Originally from Pokhara, Dr Kuwar is a living history of mental health movement and the crusade against drugs that has been going on in Nepal for almost half a century.[break]
Study of psychiatry was something that happened to him by chance. Dr Bishnu Prasad Sharma was the only other psychiatrist in Nepal when he started out back in the Seventies. Just like mental diseases and the mentally diseased in those days, psychiatrists too were stigmatized in the society.
Bijay Gajmer
But when he got an opportunity to pursue Diploma in Psychological Medicine (DPM) from the Institute of Psychiatry in London under government scholarship, he decided not to miss it. He completed his degree before the designated time, and the university authorities were so impressed with him that they offered him a job as a consultant and appointed him as Member of Royal College of Psychiatrists (MRCP). He took up the membership but declined the job offer because he realized that since there was only one other psychiatrist in Nepal, his country needed him more than ever.
“The first contribution that I made to the field of Nepali psychiatry was to establish a neurological department at [the then Royal] Nepal Army Hospital in 1976 that consisted of fifteen beds,” Dr Kuwar informs.
His campaign against drugs and disorders began the moment he started practicing medicine in Nepal after his return from England in 1975. His target group was the youth who were lost in the darkest realms of heroin addiction. The Seventies saw a lot of drug-related problems owing to the massive inflow of Hippies in Kathmandu. A lane in Jhochhe, also known as Freak Street, was their major joint where hoards of them smoked weed, took hash and did drugs.
“There were thousands of addicts in Kathmandu. But the government had attempted to convince the general mass that the number was limited to hundreds,” the doctor reminisces.
Despite the blatant lack of support from the then government, Dr Kuwar did not give up. He had two acquaintances to support him with his endeavors: Father Gaffney SJ and Annapurna Kuwar. Father Gaffney would help those addicts who were economically downtrodden, and Annapurna Kuwar had taken up the responsibility of psychological counseling.
“We were finally able to convince the people that contrary to the popular belief, heroin addiction wasn’t the end of the world and that one could get over it,” Dr Kuwar recollects with a note of satisfaction.
Today, social and government agencies like I/NGOs take care of raising awareness and doctors are there to help the addicts with medical cure. Nepal Police’s Narcotics Bureau takes care of the demand and supply reduction of addictive drugs.
But he thinks the most challenging part is structural rehabilitation for the addicts. They need to be understood and accepted by their friends, relatives and neighbors. The government, too, he says, should be supportive of their efforts to get out of the addiction.
One autumn afternoon, over tea and cookies, the doctor, also a retired General of Nepal Army, opened up about his past and present endeavors and future plans with The Week’s Nitya Pandey at his clinic in Tripureshwor where he practices medicine these days.
What’s the field of psychiatry like at the moment in Nepal?
The general prospect looks good. This branch of medicine is being taught and practiced like any other disciplines. At present, we have around 98 psychiatrists in Nepal. In my time, there were only a handful of them. The society was still not open to the idea of mental diseases, and drug-related issues were considered incurable. The government too wasn’t very supportive. Nowadays, things are gradually changing. There’s a psychiatric ward in almost all hospitals, and people are becoming aware that mental diseases, just like the physical ones, can be cured with a certain amount of medication. The government has allocated 0.8% of its annual budget to mental health. It’s certainly not enough but at least it’s a small acknowledgment of our endeavors.
Sleep therapy is a common method used to treat those with mental disorders and problems. What is this exactly and how is it carried out?
I learnt this technique at the University of London. It’s the same technique that’s modified and applied at rehabilitation centers today. In this process, a mixture of major or minor tranquilizers and vitamins are given to the addicts at the interval of every 6-8 hours on the basis of their ages. This sedates them for certain hours. When the addicts are awake, they are made to walk, eat and talk. Gradually, the amount of medication is reduced. And after the medical detoxification process is completed, they are given counseling in order to divert their minds away from drugs.
What’s the most alarming mental disorder at present?
Depression is the most common problem in the present context. The World Health Organization’s research shows that 10%-15% of population develops the symptoms of depression at some stage of their life and 8%-10% out of the whole mass develop clinical symptoms. They need medical help and attention. Headache, insomnia, loss of appetite, tension, and suicidal thoughts are some symptoms of depression.
Other than those, there are also other mental disorders, like bipolarism, Schizophrenia, anxiety, food-related disorders like anorexia and bulimia, and Post Traumatic Disorder Syndrome (PTSD) that are constantly on the rise.
What can be done to battle mental disorders more effectively and efficiently?
The ailing ones should be brought out of hiding to see a doctor. They should take medication and attend counseling sessions regularly. A law regarding mental health should be introduced in Nepal. The concept of “force treatment” should be regulated which ensures that a patient is treated even if s/he isn’t willing to. Overall, people should change their perspectives and remove the stigma surrounding mental health and mental disorders.
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