Caring communities in Nepal: How EMMS International have supported thousands with compassionate palliative care
As EMMS International’s three-year UK Aid Match project in Nepal comes to a close, people with life-limiting illnesses and conditions are receiving the support they need, and long-held stigma around palliative care is starting to shift.
In Nepal, the concept of palliative care is still very new, and people are often unable to access the services they need to live comfortably and manage their illnesses or conditions, which can be extremely isolating. As well as this, children often take on extra household chores, as the work in the household expands when one family member needs the others to care for them.
With funds raised through their UK Aid Match appeal, EMMS International’s Sunita project is changing this, developing caring communities in partnership with healthcare professionals, teachers, and community groups.
The Sunita project offers a holistic approach to palliative care through cost-effective and sustainable health and social care services. Healthcare professionals and community workers have been trained to recognise the needs of those requiring palliative care, ensuring people can get the right support sooner and more effectively. This mix of community and healthcare training ensures people living in remote areas – who are unable to access a hospital – can still be supported within the community. For people who are able to travel for care, a dedicated wing at Green Pastures Hospital (GPH) in Pokhara is available where patients can receive specialised treatment and access vital pain relief and resources such as counselling.
Stories of change
When Ramesh was 17, he suffered a life-changing fall that left him very sick and feeling hopeless. His mother Lakshmi became his main carer. Through the Sunita project, Ramesh and Lakshmi now have a growing community of support around them. They receive home visits from community nurses and doctors so they are less isolated, and travel to GPH for specialised treatment and essential medicine.
Photograph: Ramesh at home
83-year-old Jit was born with no legs below his knees, affecting his ability to walk. His son Dal works as a builder and is proud to take care of his father, albeit he did this alone. Now, they are both supported by Ganga, a Female Community Health Volunteer who lives nearby in their community. After receiving training through the Sunita project, Ganga visits Jit around four times a week, and guides him on better sleeping positions so he is comfortable, supports his care needs, and provides crucial updates to his medical team in Sahodar so they can keep track of his progress.
Photograph: Ganga, Jit’s Female Community Health Volunteer
Advocacy, community support and caring societies
One of the most powerful aspects of the Sunita project has been its focus on the holistic, human side of healthcare. Dr Dan Munday, palliative care consultant at GPH and adviser to the Sunita project, explains how palliative care training goes beyond end-of-life support, shaping compassionate communication skills that can enhance other areas of health care too. “We are now gaining pretty good evidence that palliative care is a way of enabling people to develop those interpersonal skills, which then go across the whole practice. And they’re not just to do with end of life care or people with advanced illnesses but actually it’s something that strengthens your work with anybody.”
Empathy, compassion, and advocacy are central to this approach, supporting not only healthcare professionals, but volunteers and teachers. By centring local voices and investing in community volunteers, the project demonstrates that palliative care can be both accessible and deeply meaningful, even in remote regions. As palliative care becomes more recognised and accepted, teachers trained through the project are now able to provide child carers with additional support so they can continue with their studies.
“So that’s what we need, to actually work on all the aspects…. not just the physical aspects of things, but the social, the spiritual aspects and psychological aspects. You need a person who’s empathetic to cater to the needs of the patient or their family.” Dr. Amrita Shrestha, paediatrician and palliative care physician at GPH.
Photograph: Outskirts of Pokhara in Nepal, where Ramesh (mentioned above) lives
The legacy of the Sunita project
The project’s strong emphasis on holistic approaches and breaking stigma around palliative care is key to building evidence to support the Government of Nepal’s national care strategy, laying the groundwork for future policy and government action.
Not only is immediate impact from the project clear to see, but a rise in female leadership in palliative care in Nepal is also providing hope for a long-lasting future.
Take Dr. Amrita for example (quoted above). Encouraged by the success of the Sunita project, she has pursued specialised training and completed a fellowship in palliative care. On top of being a skilled clinician she has become a passionate advocate for children’s palliative care, an area that is critically underserved in Nepal.
