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Nepal Earthquake 2015

A case study of an earthquake in a low income country (LIC).

Nepal, one of the poorest countries in the world, is a low-income country. Nepal is located between China and India in Asia along the Himalayan Mountains.

A map to show the location of Nepal in Asia

What caused the Nepal Earthquake?

The earthquake occurred on a  collision plate boundary between the Indian and Eurasian plates.

What were the impacts of the Nepal earthquake?

Infrastructure.

• Centuries-old buildings were destroyed at UNESCO World Heritage Sites in the Kathmandu Valley, including some at the Changu Narayan Temple and the Dharahara Tower.
• Thousands of houses were destroyed across many districts of the country.

Social and economic

• Eight thousand six hundred thirty-two dead and 19,009 injured.
• It was the worst earthquake in Nepal in more than 80 years.
• People chose to sleep outside in cold temperatures due to the risk of aftershocks causing damaged buildings to collapse.
• Hundreds of thousands of people were made homeless, with entire villages flattened.
• Harvests were reduced or lost that season.
• Economic losses were estimated to be between nine per cent to 50 per cent of GDP by The United States Geological Survey (USGS).
• Tourism is a significant source of revenue in Nepal, and the earthquake led to a sharp drop in the number of visitors.
• An avalanche killed at least 17 people at the Mount Everest Base Camp.
• Many landslides occurred along steep valleys. For example, 250 people were killed when the village of Ghodatabela was covered in material.

What were the primary effects of the 2015 earthquake in Nepal?

The primary effects of the 2015 earthquake in Nepal include:

• Nine thousand people died, and 19,000 people were injured – over 8 million people were affected.
• Three million people were made homeless.
• Electricity and water supplies, along with communications, were affected.
• 1.4 million people needed support with access to water, food and shelter in the days and weeks after the earthquake
• Seven thousand schools were destroyed.
• Hospitals were overwhelmed.
• As aid arrived, the international airport became congested.
• 50% of shops were destroyed, affecting supplies of food and people’s livelihoods.
• The cost of the earthquake was estimated to be US$5 billion.

What were the secondary effects of the 2015 earthquake in Nepal?

The secondary effects of the 2015 earthquake in Nepal include:

• Avalanches and landslides were triggered by the quake, blocking rocks and hampering the relief effort.
• At least nineteen people lost their lives on Mount Everest due to avalanches.
• Two hundred fifty people were missing in the Langtang region due to an avalanche.
• The Kali Gandaki River was blocked by a landslide leading many people to be evacuated due to the increased risk of flooding.
• Tourism employment and income declined.
• Rice seed ruined, causing food shortage and income loss.

What were the immediate responses to the Nepal earthquake?

• India and China provided over $1 billion of international aid .
• Over 100 search and rescue responders, medics and disaster and rescue experts were provided by The UK, along with three Chinook helicopters for use by the Nepali government.
• The GIS tool “Crisis mapping” was used to coordinate the response.
• Aid workers from charities such as the Red Cross came to help.
• Temporary housing was provided, including a ‘Tent city’ in Kathmandu.
• Search and rescue teams, and water and medical support arrived quickly from China, the UK and India.
• Half a million tents were provided to shelter the homeless.
• Helicopters rescued people caught in avalanches on Mount Everest and delivered aid to villages cut off by landslides.
• Field hospitals were set up to take pressure off hospitals.
• Three hundred thousand people migrated from Kathmandu to seek shelter and support from friends and family.
• Facebook launched a safety feature for users to indicate they were safe.

What were the long-term responses to the Nepal earthquake?

• A $3 million grant was provided by The Asian Development Bank (ADB) for immediate relief efforts and up to $200 million for the first phase of rehabilitation.
• Many countries donated aid. £73 million was donated by the UK (£23 million by the government and £50 million by the public). In addition to this, the UK provided 30 tonnes of humanitarian aid and eight tonnes of equipment.
• Landslides were cleared, and roads were repaired.
• Lakes that formed behind rivers damned by landslides were drained to avoid flooding.
• Stricter building codes were introduced.
• Thousands of homeless people were rehoused, and damaged homes were repaired.
• Over 7000 schools were rebuilt.
• Repairs were made to Everest base camp and trekking routes – by August 2015, new routes were established, and the government reopened the mountain to tourists.
• A blockade at the Indian border was cleared in late 2015, allowing better movement of fuels, medicines and construction materials.

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Culture and mental health in Nepal: an interdisciplinary scoping review

L. e. chase.

1 McGill University - Global Mental Health Program, Montreal, Quebec, Canada

R. P. Sapkota

2 Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada

3 Integrated Program in Neuroscience, McGill University, Montreal, Canada

L. J. Kirmayer

Efforts to address global mental health disparities have given new urgency to longstanding debates on the relevance of cultural variations in the experience and expression of distress for the design and delivery of effective services. This scoping review examines available information on culture and mental health in Nepal, a low-income country with a four-decade history of humanitarian mental health intervention. Structured searches were performed using PsycINFO, Web of Science, Medline, and Proquest Dissertation for relevant book chapters, doctoral theses, and journal articles published up to May 2017. A total of 38 publications met inclusion criteria (nine published since 2015). Publications represented a range of disciplines, including anthropology, sociology, cultural psychiatry, and psychology and explored culture in relation to mental health in four broad areas: (1) cultural determinants of mental illness; (2) beliefs and values that shape illness experience, including symptom experience and expression and help-seeking; (3) cultural knowledge of mental health and healing practices; and (4) culturally informed mental health research and service design. The review identified divergent approaches to understanding and addressing mental health problems. Results can inform the development of mental health systems and services in Nepal as well as international efforts to integrate attention to culture in global mental health.

Introduction

While mental health problems are increasingly recognized as a global health priority, debate continues over the relevance of cultural variation for the application of psychiatric diagnoses and treatments (Chisholm et al . 2007 ; Collins et al . 2011 ; Patel et al . 2011 ; Whitley, 2015 ). This debate has taken on renewed importance with recent calls by global mental health advocates for rapid scale-up of mental health services in low- and middle-income countries (Patel et al . 2011 , 2016 ; Bhugra et al . 2017 ). Cultural and contextual factors are now understood to influence every aspect of mental health and illness (Alarcón et al . 2009 ; Kirmayer, 2013 ; Napier et al . 2014 ). Diagnostic and treatment guidelines and frameworks for mental health systems recognize cultural variation in the manifestation of distress and disorders and call for culturally appropriate interventions (Psychosocial Working Group, 2003 ; Inter-Agency Standing Committee (IASC), 2007 ; American Psychiatric Association, 2013 ; World Health Organization, 2013 b ; Khenti et al . 2016 ).

