Four facilities (Hospice Nepal, Bhaktapur Cancer Care Center, Scheer Memorial Hospital and Kanti Children’s Hospital) were chosen as sites where palliative care would be developed. By February 2005, 25 beds had been designated and were functioning. Dr Stuart Brown is the Director of the Palliative Care Program. He, three other palliative care physicians, two nurses and a psychosocial worker have made several trips to Nepal. They have given lectures, conducted clinical workshops and attended ward rounds. The core training elements include modern methods of symptom palliation, the correct use of opioid medication and the psychosocial support of patients and their families. INCTR funded seven physicians and 24 nurses from Nepal to attend intensive courses in Calicut, India, where there is a well-established training program and similar socio-economic circumstances. Clinical guidelines have been written and will be developed further over time. As a consequence, extensive educational gains have been made and the quality of care improved. In particular, the World Health Organization “pain ladder” is now being followed.

Dr Brown has met with government officials and physicians to discuss the changes needed in healthcare policy and legislation in order to improve the availability, prescribing, distributing and dispensing of essential drugs (especially opioids). A home hospice program has begun and INCTR has provided $10,000 for the purchase of a vehicle, which is essential to the development of this program. Lastly, a number of Nepali physicians and businessmen have formed the “Nepal Palliative Care Group” which meets to discuss collaborative projects.

Future plans for Nepal include the establishment of a rural outreach service, expansion of pediatric palliative care, implementation of web-based teaching and support, and extension of the program to other regions.

It has become clear that the success of initiating and sustaining effective palliative care schemes depends on establishing the World Health Organization’s foundation measures; that is, educating the public, healthcare professionals and policy makers about palliative care, ensuring the availability of essential drugs, and lobbying government to introduce policies that emphasize the importance of alleviating cancer pain. As a result of INCTR’s encouraging progress in Nepal, there are plans to introduce similar palliative care projects to other emerging countries in the course of the next two years. This organization is in a unique position to promote such ventures because of its longstanding partnerships with institutions and societies in many of these countries. If successful, thousands of patients and their families will benefit.