And it is not just health care professionals. Arati has always been drawn to research and found herself leading a team of researchers under the Sunita project. Their work has contributed to multiple palliative care studies, with findings shared at national and international conferences, giving vital voices to patients and caregivers through data and evidence.
Dr. Bishnu Dutta Paudel Bucha, Professor of Medical Oncology and President of the Nepalese Association of Palliative Care is certain that the work of the Sunita project is shaping the way for palliative care across the whole of Nepal. “This finding of the Sunita project is very, very helpful if we really can use it to amplify in other districts of Nepal”.
These initiatives show that the Sunita project has not only paved the way for creating sustainable change, but with continued momentum palliative care in Nepal and beyond can be given the attention it deserves.
Read more about EMMS International and the Sunita project.
And follow them on social media to learn more from health care professionals involved in the project.
Through their three-year UK Aid Match project, Practical Action has supported Nepali farmers to take charge of their futures, adopting sustainable agricultural practices to overcome climate challenges and improve their livelihoods.
In rural Nepal, smallholder farmers – particularly women – face immense challenges as unpredictable rainfall, extended droughts, and rising temperatures restrict farming options and therefore limit their income. However, with the introduction of innovative climate-smart practices, farmers are adapting and thriving.
With funds raised through their UK Aid Match appeal, Practical Action has established climate field schools across three rural districts in Nepal. These schools are each led by a trained farmer ‘leader’, who provides knowledge and training on commercial vegetable farming, agroecology and regenerative agricultural practices. More than 1,000 farmer leaders are now using sustainable techniques like composting and bio-fertilizers to improve soil health and decrease reliance on chemical pesticides. Some of the climate schools introduced devices such as electric corn shellers and farm rakes, saving farmers valuable time and labour, giving them the opportunity to participate in other activities within the community.
Photograph: Farmers collecting tomatoes from their tomato plants
The programme has also improved water access by introducing an innovative solar-powered irrigation system. This has enabled farmers to be more productive and grow crops across all weathers, stabilising and increasing their income. Bishnu Oli, a woman farmer from Pariwartan village, said:
“We used to face severe water shortages, with no access to water, and the drought felt endless. We could barely farm and often had to rely on vegetables in the market for a meal. But with the solar irrigation system from the project, we now have water and can grow crops in multiple seasons.”
Photograph: Market operation in Nigalpani, Tribeni
Alongside the introduction of climate smart agriculture, women farmers have been supported to take on leadership roles within their communities and have their voices heard. More than 2,000 women have actively engaged in local government and cooperative planning, implementation, and monitoring activities, strengthening their roles in community decision-making. They have also participated in policy discussions, advocating for community and agricultural improvements.
This emphasis on inclusion and empowerment is key to the programme’s vision of long-term, sustainable change. By equipping farmers with climate-smart techniques, strengthening local leadership through peer-to-peer learning, and empowering women to take on active leadership roles within their communities, the programme is building resilience that will hopefully last into the future. With these tools and knowledge, farmers are not just adapting to climate change but driving change in their lives and communities.
Learn more about the project’s achievements.
On Tuesday 11 June, UK Aid Match grant holder ZSL held an event ‘Fostering coexistence between people and wildlife during global crises’ as part of their Science and Conservation series. They were joined by other UK Aid Match grant holders Ripple Effect, Tusk and WWF, who together shared highlights from their conservation projects and discussed important lessons to help shape future project design and implementation in this area.
Highlights from the projects
Since 2020, UK Aid Match grant holder ZSL has been supporting 4 communities in Kenya and Nepal to coexist with wildlife by increasing livelihood opportunities, building financial resilience and improving relationships with wildlife authorities.
Climate change can have a devastating effect on people and wildlife living in these areas – drought and erratic rainfall can lead to poor harvests and livestock deaths, and the lack of water can cause animals to venture onto community land, destroying crops and killing people’s cattle, goats and chickens. This can bring communities and wildlife into conflict and worsens relations with protected area authorities.
ZSL trained nearly 300 people in human-wildlife conflict mitigation techniques, such as building predator-proof livestock enclosures. They also established community meetings with protected area and local government authorities, providing a safe space for expressing concerns and suggesting solutions to conflicts. Over 400 people are now active members of a community banking scheme, helping to increase household financial management, and another 400 people have been trained in new enterprises including vegetable farming, beekeeping and shopkeeping.