Yet critics have pointed to a gap between the rhetoric of global mental health, which recognizes the importance of social and cultural context, and practice, in which local knowledge is often overlooked in favor of a generic biomedical psychiatric or psychosocial approach (Watters, 2010 ; Campbell & Burgess, 2012 ; Summerfield, 2012 ; Clark, 2014 ; Fernando, 2014 ; Mills, 2014 ; Bracken et al . 2016 ). There is continued concern over whether methods of research, diagnosis, and treatment that have been developed primarily in urban, high-income, and industrialized settings will meet the needs of populations in which the greatest mental health disparities are found. Failure to adequately address social and cultural contexts may limit the effectiveness of interventions and have other negative impacts, including promoting the medicalization of social suffering and undermining indigenous knowledge and support systems (Desjarlais et al . 1995 ; Argenti-Pillen, 2003 ; Clark, 2014 ; Whitley, 2015 ). The literatures of medical anthropology and sociology contain rich descriptions of many settings where global mental health is active; however, the generalizability of these accounts and their relevance to current mental health issues are not always clear to practitioners (Greene et al . 2017 ).

Nepal offers a useful case study in this discussion because it has seen many decades of social science research and there is a current need for information to guide ongoing efforts to scale up mental health services. A small landlocked country of about 29 million people with the third lowest human development rating in South Asia (United Nations Development Programme, 2016 ), Nepal has about 110 psychiatrists, 15 clinical psychologists, and 400–500 paraprofessional psychosocial workers (Luitel et al . 2015 ; Sherchan et al . 2017 ). Government investment in mental health in Nepal has historically been very limited (around 0.7% of the health budget), with more than half of available services provided by non-governmental organizations (NGOs) [World Health Organization (WHO), 2011 ; Inter-Agency Standing Committee (IASC) Reference Group for Mental Health and Psychosocial Support in Emergency Settings, 2015 ].

The development of formal mental health services in Nepal has been led by an array of local and international humanitarian actors over the past four decades. The WHO began mental health work in Nepal in 1980 and the United Mission to Nepal launched the first community mental health services in 1984 (Acland, 2002 ). The first mental health NGOs were established in the 1990s to treat those affected by the ongoing Maoist insurgency and the mass influx of refugees from Bhutan (Jordans & Sharma, 2004 ; Tol et al. 2005 ; Jordans et al . 2007 ; Center for Victims of Torture Nepal, 2011 ). With the end of the civil conflict in 2006, mental health NGOs and advocates shifted their focus to strengthening the mental health system (Upadhaya et al . 2014 ). Nepal became an implementation site for several high-profile global mental health projects (Hanlon et al . 2014 ; Mendenhall et al . 2014 ; Kohrt et al . 2015 ; Jordans et al . 2016 ). In 2015, Nepal was struck by a major earthquake, inspiring a proliferation of mental health and psychosocial projects (Seale-Feldman & Upadhaya, 2015 ). The financial resources and political will elicited by the disaster contributed to advancing national global mental health agendas (Chase et al . 2018 ).

While Nepal has been a popular site for research on social, cultural, and ritual aspects of healing, few attempts have been made to consolidate this body of work or explore its relevance to ongoing health development initiatives. A desk review published shortly after the 2015 earthquake drew attention to existing literature on cultural aspects of mental health in Nepal (IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings, 2015 ). However, this review was not conducted with the methodological rigor of a scholarly report and did not capture publications produced during the period of heightened interest and investment in mental health following the disaster. The present scoping review, completed 2 years after the earthquake, takes stock of the current state of scholarship on culture and mental health in Nepal, including relevant literature from across the health and social sciences.

We employed a scoping review methodology (Arksey & O'Malley, 2005 ) with the guiding research question: ‘What knowledge exists on the relationship between culture and mental health in Nepal?’ For the purposes of this review, mental health was interpreted as encompassing mental health/wellbeing and mental illness/disorder, where ‘psychiatric’, ‘psychological’, and ‘psychosocial’ were acceptable replacements for ‘mental’. Culture was interpreted as ‘values, beliefs, knowledge, norms, and practices and the notion that these are shared among a specific set of people’ (Hruschka & Hadley, 2008 , p. 947). Publications addressing social and structural issues that exist in many societies (e.g. gender inequality and mental health stigma) that were not explicitly linked to Nepali culture in some way were excluded. Publications addressing culture among ethnic minority groups in Nepal and ethnically Nepali Bhutanese refugees were included, while those focused exclusively on populations living outside Nepal were excluded.

Searches were carried out in collaboration with a medical librarian in PsycINFO, Web of Science, Medline, and Proquest Dissertation. Terms used to study mental health and illness in both social science (e.g. ‘healing’) and clinical (e.g. ‘treatment’) fields were included, as were transliterated Nepali words commonly referenced in the mental health literature [e.g. sato , meaning ‘spirit or soul’ as used in the Nepali idiom ‘soul loss’ (see Kohrt & Hruschka, 2010 ); chhopne , literally ‘to catch, to get hold of, and to cover by someone or something’, used to describe experiences of dissociation or possession (Sapkota et al . 2014 , p. 645); NB: definitions may vary according to the context and ethnic/linguistic group]. The following search terms were used in all databases: (Mental* OR Madness OR Psycholog* OR Distress* OR Idioms* OR Caus* OR Cultur* OR Belief* OR help seeking OR Healing OR Somatic* OR Possession OR Soul* OR Spirit* OR Sato* OR Rog* OR Dokh OR Psychosocial* OR Counsel* OR Witch* OR Ritual OR Chhopne OR Ethno* OR Festival OR Treatment) AND Nepal*. Texts published up to 22 May 2017, when the searches were completed, were included in this review.

