients

I see on which days.

They give me

information about

which patients are

interested in sitting

down for a session”

3

School counselling: a form of talking therapy in high demand across

South Asia

In South Asia, the benefits of school counselling remain unknown to many school directors, teachers, parents and

children. Nevertheless, interest for this form of talking therapy is growing. Recently, Nepal’s Tribhuvan University

launched a new Masters in Counselling Psychology, lead by Prof Shishir Subba (Central Department of Psychology). UiH

has been invited to review the current Master’s curriculum, and explore ways of incorporating school counselling skills

into the current training programme.

In April and to start with, Tereza Nogueira (UiH British Brazilian Child Psychotherapist Volunteer) conducted an

interactive workshop on the role of counsellors in school settings with 38 students from Tribhuvan University's Masters

in Counselling Psychology, Kathmandu, Nepal. This was a dynamic, productive discussion on the importance of

counselling in educational settings, and a self-reflective exercise on the qualities, skills and attitudes of talking therapists.

Working with children with special needs

School counsellors work with children presenting a wide range of needs.

Understanding the obstacles and challenges faced by children with special

needs is central to the role of the school counsellor.

According to Autism Care Nepal, in this country there are an estimated

300,000 people with autism. Among them, about 60,000 to 90,000 are

severely affected by this developmental disorder. Nevertheless, autism, as

many other types of special needs, is unknown to most, including health

and social care professionals. Through the newly established Unity in

Health’s partnership with Tribhuvan University, UiH volunteer Child

Psychotherapist Tereza Nogueira shared with students her experience of

working with children with special needs. Counselling psychologists and in

particular those working with children and young adults are in a privileged

position to assess and provide structured support to those with special

needs, as well as their relatives. In a country where the stigma towards

difference is disconcertingly high, raising awareness on this and other

developmental disorders is the first step towards a more open, inclusive

society.

Over the coming months, Tereza will continue working with Prof Subba

and a selected number of students from the current Masters programme;

Together, they will design and implement an innovative school counselling

pilot project in and around Kathmandu, suited to the needs of both local

counsellors and above all of children and adolescents studying in this

region.

Module I, Mental Health Awareness training programme, Nepal Medical College (NMC), April 2019. Credit: UiH

Above: Prof Subba (Tribhuvan Univ) and Tereza Nogueira (UiH).

Below: Lecture “working with children with special needs”

Kathmandu, April 2019. Credit: UiH

4

UiH has been visiting Ilam, Eastern Nepal on a monthly basis since December of last year.

Together with our local partner NMC (Nepal Medical College), we bring specialist mental

health care to isolated rural communities that otherwise have no access to such form of

support. In addition to offering much needed mental health clinical services, our objective

is also to build local capacity and support community-based mental health care projects

run by those living and working in Ilam.

On our fifth visit to this region (April 2019), we met managers from five different hill-

based health care centres. Such services are the first and, in most cases, only port of call

for people affected by mental health problems. They are managed and run by Health

Assistants (HAs), who with limited training do their best to respond to the complex needs

of this region’s impoverished rural communities. Building their capacity to respond to the

mental health problems of those seeking support is central to the long-term sustainability

of psychosocial interventions in rural Nepal.

Building local capacity for mental health and

emotional support in Ilam, Eastern Nepal

Lecturing, demonstrating and collaborating: a multitude of approaches to

teaching and capacity building Unity in Health uses not one, but multiple approaches

to building capacity, sharing skills, and encouraging

lifelong learning and self-motivation among those we

work with and for.

At the HAs 2-days workshop, Angelo Leo (UiH Clinical

Nurse Specialist) and Tereza Nogueira (UiH Volunteer

Psychotherapist) ran a series of simple, fun, but also

highly effective group exercises aimed at encouraging

participants to reflect on their behaviour and actions

whilst working with others. Different non-threating

approaches to challenging unhelpful behaviours and

encouraging positive ways of working together in

multidisciplinary team settings.

UiH staff and participants at a two-

days workshop with Health

Assistants from five different Ilam-

based health posts. Credit: UiH

“Untangling the group” - one of several exercises ran throughout the 2-days workshop. Ilam,

April 2019. Credit: UiH

5

Female Community Health Volunteers:

The driving force behind community based

health and social care in rural Nepal Female Community Health Volunteers (FCHVs) are unspoken heroes who

deserve our attention. In rural areas of Nepal, as in many other low-income

countries, they are the face of health and social care. Mothers, young women

and grandmothers, in some cases illiterate and without having left their

regions of birth, are the only ones who visit patients and families at home.

They are the ones, where there are no health professionals around, who

have access to community life and who can best understand the structure

and norms of local societies. However, and despite their unique experience

and value to rural life, their role is not celebrated but ignored. At Unity in

Health, we are determined to empower such women, and to bring greater

visibility to their remarkable contribution to rural communities. As part of our

pilot community mental health care project in Ilam, over the coming two

years we will be training FCHVs in basic mental health support skills. We will

also be advocating for better working conditions, for some form of

remuneration, and for their inclusion in decision making processes which

affect the communities they belong to. We feel excited and honoured to

work alongside such unique individuals.

FCHVs Workshop, Ilam. April 2019. Credit: UiH

6

We are shocked and saddened by the horrific events which

took place in Sri Lanka on Easter Sunday. Our thoughts have been

with those affected by these attacks, with the people of Sri Lanka,

and with all of Unity in Health’s partners in the country.

For security reasons, our scheduled programmes in Sri Lanka for

this Summer have been temporarily suspended. These will

however resume as soon as it is considered safe for local

participants of our training programmes to travel to Colombo, as

well as for Unity in Health and our partner’s staff to organise such

gatherings in the capital city.

At Unity in Health we are counting the days to return to Sri Lanka,

and we look forward to continuing working with our wonderful

partners in this resilient, magnificent island nation.

Sri Lanka. Above: mother and child near Kandy; left:

quiet, southern beach; below: a family plays by the

Indian ocean, sunset, Colombo. Credit: UiH

7

London Office:

Unity in Health (UiH)

Top Floor

15 Arundel Square

London N7 8AT, UK

Phone: 0044 7843 275 373

E-mail: info@unityinhealth.org

Web: unityinhealth.org

Charity number: 1159008

Nepal Office:

Unity in Health Nepal (UiH)

C/O Chora Chori Nepal

Bhanimandal-4

Lalitpur, NEPAL

Phone: +977 9880299999

E-mail: luvana@unityinhealth.org

UiH is a Charitable Incorporate Organisation (CIO)

registered with the Charity Commission (England &

Wales). We are committed to improving the

number and quality of mental health services in

regions where these are insufficient or non-existent.

To find out more on how you can help us to

support those at the front line of health care

services in low and middle income countries, please

visit our web page on unityinhealth.org or write to

us on

info@unityinhealth.org

We look forward to hearing from you!

UiH Team

Challenges of working high up in the Himalayas

For more information on how you can support Unity in Health and the work we

are doing in South Asia please visit www.unityinhealth.org or

www.facebook.com/unityinhealth.org

The monsoon has arrived in Nepal, this year

a little earlier than expected. With heavy

rainfall comes the challenge of reaching

remote hill communities. Blood, sweat but

not tears. Just very muddy shoes and a large

smile when we reach the top!