It can be said that because Nepal has similar socio-demographic characteristics to other South Asian countries and has undergone phenomena such as urbanisation and globalisation as in other South Asian countries, particularly India, the increasing trends in CVDs being witnessed in India 28 might well be taking place here as well. Besides, it must be noted that international migration studies on CVDs involving people of South Asian origin 29 30 have so far not recruited those migrating from Nepal, although the number of people who migrate from Nepal to Europe, the Americas and Australia is also substantial.
Infectious diseases, maternal and child health and malnutrition deservedly receive the attention of the government and external development partners—more so after the endorsement of the millennium development goals MDGs. Management of CVDs in Nepal has characteristically been focused on treatment rather than education and preventive healthcare. There has been a dramatic rise in the availability of interventional cardiology and cardiothoracic surgery services. Although these services are essential to save the lives of those who are already diseased, they have not helped to slow down the growing epidemic of CVDs in the country.
The increasing annual numbers of hospital admissions with CVDs also suggest the same. But the majority of the country comprises villages and healthcare in these remote areas is provided mainly by auxiliary health staff who do not have the training needed to deal with CVDs in the primary healthcare that they provide.
Apparently, there was an attempt to produce an NCD policy in the late s but the document did not translate into anything substantial. Another effort in has yielded an NCD policy draft. Highlights include integrated management of risk factors, capacity building and training, and surveillance. Unfortunately, the draft is yet to be endorsed by the government because of the ongoing political imbroglio. Furthermore, policies in other health-related sectors such as transport and agriculture also do not address CVD issues. Health-related legislative measures have also been absent or weak in implementation.
However, there is still no comprehensive anti-tobacco legislation, which should have been immediately in place after the ratification of the framework in However, the implementation of the strategy did not take place in most of the LMICs, and was probably overshadowed by a larger global agenda, the MDGs. The challenges and opportunities that are present in Nepal for CVD control are outlined in box 1 and feature in figure 1 as well. A concerted effort by all stakeholders at all levels is the call of the day if Nepal wants to control the burgeoning epidemic of CVD.
To ensure the smooth implementation of CVD strategies, the following areas, as advocated by the Centers for Disease Control and Prevention, shall need strong individual attention. This is an important aspect of CVD control as most of the risk factors are behavioural in origin and they need to be tackled at an incipient stage through health promotional activities.
Indeed, studies have shown that cardiovascular health literacy in Nepal is poor. Primary healthcare settings that reach down to the grass-root level throughout the country would be the most sustainable way of disseminating heart health messages to the public.
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Such a community-based health promotional primary care approach has been successfully demonstrated in many resource-constrained settings such as in Chandigarh, India, 38 and in Ashanti, Ghana. There is a dearth of public health personnel trained in CVDs and thus there is an urgent need to groom staff in this sector. Partnerships between government and private institutes are not conducive, leading to a lack of concerted efforts to deal with CVDs.
Lately, the Nepal Public Health Foundation, a non-governmental organisation, has taken up the issue of NCDs and is working towards bringing all the stakeholders together. Work from other developing and often politically disturbed countries such as Pakistan and Iran illustrates how CVD prevention can still be carried out with vision, leadership and partnership.
The Isfahan Healthy Heart Program 42 in Iran and the Heartfile Lodhran CVD Prevention Project 43 in Pakistan produced integrated public—private partnership models to work conjointly towards improving the heart health of the country, many of which are applicable in Nepal's context as well. Although the NCD policy in Nepal was already drafted in , no short-term and long-term programmes based on the policy have been formulated yet. At present, the Ministry of Health and Population appears to be at a loss on how to implement the policy in reality.
For effective implementation of the NCD policy, the geographical, ethnic, rural—urban diversities and differences must be considered while formulating action plans because the health system provision and health-seeking behaviour in urban areas are entirely different from those in the agriculture-based rural areas. For example, physical inactivity is not a problem for farmers whereas it is one of the major risk factors for CVDs in city dwellers. Tobacco and alcohol, on the other hand, are almost equally used in both rural and urban areas, but they have to be dealt differently when it comes to their control.