Results from the searches were screened according to the following inclusion criteria: (1) English or Nepali; (2) peer-reviewed journal article, book/book chapter, or doctoral thesis; and (3) substantial original discussion of culture in relation to mental health in Nepal. Initial screening of titles and abstracts was carried out by bilingual (English/Nepali) team members with graduate training in transcultural psychiatry. All full texts of publications appearing to meet criteria were then screened by two team members. When there was disagreement among reviewers on whether a publication met inclusion criteria, additional coauthors reviewed the full text and consensus was reached through discussion. Additional items were identified by screening the reference lists of all included texts, the aforementioned desk review (IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings, 2015 ), and a bibliography of psychological research in Nepal (Maharjan, 2012 ).

Texts meeting inclusion criteria were divided among team members for ‘charting’ (Arksey & O'Malley, 2005 ): key information was extracted using a form covering methods, focus, and key findings; reviewers also indicated whether the text reflected an applied orientation, defined as including discussion of how findings could inform or improve mental health services for culturally Nepali populations. Finally, texts were collated and summarized (Arksey & O'Malley, 2005 ) by the first author with input from other team members.

The search yielded 6488 results, of which 38 met inclusion criteria (see Fig. 1 and Table 1 for an overview of the search process and included texts). To facilitate practical use of this review, we have collated publications into four thematic categories.

Search strategy.

Overview of texts included in the review

(1) Cultural determinants of mental health problems

Six publications addressed how culture influences the etiology of mental distress and disorder, in particular by shaping patterns of social organization and inequality. Kohrt et al . ( 2009 ) examined the correlation between low caste and rates of depression and anxiety, identifying poverty, lack of social support, and stressful life events as mediators. In a related article, Kohrt ( 2009 ) interpreted associations between low caste and psychological morbidity though a policy analysis, highlighting the role of restrictions in social life and access to resources that affect low caste groups in the Nepali context. A book chapter by Jack et al . ( 2010 ) described how traditional Hindu Brahmanical models of the ‘good woman’ may lead to self-silencing and consequently contribute to depression among women in Nepal. Similarly, Kohrt & Bourey ( 2016 ) explored how cultural norms related to gender (e.g. perceived lack of autonomy, lack of social support for women leaving a marriage) contribute to the risk for comorbid maternal mental illness by influencing exposure to intimate partner violence.

Two articles considered how cultural values contribute to the development of mental health problems. Furr's ( 2005 ) sociological study found that ‘Western orientation’, as measured through a self-developed questionnaire assessing attitudes toward gender and caste norms and language/media preferences, was associated with lower depression scores. In a comparative study, Boehnke et al . ( 1998 ) found that Asian samples (Nepali and Fijian) valued tradition, conformity, and power more highly than Europeans (German) and had more microsocial (personal) than macrosocial (e.g. national or environmental) worries. In Nepal, microsocial worries were negatively related to mental wellbeing, but there was no direct relationship between cultural values and wellbeing.

(2) Culture and mental illness experience

A second set of 14 publications framed culture as a set of beliefs and values that shape mental illness experience. Several focused specifically on the ways that mental health problems manifest or are expressed in Nepali cultural contexts. Sharma & van Ommeren ( 1998 ) identified salient ‘idioms of distress’ (Nichter, 1981 ) among Bhutanese refugee torture survivors, including emotion-related idioms (e.g. dukha lāgyo or sadness) and somatic idioms (e.g. headache, dizziness); many attributed their suffering to bad deeds committed in previous lives ( karmako phal ). Hoge et al . ( 2006 ) found that Nepalis with generalized anxiety disorder showed more somatic symptoms and fewer psychological symptoms compared with Americans and offered possible explanations related to cultural differences in stigma, mind–body distinctions, introspection, and acceptable means of expressing distress. By contrast, Kohrt et al .’s ( 2005 ) work on jhum-jhum (a common somatic complaint in Nepal involving numbness or tingling) among depressed patients found that once the local burden of physical illness had been accounted for, rates of somatization in Nepal were comparable to those in Western settings.

Five studies explored how culture mediates the interpretation of particular symptoms and behaviors as deviant or pathological. Furr ( 2004 ) found that teachers with a more ‘Western’ orientation according to the aforementioned measure (Furr, 2005 ) were more likely to pathologize deviant child behavior. Adhikari et al . ( 2015 ) identified behaviors commonly reported as problematic among children in Nepal (e.g. addiction, negligence of studies, anger); these were mainly attributed to the social environment and intervention strategies ranged from talking to physical punishment. Burkey et al . ( 2016 b ) identified local social goals and gender norms that influenced when specific child behaviors were deemed pathological. Heys et al .’s ( 2017 ) study of Nepali understandings of autism identified beliefs that could interfere with help-seeking, especially attributions to poor parenting. Finally, Kim et al . ( 2017 ) examined which manifestations of grief among Nepali widows were locally considered pathological, finding some overlap with criteria for persistent complex bereavement disorder (e.g. prolonged duration, role/identity confusion, impaired daily functioning, mistrust).

More generally, Böker ( 1992 ) explored concepts of mental illness among mental hospital patients (likely suffering from severe/psychotic disorders) and their relatives. Most attributed the illness to spirit possession, physical problems in the body, fever, and separation or conflicts within the family. Pach III's ( 1998 ) book chapter explored Nepali villagers’ perceptions of individuals described as being baulāhā (mad), finding that afflicted individuals experienced social marginality that constrained their access to care and was at times more distressing than the illness itself. Kaplan's ( 1999 ) doctoral thesis explored the meaning of psychiatric symptomatology in rural Nepal, including common supernatural attributions (e.g. witchcraft, the intervention of ghosts and spirits), as well as treatment modalities believed to address these causes. Clarke et al . ( 2014 ) studied Nepali mothers’ concepts of psychological distress; distress was often attributed to family- and gender-related factors and women's responses to it were shaped by a fatalistic worldview.

Finally, two publications addressed indigenous illness categories. Sapkota et al . ( 2014 ) examined mental health factors associated with unintentional spirit possession. They argue that rather than mapping onto a single diagnostic category, spirit possession may function as an idiom of distress facilitating expression of ‘suffering related to mental illness, socio-political violence, traumatic events, and the oppression of women’ (p. 643). Evers et al . ( 2016 ) used the case of ‘soul loss’ in the wake of Nepal's civil conflict to illustrate how socially and spiritually anchored conceptions of the self influence the experience of psychopathology and the course of healing.

