“I like it here,” the 74-year-old says, adjusting his breathing tube and straightening his dhakatopi. Ghimire was diagnosed with cancer two years ago. 

“It is nice to be around people with friendly faces,” he says, pointing his frail finger at the health care workers in the lobby. “They are not like regular staff in other hospitals. They treat you like family, which gives me a strange kind of calm.”

One of the nurses who attend to Ghimire is Suchitra Lamichhane, who is trained in palliative care. The foremost thing Lamichhane and other nurse and health care workers are taught is to listen. “We listen to their stories, to the stories of their families and form a connection,” she says.

Palliative care or hospice, which are often used interchangeably, is an approach that improves the quality of life of patients facing problems associated with life-threatening cancer illness.

The idea of a modern-day hospice, which has flourished in the west, is a relatively new concept in Nepal, says Dr Rajesh Gongol, the chairperson of Hospice Nepal, one of the founding members of the institute that was established nearly 14 years ago. Gongol and a group of doctors, mostly specialising in cancer, continue to provide short courses on palliative care and collect funds from their social circle and donation from families to run the hospice at minimum cost.

Besides in-patient care, Hospice Nepal also offers home visiting service, day-care service, and general check up and consultations.

Hospice Nepal is one of the four such facilities in the country—three of them are based inside Kathmandu Valley and one is in Bharatpur, Chitwan—that provide palliative care to cancer patients.

Asis Kaphle, who lost his father to cancer three years ago, says palliative care centres offer ‘dignified exit’ to persons battling with terminal cancer, especially for those who come from a middle class or poor background.

Kaphle decided to keep his ailing father at Hospice Nepal after consulting his family members who were medical professionals. It was an informed choice, he says. “My father also said then, that he’d seen a lot of dignified people who didn’t had dignified death. And I knew he didn’t want that.”

The final stages of cancer can be very painful and, more often than not, family members—untrained in medical field—cause more harm to their loved ones.

“When the doctor told me that I should stop feeding my father, my immediate reaction was no. Had we tried to force feed him, he would have choked to his death,” Kaphle says, remembering what the doctor meant.

At Hospice Nepal, staff nurses have received training in palliative care. They administer painkillers, change oxygen cylinders, make periodical check-ups to see that the patient is at comfort. But it isn’t only the patient that needs support. The impending loss and the grief that comes with eventuality of cancer is devastating—if not more—for the family.

“The grieving period starts right when you find out that somebody has been diagnosed with cancer,” Kaphle says.

At hospice, Kaphle came across families on the brink of a similar kind of grief. “I’d rather be around someone who is going through the same pain, than with the relatives advising me what to do and what not to.”

The idea of taking your parent or a loved one to some other place than home is frowned upon in our society which, Kaphle says, is what keeps families from considering hospices. “There is this notion that one should die at their home. The concept has stuck and it is hard to break it.”

While the concept of opting for a hospice in the urban settings has more to do with societal perception and scrutiny, in the rural areas, people are oblivious to the very existence of such a facility.

Gongol, however, says they are expanding the palliative care service in rural parts of the country as well. They have started a pilot project in Makwanpur, where two trained nurses are looking after 30 patients in a village. “The idea of palliative care needs to be expanded and the government already has a great network of health workers to capitalise on it,” Gongol says.