June 22nd marked the end of the second 15-class Tai Chi program conducted by Bihani Social Venture’s Health and Rehab Team, led by Susmriti Bomjan Tamang, in partnership with NEPAN’s Older People’s Association (OPA) of Jorpati, Kathmandu. The closing ceremony was held to celebrate the achievements of the 42 male and female elders, age 65 and over who participated in the daily Tai Chi classes.

The second session of these classes is a true testament to the strength in cooperation between local partners to initiate grassroots level lifestyle changes. The initial pilot program during Winter 2016 hoped to “establish a commitment from the older adult participants to continue to practice Tai Chi within their communities and ideally spur the furthering of this initiative by inciting excitement around the social nature of this exercise, increasing older people’s ownership of their own health and creating a system of health accountability within the group.” The team achieved success through the Jorpati OPA’s ability to self-fund and self-facilitate the second session of classes, in coordination with the Bihani instructors. Further, the Jorpati OPA have used this new-found motivation for physical health and exercise to secure 100,000 NPR (~$1,000) worth of exercise equipment adapted to the needs of older adults from the local Lion’s Club of Kathmandu. The mayor and other newly-elected local officials attended the closing ceremony giving them an opportunity to witness the importance of including older people as active participants in their own health, well-being, and development. Exposing policy-makers to experience the excitement and passion of these older adults as they engaged in Tai Chi was a unique way to encourage social protection and challenge ageist stereotypes.

Congratulations again to all the elders who completed the sessions! We hope you continue to practice Tai Chi. And a heartfelt thank-you to all our team members for their dedication, leadership, and positivity through this process! Great job to Bihani’s Health and Rehab team of Sandhya Maharjan, Sherry Sherpa, Pallu Timilsina and more led by Tai Chi instructor, Susmriti Bomjan Tamang for conducting the session with the elders. Much thanks to Santoshi Rana (Bihani’s Executive Director) and Samrishi Rana (Bihani’s Health Adviser) for continued support, guidance, and professionalism. We are very grateful to the NEPAN staff, especially Fatik-sir, Nirmala-ji, and Dibesh-ji for their help in coordination and implementation of the program from start to finish. Lastly, this program would not have been possible without the direction and leadership of Haley Sanner, NEPAN Fellow. Haley facilitated the partnership between NEPAN and Bihani, envisioned the direction of the program and secured the funding.

Background

In Winter 2016, Nepal Participatory Action Network (NEPAN) in partnership with Bihani Social Venture’s Health and Rehab Team/Nepal’s Young Dragon team* proposed to adjust the facilitation of the traditional health camp model to pilot a sustainable Participatory Healthy Lifestyle program with the Older People’s Association of Jorpati under the funding of HelpAge International Nepal (HAIN).  The “Teach Me Tai Chi” physical exercise program provided elders an opportunity to take a more active role over their health and well-being.  From November 2016 – January 2017, 25 elders in addition to 5 younger local social mobilizers (Female Community Health Volunteers, teachers etc.) participated in 15 classes to learn basic and immediate Tai Chi movements. The objectives of the program were as follows:

  1. Mobilization of older Nepali adults to take personal ownership of their health and well-being;
  2. Reorientation of gender and age stereotypes around physical fitness by enabling women and older adults to become community public health change-makers;
  3. Build the body of evidence showing that Tai Chi is an important community health strategy in Nepal for an ageing population due to its benefits in the rehabilitation, prevention, and treatment of physical and psychological illnesses; and
  4. Enable intergenerational exchanges.

 * Athletes of the Young Dragon Team are contracted and trained to teach older people through Bihani Social Venture, a social enterprise focused on providing opportunities for older Nepali adults to live active engaged lives past retirement. From a risk management perspective, the Young Dragon athletes have worked with older adults in group and private settings. Additionally, this project empowers these young women leaders to step outside of their traditional gender roles and use their athletic training to become public health change makers in an intergenerational setting.

Rationale

Recent demographic changes present significant burdens on an already overburdened Nepali healthcare system. According to HelpAge International’s Global Age Watch 2015 Index, Nepal ranks 79 out of 92 countries in regards to health care provisions for older adults, the lowest in the Asia-Pacific region. In addition, these demographic changes have increased the risks of falls and other health conditions in older adults, as recognized in numerous World Health Organization (WHO) global health policy alerts. This simple Tai Chi community-based exercise program is an innovative idea to aid Nepal’s management of health risks and resources for older people.

In a study researching the socio-cultural/medical impacts and unintended consequences of episodic medical service delivery, David Citrin[1] offers a critical analysis of the “emergence of ‘health camps’ as an increasingly popular model of short-term medical care” in Nepal.  He argues that the health camp model “perpetuates a global and national climate where ideas of ‘health’ and ‘healthcare’ are conflated, and where pills, surgeries and syringes are championed at the expense of addressing the basic needs that promote and sustain health”.  As a means deviating from this model, NEPAN proposed to test an innovative community-led initiative that promotes sustained healthy lifestyle changes.  This program has placed NEPAN, Bihani Social Venture, and HAIN at the forefront of establishing participatory preventive health initiatives instead of perpetuating episodic curative care.

Evaluation Measures

Studies have consistently demonstrated the value of exercise programs like Tai Chi as cost-effective interventions for managing fall prevention and other common health ailments of an ageing population. While Tai Chi is commonly practiced by ageing populations in other South Asian communities, there is a recognized gap is the use and measured evaluation of such practices in Nepal. Therefore over the past 9 months, the NEPAN and Bihani team members have been working both quantitatively and qualitatively measure the impact of the “Teach Me Tai Chi” program class design, participant’s general health indicators, and funding components.

During the first phase of classes, the team members measured the participants general health indicators before and after including blood pressure, blood sugar, weight, and localized pain. Additionally, team members surveyed participant’s balance, self-esteem, fall efficacy, and pain efficacy. After the second phase of classes, the same participants completed a qualitative survey capturing experience, practice, and skill efficacy. Integrating measurable health indicators into the exercise program created a platform for empowering older people to recognize how healthy lifestyle practices positively impact their livelihood and well-being. This platform was evident during the survey enumeration as elders were active in asking questions about their health and participating in discourse amongst themselves over healthy lifestyle habits. 

A summary of these findings will be presented in an upcoming multimedia report to be sometime in Fall 2017.

References:
[1] Citrin, D. 2010. “The Anatomy of Ephemeral Health Care: ‘Health Camps’ and Short-term Medical Voluntourism in Remote Nepal.” Studies in Nepali History and Society 15(1): 27-72