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Background

Nepal is a country located between India and Tibet in South Asia, and this nation is home to 60 different ethnic groups spreading across 7 provinces of Nepal [1]. The country’s  common religion is Hinduism and a smaller portion follows Buddhism [1]. However, due to Nepal’s long history of Buddhism, Buddhist influence can be seen across the Nepalese culture, values, and believes. Nepali is the common language. 

 

The major languages of Nepal (percent spoken as mother tongue) are Nepali (48.61%), Maithili (12.30%),Bhojpuri (7.53%), Tharu (5.86%), Tamang (5.19%), Newari/Nepal Bhasa (3.63%), Magar (3.39%), Awadhi (2.47%), Rai (2.79%), Limbu (1.47%), and Bajjika (1.05%).

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Most Nepalese in America are Bhutanese refugees who were driven out from Bhutan by the local government [3].

Health Beliefs

  • Most Nepalese Americans follow Hinduism, cows are highly revered in the culture [1].

  • It is believed that by praising and complimenting a child can bring illness to the child [1].

Social Traits

  • Age hierarchy 

  • Gender roles 

  • Collectivism 

Implications for Health Practitioners/Health Questions

Greeting: Often, following the age hierarchy practice, elders are expected to be greeted first. The traditional greeting by a Nepalese would be to press their palms together in front of the chest with a bow/nod depending on the social status of the opposite party [1]. Shaking hands is also a common way of greeting [1].

 

Diet: Diet often includes rice in every meal, which can be hard to manage for patients with diabetes to lower their portion. However, Nepalese home food often offers a diverse selection of vegetables and meat [1].

 

Mental Health: Mental health is stigmatized in Nepalese culture. Cultural interpretation of mental health may be different than Westernized definitions. For example, some Nepalese people may believe that mental illness is due to spiritual possession or supernatural intervention [4]. If you are opening a conversation about mental health with a Nepalese patient, consider asking patients what mental health means to them. ​

Questions/Education

  • Healthcare Challenges:

    • Ask patients about access to primary care and health insurance.

      • Study from a cross-sectional survey suggested that Nepalese patients experienced fewer total health care visits in the past year as well as significantly less preventative dental visits [5].

        • Language barriers, coverage by health insurance, difficulties in transportation, and cultural attitudes may have been the reason behind this inability to access care.

  • Ask patients about additional treatments that they might be using.

    • Buddhist and Hindu practices are used in performing health rituals [6].

    • The herbal medicine in far-west Nepal is the basis of treatment of most illness through traditional knowledge [7].

  • Social History:

    • What are your thoughts about smoking?

      •  In the elderly population, asking a patient to stop smoking may be difficult due to strong cultural habits. Moreover, smoking is often seen as a social activity that is practiced among men.

      •  In one day, how often do you smoke? If not, how about the people around you?

      • Have others expressed concern about your smoking habits?

  • Women’s Health: 

    • Be mindful of patients’ sexual history and sexual health education.

    • The incorporation of social support may allow for more effective health interventions.

    • Females in Nepal may face many social disadvantages at birth, including limited obstetric care, health care, legal rights, and education [8].

Health Challenges

  • The top five causes of mortality in Nepal are Chronic Obstructive Pulmonary Disease, ischemic heart disease, stroke, lower respiratory infection, and neonatal disorders [9]. Other common conditions are cirrhosis, tuberculosis, and asthma. 

  • Nepal was ranked one of the top ten countries with the highest pollution status, which may contribute to the higher prevalence of pulmonary conditions in this community [10].

Women's Health

  • Anemia is a prevalent issue for women.

    • In 2016, estimated 40.5% of women had anemia [11]. 

  • Reproductive education is a highly stigmatized topic. There have been efforts to improve education in schools, but many adolescents struggle finding reliable access to resources [12].

  • Early marriage and childbearing is common

    • 48.5% of women between the ages of 20-49 were married before the age of 18 [13].

  • Birth Practices: 

    • Traditionally, majority of women give birth at home, although the reason behind this trend has shifted to lack of access to healthcare [14]. 

    • It may be common for women to consult with family prior to seeking medical care [14].

Family Structure

  • Nepalese family units are patriarchal, patrilineal, patrilocal, and multigenerational [1].