(3) Cultural knowledge of mental health and healing

A third set of 11 publications explored cultural knowledge on mental health and healing in Nepal. Several of these document aspects of Nepali ‘ethnopsychology’, or ‘cultural concepts of self, mind-body divisions, emotions, human nature, motivation, and personality’ (Kohrt & Maharjan, 2009 , p. 115). Kohrt & Harper ( 2008 ) elaborated elements of self that are ‘central to understanding conceptions of mental health and psychological wellbeing and subsequent stigma’ (p. 468) in Nepal, including the soul, heart–mind, brain–mind, body, and social status. In a 2009 publication, Kohrt and Maharjan provided an overview of Nepali concepts of child development and the perceived effects of violence and psychological trauma. Kohrt & Hruschka ( 2010 ) explored Nepali concepts of psychological trauma and associated idioms of distress and emotion terms. They highlight how the attribution of traumatic experiences to one's actions in a past or present life ( karma ) can lead to blame and stigma, with implications for help-seeking.

Three studies explored cultural concepts of and pathways to wellbeing. Bragin et al . ( 2014 ) identified locally salient domains of wellbeing in three conflict-affected countries (including, specific to Nepal, having all basic needs met and freedom of movement) and describe the influence of spiritual traditions on understanding wellbeing, evident in the use of terms such as ānanda (transcendent bliss). Chase & Bhattarai ( 2013 ) explored resilience among Bhutanese refugees in the USA and Nepal; they present idioms of wellbeing and describe processes that promote resilience, such as daily worship ( pūjā ) and involvement in community groups. Finally, a book chapter by Kohrt ( 2015 ) describes how the practice of certain Nepali traditional rituals can promote psychosocial wellbeing, particularly during reintegration of child soldiers. For example, Swasthāni , a fasting ritual performed by women for the wellbeing of male relatives and atonement of sins, may lead to increased acceptance of girl soldiers.

Several publications addressed expert or esoteric cultural knowledge – that of practitioners of indigenous healing systems. Peters’ article (1978) and subsequent book (1981) on the Tamang ethnic group draws parallels between techniques used by shamans and those of Western psychotherapy, including mediation in social conflict, facilitation of catharsis, and providing a symbolic structure for understanding illness. Skultans ( 1988 ) compared the practice of a psychiatric outpatient clinic with that of a ‘tāntrik healer’ – a type of healer known for ‘sweeping away the negative forces believed to account for ill health or misfortune, and blowing on the positive and regenerative forces in their place’ ( jhar-phuk ; Dietrich, 1998 , p. ix). The healer had adopted elements of psychiatric practice (e.g. speed and standardization) but offered causal attributions that were more likely to reinforce family support. Soubrouillard's doctoral thesis (1995) explored how Nepali shamans understand, assess, attribute and treat madness; diagnostic methods including divination are described in detail. Finally, Jolly ( 1999 ) described how a Nepali soldier in the British army was cured of psychiatric symptoms by visiting a traditional healer, noting parallels with the practice of mental health professionals. The study by Böker ( 1992 ) described above also discusses treatment-seeking pathways, including preferences for traditional healers.

(4) Culturally informed mental health care

Finally, six publications explored how attention to culture can be integrated into the detection and treatment of mental health problems. With regard to detection, Kohrt et al . ( 2011 ) proposed six evaluation questions to guide cross-cultural validation of instruments for child mental health research. Using the examples of the Depression Self-Rating Scale (DSRS) and Child PTSD Symptom Scale (CPSS), they demonstrate how these questions can guide effective translation of instruments by trained mental health paraprofessionals and discuss adaptations made (e.g. incorporation of pictographic scales). Kohrt et al . ( 2016 ) adapted the PHQ-9 for use in Nepal, developed two additional questions based on local idioms of distress, and validated these among primary care patients. They determined that an algorithm involving initial screening for heart–mind problems and impaired functioning could improve the efficiency and accuracy of screening with PHQ-9. Burkey et al . ( 2016 a ) explored the overlap between local categories of problematic behavior and Western diagnostic criteria as reflected in the Disruptive Behavior international Scale-Nepal version (DBIS).

With regard to treatment, Harper's ( 2014 ) book chapter examined how United Mission to Nepal introduced psychiatric services and psychotropic drugs in Nepal, describing how diagnostic procedures were adapted to the local cultural context; for example, the label of ‘nerves disease’ ( nasā rog ) was used to make depression treatment more socially acceptable. Jordans et al . ( 2003 ) described cultural adaptations made by the Centre for Victims of Torture, Nepal (CVICT; see also Sharma & van Ommeren, 1998 ) in training psychosocial counsellors, including demonstrating respect for clients’ social status, applying indirect ways of questioning, and specialized training modules focused on stigmatization and supernatural attributions. Tol et al. ( 2005 ) outlined some ‘cultural challenges’ CVICT faced in establishing psychosocial counselling in Nepal, as well as adaptations made to address issues related to the therapeutic relationship, illness beliefs, locus of control, and views of the self and introspection. Finally, Kohrt et al . ( 2012 ) discuss possible adaptations to cognitive behavior therapy, interpersonal therapy, and dialectical behavior therapy to accommodate Nepali ethnopsychology, with the goal of improving care of Bhutanese refugees.

This scoping review identified a modest body of literature on culture and mental health in Nepal. Publications represented a range of disciplines and research methods. Culture was investigated variously as a contributor to mental illness, a set of beliefs and values that shape mental illness experience and help-seeking, a repository of indigenous knowledge about mental health, and a factor that could be effectively integrated in mental health research and service design. Much of the literature in this area published before 2015 was synthesized in the post-earthquake desk review (IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings, 2015 ). However, it is striking that nearly 25% of identified texts were published since the beginning of 2015. This may reflect growing interest in the critical role of social context in mental health and illness (Tol et al. 2010 ) as well as the increased attention to mental health issues occasioned by disasters (World Health Organization, 2013 a ).

Nearly 75% of included publications reflected an applied orientation. Many of these were published within the past 15 years by researchers affiliated with Nepali mental health NGOs. Some applied work strived to directly integrate culture into mental health research and practice with the goal of improving quality of and access to services. Other studies conducted in affiliation with these NGOs adopted a broader focus, contributing to our understanding of Nepali concepts of distress, pathology, trauma, child development, and resilience.