In the villages, these addictions are centred on the agricultural work and often they are the only means of leisurely pleasure and escape, whereas in the towns they often underline the urban despair, glamour and peer pressure. The existing hierarchical healthcare system that is decentralised from the centre to the grass-root level can be upgraded and adapted to take up CVDs. The existing healthcare staff have to be trained in order to deal with the present situation of CVDs in the country, which might only be the tip of the iceberg. The health policy should ensure equitable distribution of the workforce.
The grass-root level health workers can be used to screen for CVDs and risk factors such as high blood pressure as well as for health promotional activities as shown by the study in Chandigarh, India. Optimal laboratory backup is essential and a hierarchical model similar to the one for communicable diseases can be adopted for NCDs as well. The use of simple techniques such as glucometers for blood sugar readings and instruments for blood pressure and body mass index measurements should be possible at the lower levels of the healthcare system.
A referral system with availability of secondary and tertiary services in the district and central hospitals will ensure cost-effective utilisation of resources. Besides, Nepal has recently witnesses an increase in the number of new private medical colleges being set up across the country. These private medical colleges can be involved as partners in NCD control because they have the technical workforce and laboratories and can provide tertiary care services. This has to be achieved by expanding and standardising resources and activities and by establishing frameworks, methods and core indicators for evaluation of policies and interventions.
Here, it may be important to develop clinical and programme evaluation protocols that are most appropriate in Nepal's context. The healthcare system can learn a lot from the successful adoption of health programmes for communicable diseases such as malaria, tuberculosis and leprosy. The development of longitudinal surveillance systems to monitor progress would also be beneficial in this context. Appropriate methods for translation and dissemination of knowledge must be determined and tailor-made to suit the local circumstances.
Research to identify best practices for effective interventions should be carried out simultaneously along with the implementation of the intervention itself. In this context, Nepal can initiate the NCD interventions as pilot programmes in some districts of the country and a simultaneous operational research can be carried out to provide crucial insights to expand the programme to national or subnational levels. The public health personnel and cardiologists in the region can come together, for example, to develop specific guidelines for CVD risk assessment in the South Asian population.
There should be opportunities to carry out collaborative work at the regional and international levels on various aspects of CVDs—from community to catheterisation laboratory and from prevention to intervention. International agencies should stop ignoring the rising problem of CVDs in the region.
They should also coax the health policy makers in the region to initiate or accelerate programmes towards CVD control. Nepal is at an interesting juncture as far as CVDs are concerned. Although in bits and pieces, we now do have data that can no longer be overlooked but rather require us to come up with definite plans and policies for the prevention and control of CVDs. A rejuvenated global and national interest has given us an ideal platform to launch CVD-related policies and programmes.
It is now time to combine all these forces and put our plans into action. AV is the sole author of this manuscript. Provenance and peer review: Not commissioned; internally peer reviewed. National Center for Biotechnology Information , U. Journal List Heart Asia v. Published online Jan 1. Abhinav Vaidya 1, 2. Author information Article notes Copyright and License information Disclaimer. Accepted Jul For permission to use where not already granted under a licence please go to http: This article has been cited by other articles in PMC.
Abstract Cardiovascular diseases CVDs have now been finally recognised as a major public health issue in Nepal. Introduction Nepal is a small country of about 30 million people with vast ethnic diversity that is situated between India and China in South Asia. Open in a separate window. Challenges and opportunities for cardiovascular disease CVD control in Nepal. Challenges Political instability, malfunctioning governance, weak laws. Opportunities A well-set healthcare delivery system from the centre to the grass-root level.
Communication to convey the urgency and importance of CVDs through a long-term strategy of public information and education This is an important aspect of CVD control as most of the risk factors are behavioural in origin and they need to be tackled at an incipient stage through health promotional activities.
Public health leadership and partnership to foster effective leadership for CVDs There is a dearth of public health personnel trained in CVDs and thus there is an urgent need to groom staff in this sector. Action priorities to identify effective policies in cardiovascular health promotion and CVD prevention at the national and local levels to ensure effective public health action against CVDs Although the NCD policy in Nepal was already drafted in , no short-term and long-term programmes based on the policy have been formulated yet.
