See here for Maiti Nepal Visit One

 

First Impressions

Through sheer happenstance, I managed to find a Psychotherapist to accompany me. Julia was from Norway, and specialises in early childhood development. She was working in the same hospital as me during my time in Kathmandu.

We met at the head office of Maiti Nepal. Accompanied by Sumitra, lead counsellor for the charity. She had been working for Maiti Nepal since its inauguration in 1993. To this day she gives counselling to new survivors and older residents.

The hospice is named after the daughter of one of the founders of the charity who had unfortunately passed away in a cycling accident in Germany. A framed photo of her is in the entrance hall. The Sonja Kill Hospice was around a 20 minute taxi ride away from Pashupatinath Temple, in a quiet suburban district.

I was asked not to take any photos whilst I was there. I agreed with this request as it felt inappropriate to be photographing the home of vulnerable women. The ladies who live at this shelter are living with the effects of their past, their ongoing illnesses and psychological traumas. To treat their place of safety with respect was the least we could do.

 

Service Provisions

There is housing for approximately 30 residents at the hospice. There is a doctor’s assessment room, a huge kitchen and dining area, a TV and entertainment room, and an education and training room. Something Julia and I loved was, a massive plot for therapeutic gardening.

Sumitra explained to us that the centre had been using therapeutic gardening, dance and singing since its onset. The residents engaged in these activities every day. Some of the older survivors had additional responsibilities like cooking and teaching. A few of the women required extra assistance with daily tasks, due to their disabilities. The staff and residents were very good at managing when for example, a young lady had an epileptic fit during some dancing.

 

Theraputic Gardening for Trauma Survivors. Pixabay

 

We had a fun time dancing, eating learning and talking with the residents during our visit and enjoyed how structured and playful the centre’s approach is to care.

The residences were curious and kind to us. Welcoming us into their home, and responded to our prescence exactly how they wanted to. Nobody was forced to join in or interact any more than they felt comfortable.

Julia spoke to me of her happiness at seeing this centre. She had been visiting charities doing similar work all over Kathmandu. She explained that the level of care was usually poor, and never more than basic. Julia had the impression that some other charities facilities were little more than ‘holding spaces’ for persons with psychological needs, and did not treat them as individuals. We were both touched that Maiti Nepal was doing such a good job.

We both sat down with two of the board members at the head office to present our findings after the tour. We explained what we thought was being done well. Also what we felt could be improved with no and low cost changes. In SIRPA style, we considered the needs of the community with the Physical, Mental and Emotional and Spiritual needs of the service users.

 

Suggestions:

All suggestions are with the consent of the survivor. If they don’t want to play/engage they don’t have to. No forcing of the below suggestions, as they will not have the desired effect of improving well-being.

(There was no reason that any suggestions would have been enforced, however, to get the best outcomes, consent is an essential precursor.)

 

Physical:

Group sports – ball catch/simple outdoor games. Daily time.

(no regular sport time is currently scheduled in the day. Regular out of hospice outings are arranged for those who are physically and mentally well enough to participate.)

‘Work stations’ – small tables or boxes to raise the work space. To allow working with a more comfortable position for longer time. Some residents find great solace in their jewellery making, so we want to make sure they are comfortable to sit their as long as they wished.

(Although we know from evidence that poor posture is not the cause of pain, it seemed beneficial for the residents to have a basic set up to make the day more comfortable. Long hours spent seated cross legged on the floor is not a bad posture, but regular changes can be very helpful for physical and mental rest. Breaks are already taken in the day, as much as individuals wished.)

 

working on the floor at the hospice. Pixabay

 

 

Well-being:

Self care amongst the employees: Self care policy

(An example policy from the International Centre for Missing and Exploited Children was shared. Maiti already do an excellent job of providing for the survivors. But, as with any team working with vulnerable people, employees need additional support to manage the stresses of the job, communicate their concerns and reduce chance of burn out)

Buddy system– set up between an older resident and a younger survivor entering Maiti. Someone they can talk to outside of the staff/patient hierarchy to learn the systems, expectations, but also a friend to share feelings and emotions.

(I owe this suggestion entirely to Carole Randell https://www.chronicpainreliefonlineclinic.com/ who offered to have a meeting with me to discuss what the SIRPA approach could do to aid the care at the charity. It was one of the suggestions Maiti felt most achievable at the hospice.)

Problem express box – each survivor to have a sticker/badge, something they can put in a designated box in case they wish to request counselling/any other discussion wishes. An opportunity to build on individualised care plans for each survivor.

(Most of the survivors cannot read or write. Therefore they would benefit from a way to express a need privately. This also allows for survivor driven support and encouraged agency.)

 

Somatic Awareness and Breathing Strategies:

Vipasanna – a few employees and some older Maiti residents to trial the technique at the Vipassana centre in Dhamma Shringa. Free course.

Annapanna Breathing Technique – old student to come from Vipassana main office in Kathmandu to teach survivors. Free service.

(Vipassana is a meditation technique that originates from Gottama the Buddha. It is non-secular and can be used by any person of any religion. Ideal and achievable to any person’s level of education, it is also free.)

 

Trauma tool - breathing and somatic meditation. Pixabay

 

Community projects:

Children days – for the women to teach the children how to do bead or garden etc. to foster caring roles and sense of purpose for the women. For the children to put on dance shows/ other forms of entertainment for the survivors. Bringing the Maiti community together in the hospice setting.

(This suggestion was inspired in part by Atul Gawande from his book ‘Being Mortal’. His influential work on the experiences of persons in geriatric communities found a significant improvement in quality of life and illness reduction by integrating outside life back into the facilities. To encourage elderly residents to take on simple care roles for others. In his book he uses pets. In Nepal, there is not a large relationship with pets, children were the next obvious choice. There is a school that Maiti Nepal runs for children born into the charity, and rescued from abusers. This felt like a perfect way to bring the community together.)

 

Children Days for the Hospice. Pixabay

 

Barriers and Learning

Reflecting on the input Julia and I gave to Maiti Nepal we notice one thing we could have improved. In part due to the constant need for translators, and due to the activity schedule of the day, we did not get a chance to interview a resident for their opinion. We advised that a suggestions and problems box was implemented. Knowing that the women’s voices are paramount, we should have requested more time to speak with them about service improvement.

Overall, Maiti Nepal surprised me with the good physiotheraputic and psychotherapeutic tools that were already in use. I was grateful to be asked for my advice on what they could do to improve further. The feedback received from the findings meeting was very positive and it felt good to help to improve a service considered from a Mindbody & social perspective. I left Nepal a month after this visit, having seen many more hospitals and remote clinics and I believe we had witnessed a very good Nepali example of hospice care.