Agenda: The gap left by the missing generation

FIFA has announced plans to invest money from its World Cup Legacy Fund into the education of girls and women in India and Nepal – two countries from which many migrants travelled to work on the building of the stadiums in Qatar, sometimes with fatal results.

Helping girls and women into education in India and Nepal is something EMMS International, Scotland’s oldest healthcare charity, has been working on for several years. Girls in developing countries may not see female role models in careers such as health, so EMMS has been helping girls into healthcare courses that can provide them with a path to a secure job. The hope is many will return to their often remote communities to work there.

One of the particular issues for healthcare in Nepal is the “missing generation”. Many of the workers who left their homes and families for Qatar found it was not the promised land they hoped for. Some five million travelled to the country, but more than 6,000 died – most of them from India and Nepal. The road to the World Cup has been dark and treacherous.

For the families of the workers left at home, the loss of their loved ones can also plunge them further into poverty and vulnerability. Frail and elderly people in Nepal now often don’t have the generation below to look after them if they fall ill. It’s estimated that about a fifth of households need palliative care at any one time, but only 1.7% of families have access to it.

To help tackle these problems, EMMS and partners in Nepal have begun a three-year UK Aid-funded programme, Sunita, to develop palliative care in hard-to-reach places. We have also developed a national palliative care strategy and one of the challenges has been to define what palliative care actually means. To many, it means pain relief but EMMS is doing much more than that. We consider the whole family. It’s about making sure everyone is getting what’s needed. Bringing quality care closer to home can also ease the burden of care which can all too often force girls out of school.

So this is really what our project in Nepal is all about. The rural model we’re developing, at five different sites, is based around hospitals. We’re training people to support their communities as health volunteers and to support patients by offering to do some shopping for example, or a bit of cleaning or cooking, or watching the animals while someone goes to the city for medicines. Because families are lacking that middle generation that left to work in places such as Qatar, you have to get the rest of the community to fill the gap.

The project in Nepal is also a continuation of the work EMMS has been doing for more than 180 years. When the organisation first started, we were training missionary doctors who would establish and work in hospitals mostly in China and India. We no longer send doctors overseas, but build health systems from the ground up; it’s more sustainable and provides a hand up, not a hand out. EMMS still has the India connection almost two centuries later but we’ve added Malawi and Nepal too. Times have changed. But the vision remains the same: a world in which all people have access to good quality and dignified healthcare.

Cathy Ratcliff is chair at EMMS International and Scotland’s International Development Alliance.

EMMS International Festival of Nine Lessons and Carols is at St Andrew’s and St George’s West Edinburgh on December 8th. For more information, see

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