Organisational capacity at the national and local levels, including laboratories, to address CVDs and develop the needed competencies and resources through training The existing hierarchical healthcare system that is decentralised from the centre to the grass-root level can be upgraded and adapted to take up CVDs. Monitoring and evaluating the burden of CVDs and measuring progress in prevention and treatment This has to be achieved by expanding and standardising resources and activities and by establishing frameworks, methods and core indicators for evaluation of policies and interventions.
Policy research to develop a comprehensive agenda that fosters translation of this research into practice Appropriate methods for translation and dissemination of knowledge must be determined and tailor-made to suit the local circumstances. Family stays Living with Nepali families helps provide necessary context for issues raised in lectures and readings and is one of the foundations of your experience in Nepal.
Accordingly, your participation in Nepali family and cultural life is a factor in the grade for the Nepal Studies course. Over the course of the program, you live with two Nepali families, representing different ethnic, cultural, and economic backgrounds. For the majority of the program, you live with Brahman or Chhetri families in rural villages of the Kathmandu Valley.
During trek, you live with Sherpa, Tamang, or Gurung families in the Himalayan foothills. As many of us know from our experiences with traditional coursework, ideas removed from the complicated realities of daily life can often be dry and academic at best, inaccurate and irresponsible at worst. But experience alone, without the benefit of serious reflection, has its own shortcomings, particularly in a place as unfamiliar, stimulating, and challenging as Nepal. What factors — social, historical, religious, geographic, economic, etc.
What have you learned from your relationships with Nepalis, and how have these relationships shaped your experience and understanding of the country around you?
Considering these issues can lead to deeper, perhaps even more important, questions: What can I really know — about myself and others; about my own culture, and the cultures of another place and people? What are my responsibilities and obligations here in Nepal and in the world more broadly? The fieldbook provides you with an opportunity during your time in Nepal to record, evaluate, and communicate your thoughts, observations, and feelings on a range of areas central to Nepali life: Whatever the subject, assignments will ask you to synthesize material from traditional sources such as lectures or readings with what you learn through in-depth conversations and interviews with Nepalis.
The fieldbook asks you to make the most of your valuable time in Nepal not by isolating your ideas from your experience, but by combining academic reflection and experience into a more meaningful whole. Be sure to provide necessary context and background information — cultural, historical, etc. Your writing should include and integrate academic reflection, in-depth discussions with Nepalis themselves, personal experience, and other sources — readings, lectures, study trips, etc.
Kinship and Family Relations Kinship relations affect every aspect of social relationships in Nepali society and are a constant reference point for interactions at work, school, and village life in general. Learning the Nepali kinship lexicon will be helpful and important for understanding social interactions both in and outside of your family. Looking back on your time in Nepal, write a descriptive account pages of a cultural experience or encounter that has been especially important to you. Whatever your subject — family life, language learning, an incident during trek or your independent study project, etc.
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Your writing can draw from your journal and may take the form of a personal essay or a fictional account. This is an opportunity for you to begin to process your experiences and impressions, and to present a narrative of one important aspect of your time in Nepal. From the list below choose an article on a topic that interests you.
Using this article as a starting point, explore the subject through detailed conversations and interviews with Nepalis. The article will provide background information and a point of reference, but for this assignment your main focus should be on the conversations and discussions generated by the issue — i. Who you speak with will depend upon your topic: Whatever your topic, speak with several different people to get their perspectives and opinions on the issue, and include other sources to complement information gathered from your discussions.
You will have the opportunity to work with the gurus to learn new vocabulary and practice asking questions appropriate to your topic. After reading your article, make a list of vocabulary and questions that will be important and useful for your interviews and be prepared to discuss these with the gurus.
Focus on one aspect of village life that interests you and examine it by conducting interviews with at least five people. Work with the language teachers to develop a list of vocabulary and questions appropriate to your interviews. Talk with several people in the village, making sure to include people of different backgrounds, to get their views and opinions on the topic. Please be prepared to give a formal presentation minutes of your interview and to turn in a detailed outline of your presentation.