At the same time, we noted that applied research (with a few important exceptions such as the work on ethnopsychology) tended to be structured around concepts emerging from globalized psychiatric knowledge, with accounts of culture often reduced to one or two dimensions that shaped or interfered with conventional methods of research and practice. Only three studies were framed around indigenous illness categories (Kohrt et al . 2005 ; Sapkota et al . 2014 ; Evers et al . 2016 ). All of the included research on traditional healing was conducted prior to the year 2000, despite the fact that these healers continue to be the primary source of treatment for mental health problems in Nepal (Luitel et al . 2015 ). In some cases, narrow and essentializing conceptualizations of ‘Nepali culture’ were evident. For example, Furr ( 2004 , 2005 ) considered willingness to support female political leaders to be an indication of ‘Western’ (as opposed to ‘Nepali’) cultural orientation – yet, Nepal has now elected a female president well in advance of many Western countries. Moreover, there is evidence that cultural beliefs and idioms take on new meanings when instrumentalized within mental health diagnosis and service provision, raising questions about the limits of culturally adapted interventions (Abramowitz, 2010 ). There remains a need for long-term ethnographic research that examines local understandings and experiences of mental health problems. In addition to improving our understanding of the contexts and consequences of global mental health interventions, studies of this nature may shed light on underlying processes of psychopathology and intervention strategies grounded in local ethnopsychologies and indigenous healing systems that can contribute to a truly global psychiatry (Chase & Sapkota, 2017 ).

The body of literature outlined here can and should inform mental health policy and practice in Nepal (Kirmayer & Pedersen, 2014 ). This review comes at a critical historical moment: Nepal's government has allocated a budget for mental health care at the district level for the first time, revised mental health policy is pending after 20 years, and the Ministry of Health has demonstrated a commitment to addressing mental health in the context of its action against non-communicable diseases (Chase et al . 2018 ; Government of Nepal, 2014 ). Findings may be relevant to a range of stakeholders involved in the anticipated scaling up of services. The national baseline psychiatric epidemiological study that is currently being planned may use instruments described here that have undergone a culturally informed validation process. The wealth of information identified in this review about idioms of distress, concepts of causality, and indigenous illness categories could enhance the assessment of mental health problems, and should thus inform future revisions of the Standard Treatment Protocol for mental health in primary care as well as efforts to improve and contextualize medical school curricula on mental health and mhGAP-based trainings for physicians. Clinicians working in Nepal should consider incorporating the cultural adaptations to psychological and psychosocial treatments documented above.

One possible barrier to the application of research findings is disciplinary variation in jargon and writing conventions; social scientists seeking to inform practitioners should consider publishing versions of their findings in clear accessible language (Greene et al . 2017 ). Working in collaboration with patients, clinicians, policy makers and other knowledge users may help researchers find the appropriate vocabulary to translate their findings into practical applications. The recent development of a ‘community informant detection tool’ in Nepal (Subba et al . 2017 ; published shortly after our review) offers an excellent model for collaborative, culturally informed mental health work of this nature.

Finally, it is noteworthy that only three included publications had a Nepali first author. The small number of Nepali scholars who have published in this area has implications for the peer review process, as relying mainly on non-Nepali reviewers could result in the dissemination of limited or misleading interpretations of local terms and perspectives. Findings of this review thus lend support to calls for greater representation of scholars from low-income countries in the global mental health literature (Kohrt et al . 2014 ).

Limitations

This scoping review has several limitations. Nepali language search terms could have been transliterated in multiple ways and we did not include search terms in Devanagari script. Following Arskey & O'Malley ( 2005 ), this study did not assess the quality of included texts; caution is therefore needed in applying findings. In addition to considering information summarized in Table 1 , readers should refer to the full texts of publications. Our stringent inclusion criteria may have led to the exclusion of some relevant literature. Some potentially relevant work on emotions, coping, and self-hood that did not make an explicit link to mental health and illness was excluded (e.g. Mchugh, 1989 ; Cole & Tamang, 1998 ; Cole et al . 2002 ; Chase et al . 2013 ). Some instrument validation studies that did not meet the criterion of ‘substantial original discussion’ of culture and mental health did make references to the culture and context and may be relevant for researchers planning to use these scales in Nepal (e.g. Kohrt et al . 2002 , 2003 ; Haroz et al . 2017 ; Sochos & Lokshum, 2017 ; see Chen et al . 2013 for more on psychiatric scales used in Nepal). We recommend that all future studies reporting successful cross-cultural validation of instruments describe the translation process and adaptations made in detail. Finally, we note the exclusion of a rich body of ethnographic literature that explores suffering and healing in local Nepali terms, without employing the language of mental health and illness (e.g. Hitchcock, 1967 ; Hitchcock & Jones, 1976 ; Stone, 1976 ; Desjarlais, 1989 , 1992 ; Maskarinec, 1992 ; Subba, 2007 ). More work is needed on ways to integrate this rich body of contextual knowledge in global mental health programs.

We identified 38 papers, book chapters and monographs that explicitly addressed cultural dimensions of mental health and illness in Nepal. As documentation of four decades of work focused on translating among divergent approaches to understanding and addressing mental suffering, this review speaks to ongoing debates about the significance of cultural variation in psychiatric distress and disorder. Although still modest, the available literature on Nepal does not support claims that service development initiatives have completely overlooked local cultures. On the contrary, applied work done by a new generation of clinician–researchers with interdisciplinary interests and training is refining our knowledge of how culture shapes the experience, expression, and interpretation of suffering and the translatability of biomedical diagnostic categories and treatments. While this review does not speak to how well available knowledge has been applied at the level of health systems or service delivery, it suggests there is a growing interest in culturally informed mental health research and practice in Nepal. At the same time, findings suggest that applied research geared toward mental health service development still needs to engage with long-term, ethnographic studies that attend holistically to local knowledge and experience. Gaps remain in our understanding of indigenous illness concepts and healing approaches. There is a continued need to build capacity in Nepal for research driven by the needs and concerns of local stakeholders, particularly people with mental health problems and traditional healers, and to engage with open-ended methods of inquiry that recognize diverse modes of understanding mental suffering and healing.

