Alcoholism is a huge problem in Nepal. I see men and women in their 30s with liver failure because of alcohol. Many of the ethnic groups traditionally brew their own alcohol and will start drinking in childhood.
The Newaris – who are the predominant ethnic group in Kathmandu valley – traditionally drink rice wine every day, and lots of it during their many festivals.
How well this law is enforced is another matter, but I’ve noticed the ‘supermarkets’ have been building glass partitions to separate off their alcohol section from the rest of the shop.
The biggest problem though is in the tiny, local shops, where bottles of whisky and local brew are on the shelf next to soap, instant noodles and shampoo. Every local tea shop makes most of their money not from selling cups of tea, but from the cups of ‘home brew’ rice wine.
Detox
Alcoholics Anonymous groups do work, but there are not enough of them.
There are only two in Kathmandu valley, one of which is in Patan hospital. I learnt from a patient last week that a group also exists in Bharatpur, a big city in the south of Nepal.
Some other encouraging news is the increasing awareness in more rural areas of the problem of alcohol. Okhaldunga mission hospital in the east of Nepal, has started a community detoxification programme with follow-up in a newly-formed AA group. Tansen mission hospital is looking to do the same.
Doctors also need to be more aware and sensitive to the problems of alcoholics. One of my patients told me this week: “My husband is willing to keep coming to talk to you and to stop drinking because you treat him with respect – you don’t shout at him and tell him off all the time. Most of the other doctors just lecture him and that doesn’t work”.
I’m trying to work with my junior doctors to change the way they talk to alcoholics, because it makes a difference. It’s not easy to work with alcoholics, but it can be very rewarding.
The challenge is to see them as people who matter, so that they don’t end up like the man in this picture.