In the presentation, please present a background and discuss the interviews as well as your own analysis and thoughts on the issue. Include quotes from your discussions and supplement your interview material with references to readings and lectures where appropriate. Looking back on your time in Nepal so far, write a descriptive account pages of a cultural experience or encounter that has been especially important or challenging for you. You may wish to consider a single incident, or explore your on-going efforts to come to terms with a particularly challenging aspect of Nepali culture or society.
You might write about your adjustments to life in a new family, your language learning experience, confrontations with caste or gender differences, or a particularly provocative conversation in the bazaar or along the trail. The experience — describe, in detail, both the experience and your reaction to the incident, conveying the intensity and complexity of the encounter from your own perspective.
Be sure to provide specific narrative detail and focused descriptions of the experience. Cultural attitudes and influences — provide an account of the larger cultural assumptions and beliefs informing each side of the encounter:.
Explore Nepali perspectives of the incident, describing the individual and cultural influences, which may explain the thoughts, feelings, and actions of the Nepali or Nepalis involved. Be sure to talk to Nepalis about their impressions of the encounter and other similar incidents; speaking with many different people of different backgrounds will help to clarify your understanding of Nepali perspectives and attitudes.
Explore your own perspectives, considering both broader cultural and more personal factors, which informed your role and your reactions to the incident. Consider how much of your experience may be to traced to broader American cultural trends and perspectives, and how much of your experience is rooted in your particular personal and social background. As you step back and reflect on your experience, also step back and reflect on your attempt to reconcile differing cross-cultural perspectives of the encounter.
What kinds of difficulties do you face in trying to write about this encounter from all points of view and in explaining them honestly and objectively? Use the social, residential, and occupational history of one family as a means of understanding larger social and economic changes taking place in the Kathmandu Valley. Find one or more people in your home who can relate to you the history of your family over three generations. Learn the educational, residential, and occupational history of each member of your immediate family, making sure to include people from three generations.
After compiling these details, choose three people — one from each generation — whose lives you want to examine in more depth. Include an overview of the educational, residential, and occupational history of each family member. Provide more detailed description and discussion of the lives of three individuals from different generations. Discuss the changes and continuities you observe from one generation to the next; choose one or two topics of particular interest and focus your discussion accordingly.
What differences do you observe, for example, in the educational achievements between the youngest and oldest generations? Do you find significant changes in religious practice and belief between generations? What social, cultural, historical, economic, and other factors would help to account for these changes? Although your main source of information should be your observations and discussions with your family, supplement these with relevant information from lectures and readings.
Essential for understanding religion in Nepal is an appreciation of not just the philosophical or conceptual dimensions of Hinduism and Buddhism, but an understanding of religious practice on a concrete, daily level. Choose a public temple or shrine that is small enough to observe closely and that has several visitors 5 or more performing puja in the mornings and evenings. Plan to spend four half-hour sessions, ideally two in the morning and two in the evening, at the site. For the second two sessions, talk with worshippers about the puja — what do they say about the role of the ritual in their daily life?
Do you come to the temple every day? Why do you come to this particular temple? Do you always perform the same puja? Or maybe there is something that you have heard about but not yet seen and want to look into. Whatever it is, the Design Your Own is an opportunity to be creative or explore a quirky interest. The project can take an offbeat approach or can be a more conventional look into something that has struck you about Nepal. We encourage you to find some alternative method of presenting your findings—through photo essays, maps, charts, drawings, or demonstrations. If you find some graphic way to display your research, the written component of your project need only be 2 pages min.
If the heart of your project is in a written medium, then your write-up must be pages. For example, if you choose to focus on Nepali poetry, you could examine the writing of several Nepali poets, write poems of your own in the style of these poets, and then write about the tradition of poetry in Nepal. Write-Up Be sure to consider the cultural context of your subject, and its role or function in the lives of Nepalis.
If appropriate, describe the traditions — technical, cultural, etc. Also consider the impacts your subject has on the social environment of which it is a part. If you choose to study Nepali music, for example, you could focus on changes and continuities in particular musical traditions, and the social and cultural role of music in a specific community. In order to complement our lectures, and as a means of fostering discussion and analysis of both lecture material and related issues, we will hold periodic student-led discussion sessions throughout the course of the program.
