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: [email protected]
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: [email protected]
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
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!