Table 4.

Recurring challenges and solutions

Challenges	Solutions
Patient adherence	Patients show initiative by setting out to access the referring hospital for care If the patient arrives as an outpatient, the patient and caregiver are advised to immediately set off for Kathmandu the next day, avoiding a return home. If they return home to settle their affairs, they often do not return. The multidisciplinary team emphasizes the need to act quickly, avoiding any unnecessary returns to the village If the patient is coming from inpatient care, the referral is planned in advance and the family receives prior counselling
Loss of income	Flexibility is given as to who might be a caregiver: a grandparent, aunt/uncle, or sibling can accompany the patient to Kathmandu so that the parent can stay to provide income for the family or care for other children
Legal implications	Patient consent for navigation is obtained upon arrival at the PN centre
Mental health challenges related to disability	Integration of persons with disabilities (PWD) into key roles within the organisation Involvement in community life at SDSS gives birth to hope after disability
Blood shortage	Initiation of blood donor campaigns and establishment of a donor roster to assist the cardiac hospitals
Return to home village	Adaptation of home environment through local NGO