‘He never makes false promises’: the ANU scientist blending cultural practice with clinical care

Seven years ago, Dr Uday Yadav made a promise to his community in eastern Nepal.

“I can’t do it justice right now,” he told them. “But one day – one day I’ll get the funding, and I’ll come back and do the right thing that fits our ways of living and culture.”

The ‘right thing’ was finding a way to address a pressing problem – one that had touched too many lives around him: multimorbidity – the presence of two or more chronic conditions at once.

In Nepal’s Koshi Province, more than 35,000 people live with combinations of conditions including hypertension, diabetes and chronic obstructive pulmonary disease (COPD). These burdens fall disproportionately on marginalised groups including the Madhesis, Indigenous and Dalits peoples.

“I’ve seen my own family and community members die, many of them from preventable chronic conditions,” says Yadav.

Now a chronic disease implementation scientist at the ANU National Centre for Epidemiology and Population Health, Yadav is working to make things right.

The multi-factors to multimorbidity

According to Yadav, the rise in multimorbidity across these communities is shaped by a complex mix of factors.

Health literacy is low, with most people not knowing how to manage these conditions. The quality of accessible primary health care is mixed, with some clinicians treating one issue but overlooking others. When symptoms persist, people are likely to lose trust and turn to homeopathy or traditional medicines.

“You can’t manage these conditions by just focusing on one element,” says Yadav. “You need holistic thinking.”

Modifying health behaviours – especially at scale– is never easy, but Yadav is determined to develop a patient-centred model of care that will improve health outcomes for his people.

“To me, this is a mission beyond the academic walls,” he says.

Returning with a plan

After years as a public health researcher, Yadav is leading an ambitious five-year implementation trial in his home region, funded by a National Health and Medical Research Council (NHMRC) Global Alliance for ChronicDiseases (GACD) grant.

The core of the intervention is a group of local community health workers, who live in the community they serve and play crucial roles in Nepal’s primary healthcare systems.

“They are not purely lay, and not purely medical,” says Yadav.

“They are the bridge in between, with strong connections to – and deep trust from – both the communities and the healthcare system.

“We will provide extensive training to community health workers, valuing their strengths and knowledge to manage multimorbidity in a culturally safe approach.”

Many previous interventions were very clinical, with limited use of a holistic approach and community engagement, explains Yadav. That’s why his team is working differently, emphasising the concept of co-design from the ground up.

Project collaborator, Clinical Professor Narendra Bhatta, is Head of the Department of Pulmonary, Critical Care & Sleep Medicine at the B.P. Koirala Institute of Health Sciences.

“True change happens when power is shared, not just when voices are heard,” he says and

“This project will be designed, implemented and evaluated with the active involvement of clinicians, patients, families and other stakeholders – ensuring that the unique needs, preferences and cultural values of the people of Nepal are not just acknowledged, but embedded at its core.”

For and by the community

The project’s 16-month co-design process involves working with individuals with multimorbidity, their families, community leaders, community health workers, clinicians and policymakers.

Once implemented, the trained community health workers will deliver home visits, peer support group sessions and community events. They will also provide symptom monitoring, education and behaviour change support.

The outcome and cost-effectiveness of this intervention will be compared against usual care.

“The power should be given back to the community,” Yadav says, “Then you’ll see how community can improve their own health and wellbeing. It’s all about training the local leaders and creating the local champions, to do right things in the right way.”

So far, the local communities and government stakeholders have embraced the project.

“The best part of Yadav’s research work is that he visits the community, engages them and listens to their voice,” Dev Tamang, a community member from Eastern Nepal, says.

“He shares academic knowledge with us and never makes fake promises, and respects our way of living and knowledge while designing the project.”

Global lessons for local changes

While Yadav’s work is grounded in Nepal, there are broader implications beyond the landlocked country.

“Countries like Australia, where Indigenous and culturally diverse communities face similar health challenges, stand to benefit from this research,” says Dr Bhim Prasad Sapkota, a project partner from Nepal’s Ministry of Health and Population.

“This project is more than research – it’s a global exchange of knowledge, an opportunity to adapt and localise solutions for those most in need. Together, we can build more inclusive, responsive and equitable health systems.”

Yadav wholeheartedly agrees.

“Transformation can happen when we can blend local wisdom and global learnings into action, and action into change in the real world,” he says.

At the end of the day, solutions can travel – but only if they’re grounded in local realities.