Acknowledgements

We are grateful to Dr Danielle Groleau who provided mentorship to the second author during early stages of planning and carrying out searches. We would like to thank Teodora Constantinescu, medical librarian at the Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal Canada, for help in conducting searches. We are further thankful to four anonymous reviewers for Global Mental Health , whose input led to important improvements.

Financial support

This project was supported by the McGill Global Mental Health Program ( www.mcgill.ca/gmh ).

Conflict of interest

Ethical standards.

Not applicable.

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Loss of Meaning in Translation: The Case Study of a Nepali Novel ‘Basain’

• Dr. Ramesh Prasad Adhikary Assistant Professor (English) TU, M. M. Campus, Nepalgunj, Nepal

The research paper titled‘Loss of Meaning in Translation: The Case Study of a Nepali Novel Basain’ was an attempt of the researcher to find out the cases of cultural meaning loss in the translation of a novel ‘Basain’. It further aimed to explore the causes of loss of meaning in translation. In addition, it aimed to analyze the ways that can be used to compensate the meaning gap in translation as well. Only the secondary sources of data were used in the study employing descriptive and analytical design along with qualitative data. Twenty two cases of meaning loss in the translation of the novel Basain were found. The study also explored causes of the loss of meaning to occur in translation. Some of the major causes were pointed out i.e. cultural gap, deletion, negligence of the translator, lack of functional equivalence, lack of co-cultural and socio-cultural knowledge (of the SL) of the translator, over generalization of the meaning, carelessness of the translator, incomplete linguistic knowledge (of the SL) of the translator, transliteration and so on.

Author Biography

Dr. ramesh prasad adhikary, assistant professor (english) tu, m. m. campus, nepalgunj, nepal.

Dr. Ramesh Prasad Adhikary is an assistant professor of Tribhuwan University, Kathmandu, Nepal. He has been teaching English literature at M.M. Campus since 2007. He has completed his PhD in Existential philosophy and has been researching on English language, literature and literary theories. He has created more than 40 international articles and 18 books on various topics of English literature.

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English teachers’ awareness of collaborative learning: a case study in Nepal

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This article reports the examination of secondary English teachers’ awareness of collaborative learning strategies. This study based on qualitative research employed a semi-structured interview with secondary English teachers and students to investigate English teachers’ practices of collaborative learning strategies in their classrooms. Classroom observation revealed how the teachers managed a collaborative environment and involved students in learning activities. This study involved English teachers and students from eight secondary schools representing different parts of the country. Teachers’ classes were observed to crystalise the data elicited from the interviews. The sociocultural theory (SCT) has provided a lens to analyse the qualitative data. The findings indicate that teachers’ traditional pedagogy dominated the limited collaborative language learning activities in the classrooms. Group work, peer support, and dialogue, albeit limited, have been identified as effective collaborative learning strategies in the English language classroom. Teachers’ limited knowledge of collaborative learning, however, seemed to be a barrier to implementing collaborative learning activities extensively in the English classrooms. Adequate training would develop English teachers’ ability to involve students in various collaborative activities and allow them to learn English from interactivities.

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Rana, K., Rana, K. English teachers’ awareness of collaborative learning: a case study in Nepal. SN Soc Sci 2 , 107 (2022). https://doi.org/10.1007/s43545-022-00405-9

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• Background of the study                                               1
• Significance of the study                                               1
• Statement of the problem                                             2
• Objectives of the study                                                   2
• Delimitation of the study                                               3
• Methodology of the study                                              3
• Conclusion of the study                                                  9

Annex A                                                                                          

Background of the study.

Case study is an investigative task that is to be done by every student teacher during his/her practice teaching in school This is an investigative study of a student about his / her different aspects to find out the strengths or weakness of the student and to find out the solutions for solving the problems. As a student of B.Ed. III year, I also went to Taudaha H.S School, Kathmandu for my practice teaching. During my practice teaching in the school, I taught in grade seven, I observed all of the students of the class. I selected one intelligent student of the class Mr. Bikash K.C Kapoor for the case study. I selected him because he is the most intelligent student in the class and he has secured the highest marks in him first terminal exam 2009.

Significance of the study

It is said, “A good teacher has to read every page of the students”. A teacher’s main task is to teach the students and make them learn new things. But the teacher cannot be always successful in achieving his goal because sometimes the students fail to learn what the teacher teaches. The teacher generally thinks that the students fail their examination because they do not care about their study. But this is not the sole cause of failure. There may be various causes of the failure. There may be some physical, psychological, economic, educational and environmental problems that create hindrance in study. If a teacher neglects all these factors of a student and confines his work just in teaching, his objective will never be achieved. So a teacher has to study all the relevant matters of the students that have been affecting in his/her study to treat him/her psychologically and diagnostically. Case study is an investigative and detail study of a student. It helps a teacher to get each and every detailed information about the student- personal, familial, social, educational, economic, etc. It helps the person, who studies, to find out the matters or causes that have helped or affected the study of the student. It helps to find out the psychological and other factors of the student that have been either assistance or hindrance in his/her study and other activities. A person can find the factors contributing to make a person either extra-ordinary or dull. It helps in treating the students diagnostically and psychologically providing feed back to the teacher. Such kind of study may help in the study and investigation of other similar students, too.

Statement of the problem

In course of practice teaching. I have taught in class seven in Taudaha H.S. School. Among 25 students, Mr. Bikash K.C one intelligent student has been selected for case study. He is the most intelligent student in the class. He has secured high marks in his first terminal examination 2009. The main objective of this study is to find out the reasons how Bikash K.C became an extra-ordinary and how he can do better than this. The study is concerned with the investigation of the factors that contribute to make his intelligent.

Objective of the study

A study or investigation without any objectives becomes haphazard and cannot meet its target. This study has been done taking certain objectives. The main objectives of this study are as follows:

• To find out why Mr. Bikash K.C is an extra- ordinary student.
• To find out the factors or matters that has been hindrance in his study.
• To find out his family background.
• To find out what his family’s economic condition is.
• To find out the social and educational background of his family.
• To find out what types of behaviors he performs with his peers and teachers.
• To find out his educational status.
• To suggest him to do better in future.
• To suggest the teachers and his parents to improve his educational condition and activities.
• To get feedback to treat the student psychologically and diagnostically.