“I have learnt that the environment including trees are very beneficial to us. Even the way I relate with wildlife has changed. I now know they are of great benefit.”
Photograph: A project participant with her goats
Ripple Effect and Tusk along with their partner Uganda Conservation Foundation, have recently completed a three-year ‘Living with wildlife’ project which supported people and wildlife to live side by side around Murchison Falls National Park in Uganda.
Similar to ZSL’s project, crises such as drought, flooding, and COVID-19 had an affect on project activities. Flooding displaced wildlife, like hippos, from their natural habitats, pushing them onto cultivated lands and increasing human-wildlife conflict. COVID-19 led to market closures, leaving farmers unable to sell their produce, and the disappearance of tourism collapsed the local economy, causing a spike in poaching within the park.
Despite these challenges, by the end of the project, 37,000 farmers had improved food security and livelihood opportunities. A further 260 young people benefited from apprenticeship and vocational courses, which were set up to provide alternative income from illegal activities such as poaching and fishing which can lead to more conflict. Community members and school children were offered trips to the park so they could learn the importance of protecting endangered species and advocate for the protection of wildlife in their respective villages.
“…After the park visit, I came back to my village and encouraged poachers to stop poaching wildlife. Three poachers have since stopped poaching after following my advice”.
WWF’s Land for Life project is improving the livelihoods and wellbeing of Maasai communities in Kenya and Northern Tanzania through sustainable enterprises, whilst protecting and recovering wildlife in critical corridors in the area.
Over the past few years, with the uncertainty of climate change and the rise of COVID-19, people were struggling to make a living with some resorting to unsustainable activities such as wildlife poaching, cutting down trees for firewood, and encroaching on important wildlife corridors.
WWF and their partners African People & Wildlife and South Rift Association of Land Owners (SORALO) are supporting 27,000 people to thrive with nature through community owned conservation. Maasai households transitioned from traditional corrals (enclosures for livestock) to predator-proof Living Walls which protect their livestock from carnivore attacks at night. These Living Walls involve planting Commiphora trees (or similar) in a circle around the perimeter of a livestock enclosure and secure with chain-link fencing.
Communities have been supported to understand sustainable rangeland management, learning to remove invasive plant species, allowing crucial habitats to regenerate. Further, the introduction of drought-tolerant sunflower cultivation and beekeeping has been successful in creating new economic opportunities.
“Nature has an amazing way of coming back, if you give it time and space”
Photograph: A Maasai community member stood next to his Living Wall
Key lessons and recommendations from UK Aid Match grant holders
- Factoring climate resilience adaptation into project design is vital to ensure projects are prepared for the effects of climate change and natural disasters. For example working with new partners to trial options for drought resilient livelihoods and / or improving the management and supply of water in the project area
- Whilst human-wildlife conflict measures can be extremely effective, they can also be limited to certain species and areas, risking pushing conflict to new areas. Implementing solutions at a landscape scale not a local scale can help mitigate this, taking a holistic approach to human-wildlife conflict management
- Improving relationships between community members and authorities is key for project acceptance and sustainability. This needs to be done over time, with regular engagement between communities and authorities. In some cases formalising this engagement is a good way to ensure sustainability – for example in Kenya, ZSL supported human-wildlife conflict resolution committees to provide a crucial platform for community members to discuss human-wildlife conflict issues with the Kenya Wildlife Service. In Uganda, Ripple Effect and Tusk took school and community groups on trips to the National Park, and these had a profound impact on communities willingness to co-exist with dangerous wildlife
- Building resilience with project participants is really important. Ripple Effect and Tusk found that farmers they worked with demonstrated considerably more resilience to crises than members of the wider community
- It’s important to commit to adaptive management throughout the project. Factor in time and budget to stop, reflect, explore the ‘why’ and adapt
- Every community is different and so all project designs need to be unique. It’s essential to consider local needs, cultural identities and traditions and to engage communities as collaborators.