    • While most households are strongly patriarchal, some in rural areas are matriarchal.

    • New rise in nuclear families leading to more independence and privacy for adult children, especially in urban areas.

  • Both love and arranged marriages are equally common and divorce is frowned upon and seen as a ‘last resort’ [1].

    • Common practice is to live separately but have parents live separately. 

Conclusion

  • Most Nepalese Americans follow Hinduism, traditional gender roles, and age hierarchy. 

  • The traditional greeting involves pressing palms together in front of the chest with a bow/nod depending on the social status of the opposite party.

  • Mental health is highly stigmatized in Nepalese culture, and the interpretation of this topic may be different than Westernized definitions.

  • The top five causes of mortality in Nepal are Chronic Obstructive Pulmonary Disease, ischemic heart disease, stroke, lower respiratory infection, and neonatal disorders.

Resources for Patients

This information was collected and organized by our team. As of this time, we have not yet been able to connect with any individuals in this community that could review this article. If you are interested in reviewing this article, please contact kaitlynn.borik@health.slu.edu

References

(1) Evason, N. (2017). Nepalese Culture. Cultural Atlas. Retrieved March 24, 2024, from https://culturalatlas.sbs.com.au/nepalese-culture/nepalese-culture-core-concepts#nepalese-culture-core-concepts

(2) 

(3) Shukla, A. (2010, July 22). Bhutanese refugees' American dream. The Washington Post. Retrieved March 24, 2024, from web.archive.org.

(4) Chase, L. E., Sapkota, R. P., Crafa, D., & Kirmayer, L. J. (2018). Culture and mental health in Nepal: an interdisciplinary scoping review. Global mental health (Cambridge, England), 5, e36. https://doi.org/10.1017/gmh.2018.27 .

(5) Thakur, A., Adhikari, S., Anderson, D., & Feinn, R. (2019). Health Care Access and Utilization by Nepalese Adults in Connecticut. Cureus, 11(4), e4543. https://doi.org/10.7759/cureus.4543 

(6) Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Nepalese. (2020, November 2). Lamar Soutter Library . Retrieved March 24, 2024, from https://libraryguides.umassmed.edu/diversity_guide/nepalese#:~:text=Concepts%20of%20Health%20and%20Wellness 

(7) Kunwar, R. M., Shrestha, K. P., & Bussmann, R. W. (2010). Traditional herbal medicine in far-west Nepal: a pharmacological appraisal. Journal of ethnobiology and ethnomedicine, 6, 35. https://doi.org/10.1186/1746-4269-6-35 

(8) Baker J. Women's health in Nepal: the neglected dimension. JNMA J Nepal Med Assoc. 1994 Jul-Sep;32(111):214-8. PMID: 12154943. 

(9)  Nepal. (n.d.). Institute for Health Metrics and Evaluation. Retrieved March 24, 2024, from Institute for Health Metrics and Evaluation. Retrieved March 24, 2024, from https://www.healthdata.org/research-analysis/health-by-location/profiles/nepal 

(10) Mandal, C. K. (2020, October 22). One more report ranks Nepal among most polluted countries in the world. The Kathmandu Post. Retrieved March 24, 2024, from https://kathmandupost.com/climate-environment/2020/10/21/one-more-report-ranks-nepal-among-most-polluted-countries-in-the-world

(11) Rai, A., Khan, M. N., & Thapa, S. (2020). Trends and determinants of anaemia in women of Nepal: a multilevel analysis. Maternal & child nutrition, 16(4), e13044. https://doi.org/10.1111/mcn.13044 

(12) The United Nations Population Fund — UNFPA. (2021, September 13). Fact sheet sexuality education: Comprehensive sexuality education. 

https://nepal.unfpa.org/sites/default/files/pub-pdf/Factsheet%20sexuality%20education_0.pdf, 

(13) Reaching adolescents with health services in Nepal. (2017). Bulletin of the World Health Organization, 95(2), 90–91. https://doi.org/10.2471/BLT.17.020217 

(14) Chand SB. (2016) Cultural beliefs and traditional rituals about child birth practice in rural, Nepal. MOJ Public Health.;4(7):196–199. DOI: 10.15406/mojph.2016.04.00106

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