Delimitation of the study

Every investigation has its own limitations. Due to limitation of time, money and labor, an investigator has to limit his/her study or investigation.  This study also has some limitations. An Investigator cannot study and investigate each and everything of a person. I have limited this study only to Mr. Bikash K.C. This study is confined within the personal, educational, familial, economic, psychological and behavioral aspects of Mr. Bikash K.C.

In course of this study, I have interviewed the student, his English teacher and the principal of the school. I have interviewed only few students of his class for this study. I have involved some other teachers of the school in this study. Other necessary information has been collected from observation of the student’s activities and behavior.

Methodology   of the study

Any study or investigation needs some data and information to find out the desired facts. Certain sources of data collection are to be consulted for data collection. There are different tools of data collection that are to be applied in the study during data collection. The sources of data, tools of data collection and methods of data collection applied in course of the study are listed below:

• Sources of data collection

The following sources have been consulted as sources of data during the study to collect necessary data & information.

• Mr. Bikash K.C. – the student himself.
• Mr. Anil K.C. – the student’s father

iii. Mr. Sovit Ram Karki – the principal of the school.

• Mr. Shatrughan pd.Singh- The subject teacher.
• Staff of the school.
• School Record

vii. The student’s peers of class 7 etc.

• Tools of data collection

The following tools of data collection have been used in the data collection in this study:

• Some questionnaires
• Questionnaire forms

iii. Notes, etc.

• Methods of data collection

The data and information have been collected applying the following methods:

• Different questionnaires
• Observation of the student’s activities and behaviors

iii. Interview with the teachers

• Interview with the student’s peers
• Face to face talk with the student, etc.

Interpretation and analysis of data

• General introduction of the student

General introduction of the student has been given below

Name                             : Mr. Bikash K.C Kapoor

School                            : Shree Taudaha H.S School

Class                              : 7

Roll No.                         : 1

Gender                           : Male

Age                                : 13 years

Date of Birth                  : 01-05-2053

Religion                         : Hindu

Permanent Address        : Saibu Lalitpur

Temporary Address       : Saibu Lalitpur

Fathers’ Name                : Mr. Anil K.C Kapoor

Occupation                    : Businessman

Mother’s Name              : Ambika K.C Kapoor

Occupation                    : Housewife

No. of family members  : 5

Elder Brother                 : Bikkey K.C.

Name of Sister               : Anu K.C

Date of Admission         : 2060

Future Aim                    : To be an Pilot

Mr. Bikash K.C is a student of class 7 in Taudaha H.S School

He is the most intelligent student in the class. He was born on 1 st   Bhadra 2053B.S. as the second son of Mr. Anil K.C and Mrs. Ambika K.C in Kathmandu and has been living in Saibu, Kathmandu with his  parents elder sister and brother. His religion is Hindu. His father is a businessman and her mother is a housewife. Her elder sister and brother are students. His favorites subject is science, Nepali and English. His aim is to become an pilot.

• Student’s familial background

According to the student, there are altogether 5 members in his family- father, mother, elder sister, elder brother and student himself. They are the residents of Kathmandu but have been living in Kathmandu. I have presented and analyzed the data about the educational and economical condition of the family.

i. Economic condition of the family

Main occupation:                              Temporary job.

Father’s occupation:                          Businessman

Mother’s occupation:                        Housewife

Monthly familial income:                  Tolerable

Source of income:                             Business

According to the student and his father, his father has a Business. Familial income is tolerable and the source of income is father’s business. According to them their economic status is medium.

ii. Educational condition of the family

According to the above data, his parents are Literate. His father is S.L.C passed. But according to the student himself, his father guides him and his sister and brother in their study.

iii. Student’s health condition

Height         :         4.5ft.

Weight        :         29 kg.

Eye sight     :         good

Hearing       :         good

Disease       :         normal health problem (sometimes)

From the above data, it is clear to see that his health condition is good. He is neither two fat nor to thin. He likes to have Nepali dishes and fruits. As a whole we can conclude that his study is not affected by his health.

3. Student’s activities in school and house

According to the principal of the school and gradate teacher of class he attends his classes most often. He is clever in other activities. He is neat and clean. He is serious in his study. He asks questions with the teachers only sometimes. He does his homework most often. Sometimes he participates in extra-curricular activities. He is co-operative, obedient and loyal to his teachers. His behavior with his friends is satisfactory. He does not   make noise in class and pays attention to the teachers and listens to them. I am also his English teacher. In my opinion, he is the most intelligent, obedient and loyal student.    According to his peers in the class, He sometimes talks in the class and makes noise. He pays attention to the teachers. He never disturbs others.

According to the student himself and his father, he spends most of his time in study and studies seriously. He studies four hours in house each day. During his examination, he studies for about 10 hours. His parents are helpful in activities of house. His father inspires him in his study and pays more attention to his study. His father says that he sometimes quarrels in house. Sometimes he listens to the radio, watching TV and plays some games, too.

Student’s discipline

According to the teachers and the peers of the student his discipline is Good. He respects his teacher and other seniors and loves the juniors. He loves and co-operates her friends. He is neat and clean. He does his homework regularly. He does not make noise in the classroom and pay attention to his study. But he is sometime bad tampered. It is his weakness.

Student’s educational condition

Here, I have presented the marks-sheet of Mr. Bikash K.C. of the first terminal examination of class 7 taken in 2009.

Percent: 60.48%

Division: First

Position: 1 st

Result: Passed

The marks show that he is very intelligent in his study. He had passed the first terminal exams of grade7 in 2009 and is studying in the same class now. This shows that his educational condition is very nice. In classroom also, he answers the question asked to him. He is intelligent and extra-ordinary.

