- by Dr. Arun Jha FRCPsych, Consultant Psychiatrist

In 2008, the Nepal chapter of the South Asia Forum on Mental Health and Psychiatry (SAF-Nepal) and the Nepalese Doctors’ Association (UK) declared the week 20-26 September 2008 as the Mental Health week in Nepal. The key events took place in Kathmandu and Janakpur . We decided to join hands with the Alzheimer Association of Nepal (AAN) to celebrate the World Alzheimer’s Day on 21 September as part of the mental health week.

World Alzheimer’s Day is observed on 21 September each year by the Alzheimer’s Disease International (ADI) and Alzheimer Associations in different countries. According to the ADI, having a globally coordinated awareness day sends a strong message to governments and policy makers alerting them of the fact that dementia is a serious health issue which will have serious implications on services and health systems around the world as the world's population grows older. We received encouragement and support from the Nepalese Diaspora Volunteering Programme through the Connect for Change in the UK. This report summarizes the events and activities of the week.

Nepal is a small low-income south-Asian country with a population of about 27 million of which over 1.6 million (7% of the population) are over the age of 65 years, and this population is estimated to double in next ten years. In Nepal there is virtually no awareness of this problem amongst general public, professionals or policy makers. Even if it is not recognised as dementia, the illness places a heavy burden on both the elderly patient and their relatives.

As the average age of the global population increases, dementia and other age-related illnesses are increasing in prevalence. Recent estimates have suggested that over 24 million people live with dementia worldwide, with 4.6m new cases every year. However, a number of studies have suggested that the prevalence of dementia in the developing world is between a quarter and a fifth of that typically recorded in developed countries. New research suggests that this figure has been underestimated and that levels of dementia in the developing world may be much closer to those in the developed world. The research was conducted by the 10/66 Dementia Research Group, an international collaboration. The 10/66 dementia prevalence, as opposed to DSM IV dementia, was higher than that of DSM-IV-dementia and more consistent across sites, varying between 6% in rural China and 12% in the Dominican Republic. Even if we consider the risk of developing dementia in this age group as 5%, the global prevalence rate, it can be estimated that currently about 320,000 people would be suffering from some kind of dementia in Nepal. This figure is likely to double every 20 years.

The relatively high prevalence of smoking, alcohol use and the high and rising prevalence of Type2 diabetes are matters of concern in Nepal. There are many misconceptions regarding geriatric medicine and psychiatry. Geriatric medicine is perceived to be somehow connected to geriatric, i.e. senile patients, with unfortunate implications. It is not considered relevant to teach geriatric medicine to the undergraduates in medical schools. While trying to convince the government and policy makers to fill the glaring public health gap of dementia care in Nepal, health and social care professionals along with voluntary organisations need to help older people with dementia and their families. The following life story of an 86-year old woman succinctly summarises the plight of older people in Nepal:

In August 2008, the Alzheimer’s Association of Nepal (AAN) wrote to various international Non-Governmental Organisations (NGOs) for support. It was a pure coincidence that the NDA (UK) and SAF-Nepal were planning to organise a mental health week in Nepal in the autumn of 2008. The World Alzheimer’s Day on 21 September provided a perfect opportunity to plan the mental health week including a memory walk, Alzheimer’s workshop and a mental health camp in Janakpur along with articles in national media, radio and national TV.

Memory Walk indeed was indeed one of the highlights of the week. Despite the political turmoil in the capital that day several hundred people took part in an unprecedented mile-long walk in Kathmandu . The Alzheimer’s association was unsure until the previous night whether the walk would go ahead. To everyone’s surprise people, especially college students, started gathering in front of the international conference centre from 6 am. It was a stunning autumn morning in Kathmandu valley surrounded by panoramic Mountain View with glimpses of the Everest.

Participants from over eighteen different organisations and colleges marched with full of energy and enthusiasm. The smile on their face and banners in their hands they managed to announce clearly and loudly that we must hear the voice of older people suffering from Alzheimer’s disease and other types of dementia. Free leaflets were distributed amongst the passers by. The walk terminated at the Mandala with a vow to celebrate the WAD next year and every year. The group dispersed peacefully following a group photographic session.

The ceremony, presided by Professor Leela Devi KC, the NSCONN Chairperson, was well attended by representatives from over twenty organisations. The key note presentation on Alzheimer’s disease by the senior psychiatrist Dr. Dhrub Man Shrestha was followed by Dr. Shailendra Adhikari, Dr. Arun Jha and Mr. Ajay Chhetri. The release of a well-edited DVD on dementia was very moving by its first hand depiction of the trials and tribulations in the life of individuals with Alzheimer’s disease.

Each Medical College is supposed to have a psychiatry department to provide psychiatric training for the undergraduate students. Unfortunately, the Janki Medical College in Janakpur, Nepal could not recruit any psychiatrist due to an acute shortage of psychiatrists in Nepal. The first batch of its final MBBS students were due to graduate in early 2009 but they had no access to any mental health service in Janakpur and surrounding area. The SAF-Nepal offered a unique special training opportunity by organising a 2-day mental health camp in Janakpur on 23-24 September 2008. There were four psychiatrists at the Janakpur camp – one (AJ) from the UK, one each from Kathmandu, Dharan and Birgunj. We say nearly 200 patients in two days.

Following the success of the mental health week in September 2008, we organised a special conference on healthy ageing in Kathmandu and mental health workshops for doctors and health care workers in Janakpur. In total 50 doctors and 60 health professionals from Dhanusha and Mahottari districts participated in the training .