Nepal: an inspiration for holism
RUNNER UP - SANDS COX CHARITY ESSAY PRIZE 2018 - DENTAL STUDENT
Nepal has been faced with political turmoil, civil war,
the collapse of a monarchy, corruption, the establishment
of a Constitution and devastating natural disasters – and
that’s just in the 21st century! Perhaps then, not a
comparator to the UK healthcare system which one
would immediately think of.
Despite such challenges to development, the country
has made strides towards the government’s aim to
become a lower middle-income country by 2030.
Upon visiting the country, one is taken aback by
the stunning diversity of landscape, food and religion.
However, by far and away, the most striking aspect of
the country is its people. Their welcoming nature is
immediately perceptible but after having been
immersed in a rural village for one month, the sense
of community is more than something to be appreciated
but becomes inspirational.
Dhunkharka is a rural village about thirty miles south east of Kathmandu. Although this may not sound very rural, the journey takes almost two and a half hours due to road conditions. The closest dentist is a two-hour journey away. If someone suffers from toothache, they are likely to apply clove oil to the tooth, visit a local health centre where there is no dentist or wait for a dental camp to visit over the next few months.
In aim of sustainably improving the oral health of the community, a group of students studying Dentistry, Oral Hygiene and Therapy, Medicine and Nutrition from universities in UK, Canada, Australia and Nepal conducted a health needs assessment and implemented a tailored intervention which considered the United Nations’ Sustainable Development Goals.
Universitis 21’s Global Learning Partnership program was insightful in many ways. Chief among these was the advantage of an inter-professional approach in healthcare. For example, the nutritionist student helped others to appreciate that asking questions about the amount and frequency of exposure to sugar and acid in the diet was insufficient. A few simple questions provided an insight into the balance of their diet, potential dietary deficiencies and ability to relate this back to medical and dental manifestations. The collaboration of different professional perspectives was vital in ensuring a sustainable intervention in Dhunkharka. A similar approach is required to ensure holistic patient care worldwide.
Many would argue the fragmentation of primary care in the UK is not conducive to providing holistic care (Peckham and Exworthy, 2003). This is not a phenomenon unique to the UK. Holistic care requires frequent, effective understanding and communication between inter-professional healthcare practitioners regarding individual, tailored patient care. There are some aspects of the health system which already facilitate this: joint GP and GDP practices; community health centres with multiple health disciplines; inter-professional undergraduate teaching. However, the joint practices tend to be mostly private and the health centres are restricted to community care – the vast majority of patient care is still provided in individual healthcare practices. Currently, most inter-professional education is restricted between dentists, medics and pharmacists. The issue at the moment is therefore twofold: holistic care is limited in both amount and scope.
The program in Nepal highlighted that healthcare is far more outreaching than medics, dentists and pharmacists. Physiotherapists, nutritionists, psychologists, optometrists, audiologists are just some key health practitioners who play a vital role in overcoming significant health challenges in the UK, such as occupational health, obesity, mental health and an ageing population.
One potential way to achieve this could be to ensure the vast majority of primary care is provided in inter-professional health centres containing an array of health professions. Such centres would not only improve access and awareness amongst patients but would also facilitate and encourage communication between health professionals to provide tailored, holistic care. More inter-professional education amongst a more diverse array of disciplines at undergraduate level is required to prepare professionals for this.
There are a number of barriers, particularly financial and political, to achieving this in the UK. Following an immersive experience in Nepal, the sense of community provided an inspirational metaphor for overcoming barriers to undergo sustainable development: a more integrated system promoting a collaborative, inter-professional approach amongst health professionals could be a useful mean of achieving truly holistic healthcare in primary care in the UK.
Peckham, S. and Exworthy, M., 2003. Primary Care: policy, organisation and management. MacMillan/Palgrave.