Conclusion and suggestion

I completed the case study in short period but I tried to collect more data and information as far as possible. I studied and analyzed the available data information. The data and information show that Mr. Bikash K.C, a student of grade 7 in Taudaha H.S School and the younger son of Mr. Anil K.C and Mrs. Ambika K.C is very intelligent student in his study from the analysis of the data, I came to the conclusion that he has become an extra-ordinary in his study due to the following causes or reason:

• He attends his class regularly.
• He pays to his study. He does not make noise in the class and listens to the teacher.
• He does his homework regularly.
• The teachers pay more attention to the students personally.
• His educational background is nice.
• His father wants to make his son more educated person.
• Suggestions

(i)      Suggestions for the school

The children are the pillars of nation. The children of today are the good citizens of future to handle the nation and drive the nation to its bright future. They need proper education today. Some students are extra-ordinary in every class. The teachers as well as parents should not leave them without any care. The student Bikash K.C is different from other students. His aim in future is to be a Pilot. He is in need of extra activity to achieve better result. I would like to give the following suggestions:

• The school should manage enough instructional materials and educational programs in the school.
• The school should give more emphasis to such students in teaching and learning and also in other extra-curricular activities.
• The school should give more emphasis to students’ discipline.
• The school should call the parents of the students and get information about the students. It should establish good relationship with the parents and should have mutual co-operation.
• School administration should supervise teaching and other activities of the teachers and should provide necessary guidelines.
• The teachers should pay more attention to such students and give more time for the students to practice.
• Student-centered method in teaching and learning is more necessary in the school.
• The teachers should discourage talking in the class and encourage practice, doing homework etc.

(ii)     Suggestions for the student’s family

• The family should manage enough instructional materials for the student.
• The parents should encourage him in his study and should discourage unnecessary activities.

 (iii)   Suggestions for the student

I want to give the following suggestions to the student Mr. Bikash K.C:

• You should pay more attention to your study.
• You should listen attentively to your teachers and should practice given homework.
• Do your homework regularly and if you don’t understand anything, don’t hesitate to ask your teachers.
• You should not talk in the classroom. You must be more serious towards your study. You have to reach your goal.
• Give more time to your study.
• Try to learn many things from your friends but don’t adopt bad things.
• Take suggestions from your teachers and your parents to improve your educational condition.
• Name of the student:                                                           Class:

Address:                                                                                            Roll No.:

Date of birth:                                                                                     School:

Father’s Name

Mother’s Name:

Weight of student:

Height of student:

Date of admission at school:

• Other information

2.1 When did you start study at this school?

………………………………………………………………

2.2 Do you come to regularly?

• always b. Seldom       c. mostly           d. rarely

2.3 What is your aim in life?

……………………………………………………………………………………….

2.4 Which subject do you like most?

…………………………………………………………………

2.5 How many hours do you study at home?

………………………………………………………………….

2.6 What do you do at home in your holiday?

2.7 Do you help your father mother? How?

2.8which book do read expect your textbook?

…………………………………………………………………….

• English literature b. Nepali literature                 c. science
• history e. mathematics        f. newspaper

2.9 do you watch TV?

• always   b. mostly                        c. very little                                   d. never

2.10 do you watch TV? Which programmed do you like most?

……………………………………………………………………….

2.11do you do your homework given by the teacher?

2.12who is your best teacher?

2.13With whom do you ask if you get any confusion.

• friends b. related subject teacher c . Father mother
• brother sister e. tuition

2.14 How do you study at home?

• alone b. with brother sister

2.15 What types of materials do the students need to study?

…………………………………………………………………………………………..

2.16 which subject is difficult to study for you?

…………………………………………………………………………………………

2.17 which is your favorite subject?

2.18 Which subject do you study much?

2.19 Which subject do you study less?

………………………………………………………………………………………..

2.20 What is your favorite game?

……………………………………………………………………..

2.21 Do you like music?

2.22 Do you fight with your brother and sister?

• always b. seldom c. never

2.23 In which matter does you fight with your brother and sister?

………………………………………………………………………

2.24 Do your father –mother scolds you?

• always b. seldom                         c. never

2.25Do you quarrel with your father and mother?

• always                   b. seldom                         c. never         d. mostly

2.26What do your father and mother does if you quarrel with them?

• scolding b. beating c. suggest                d. nothing

2.27Do you consult Doctor while you fall in sick?

………………………………………………………………………….

2.28 What do you have every day as your meal?

…………………………………………………………………………..

2.29What do you like to eat as your lunch?

………………………………………………………………………..

2.30How do you evaluate yourself?

• Capable b. middle        c. common                   d. weak

2.31 How do your parents help you?

• Remove confusion
• Suggest to study
• Buy necessary materials
• Give money only

2.32 What do you do if you couldn’t understand the lesson taught by your teachers?

• ask with teacher b. ask with students c. ask with father and mother

2.33 Tell your three good habits.

2.34 Tell your three bad habits.

2.35 Why didn’t you go to study in boarding school?

……………………………………………………………………………

2.36 Which colors do you like most?

2.37 Which animal do you like?

2.38 Tell the name of a great national hero?

2.39 What are the main qualities of a student?

2.40 Who is your favorite friend?

2.41 Do you like to have entertainment inside the classroom?

• always b. never c. mostly       d. seldom

2.42 Do you fight with your friend?

2.43 Do you have to tell anything else?

For Subject Teacher:

Name of Student:

This Questionnaire is prepared for child study.

You are requested to fill up true answers only.

Name of teacher:

• What three strong points do you see in your student?
• What are the three weak points of Bikash K.C.?
• Discipline of your student
• quiet discipline b. good    c. well  d. well  e. Not at all
• Regularity and punctuality of your student
• always b. seldom   c. mostly
• What suggestions do you give for his better performance?

Case Study in Nepali

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Nepali To English Dictionary

Case meaning in nepali, meaning of "case".

Other word with "Case"

• (case) documents, file ,
• to beat, to charge upon, to drive in, to hammer, (case) to file, to lodge a complaint, (slang) to fuck ,
• (gram) dative case ,
• address, (gram) vocative case ,
• box, trunk, suitcase, any luggage ,
• drawers, cupboard, wardrobe, cabinet, shelf, bookcase ,
• civil case ,
• of court, court case ,
• criminal case ,
• direct case ,
• filing a case, lodging a suit ,
• if, in case, provided that ,
• if, whether, in case, supposing that ,
• in case of emergency, when troubled, if a disaster occurs ,
• in that case, then, so, if so ,
• provided that, in case of ,
• in that case, in such circumstances or conditions ,
• to file a case, lodge a suit ,
• to be a case of arson, to catch fire, to be a fire accident ,
• to fight a case, to frequent a court ,
• to file a case, to lodge a suit, to sue in a court ,
• to win a case
• मञ्जुरीनामा