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Though there are many possible topics to discuss, and though we could spend a good deal of time on any one topic, the demands of our schedule will have to limit our discussions somewhat. For each session, we will focus on two topics from the lectures we have heard; two to three students will be responsible for each topic. For each topic, the students should briefly recap the main points of the lecture, highlight any unclear or controversial points, suggest a few topics for discussion, and then open up the session to the rest of the group. The students presenting the topic will then have responsibility for directing or mediating the discussion as needed.
The topic should be chosen from the lectures we have heard, but need not limit itself to the lecture material. Each session will run for about two hours, so we will have about an hour to spend on each topic. The presentation of each topic should run five or ten minutes, and the students should prepare and present their topic together. In preparing your presentation, feel free to discuss any issues or questions with us. These sessions should be a chance for the group to have a more focused look at some of the lecture material, and to pursue interests and questions in more depth.
The Independent Study Project is a chance for students to explore in-depth an aspect of Nepal in which they are particularly interested. Project topics range from the empirical investigation of a research question to internships with development organizations. Students begin formalizing ideas for their projects during the second month of the program, developing an initial proposal for a topic and plan for their research.
During the actual project period, students function independently with program staff and advisers available for assistance when needed. Assessment for the Independent Study Project will be based on the following criteria: To deepen your understanding of topics covered in the core course, you will travel to various locations in Nepal. Day and Half Day Study Trips: These study tours are led by Tribhuvan University professors and allow you to complement classroom learning with direct observation and experience in the field.
Live in a middle hill village with a subsistence farming family. Terai Visit national parks in southern Nepal which are home to elephants, one-horned rhino and royal Bengal tigers. See firsthand how Nepal is attempting to integrate traditional subsistence farming activities in and around the park with sound resource management and ecological development. Annapurna Conservation Area Project ACAP Nestled in the foothills of the Annapurna Himal, this internationally acclaimed project attempts to take a balanced approach to traditional subsistence farming activities, tourism management, conservation, village health, development and education through involving local villagers in decision-making and implementation.
Half-day trips in the Kathmandu Valley Explore important Hindu and Buddhist temples, non-governmental organization sites, palaces, markets, festivals, pilgrimage sites, ancient cities, and the studios of local craftsmen. Buddhism, As I See It: Modernization is in the Eye of the Beholder: Community Structure, Relationships Within it, and Responsibility towards it: Women, Work and Food: Tourism and Societal Configuration: Public and Private Schools in Kathmandu: Birthing Practices in Nepal: From Bottom to Top: The Sickle and the Cleaver: The heart of the program is the family stay near Kathmandu and a middle hill village.
The chance to become a member of these Nepali families and to develop a personal relationship with the individual family members is a privilege seldom experienced by most trekkers, diplomats or researchers. The families often speak little or no English and live in brick houses with mud floors, little furniture, and no bathrooms or running water. There is little chance of privacy.
Lifestyles are heavily informed by subsistence farming practices and by traditional Hindu beliefs. Students often consider the family stays to be the most meaningful dimension of the program. Academics Courses Course Credits. Course Components Orientation Period: The Nepal Studies course includes the following components: Mukunda Aryal Economics Dr.
Jesuit Research Center, former editor, Kailash: Pitamber Sharma, former professor of geography, Tribhuvan University; specialist, issues in development and tourism Traditional Health and Healing Practices Dr. Media in Nepal Mr. Discussion Paper, Series No.
Tackling cardiovascular health and disease in Nepal: epidemiology, strategies and implementation
Emerging Ethnicity and Aspects of Community Adaptation. Ratna Pustak Bhandar, A Short History of Hinduism. Reviewing the Strengths and Weaknesses. The Anthropology of Nepal: Peoples, Problems and Processes. Mandala Book Point No Bang for the Buck. Social Change in a Buddhist Society of Nepal. Newar Buddhism and its Hierarchy of Ritual. Cambridge Studies in Social and Cultural Anthropology, vol. From Tradition to Modernity. French Cultural Center, Backwater or New Frontier?
A National Language and its Literature. Institute for Integrated Development Studies. A Country Study on Nepal. Nepal Research Center Publications No. Franz Steiner Verlag, A Cultural Study of the Kathmandu Valley. Princeton University Press, Myths, Limitations and Rational Concerns.