Tuesday, October 17, 2017

Rohingya Refugee Crisis

There has been a huge influx of Rohingya into Bangladesh in the past few weeks.

Dr. Farzana Khan, CPCIB Co-Lead, has recently been providing medical care with local humanitarian partners.

For Hats on For CPC, on Oct 13, she took the following photo with some of the children:

She writes: "these smiling children often remind me how to live in the present moment, no matter how harsh the environment is"

A look into what palliative care is available for those with life-limiting illnesses in Bangladesh

In the lead up to World Hospice and Palliative Care Day, the Daily Star published this article which raises awareness about the need for palliative care. 


Friday, October 13, 2017

World Hospice and Palliative Care Day 2017

“Death belongs to life as birth does
The walk is in the raising of the
foot as in the laying of it down” 
― Rabindranath Tagore, Stray Birds

World Hospice and Palliative Care Day, a unified day of action to celebrate and support hospice and palliative care around the world will be celebrated on Saturday 14th October. 

The theme is Universal Health Coverage and Palliative Care – Don't leave those suffering behind. 

We are celebrating this day in Bangladesh with events at many of the hospitals where we work, including:

Dhaka Shishu Hospital- Awareness event in the Conference Hall at 9:30am

Dhaka Medical College Hospital-Share your wishes on the Before I Die Boards from 9am-2pm.

BSMMU-Awareness event in A Block Auditorium at 9am

Rally and Human Chain at the Press Club, at 11am-Human Chain, 12pm- Press Conference

Here is a link to the article which World Child Cancer has published for the day.

Friday, October 6, 2017

Speaking out about the need for pain management in Bangladesh

Recently we published this article (https://tinyurl.com/y8fp7ajr) which describes the incredible burden of pain and other symptoms which are very rarely adequately treated in patients with advanced cancer and other illnesses. 

There are a large number of people living with cancer and other advanced illnesses in Bangladesh. Most of these people will not be able to access cancer treatments which will be curative, as they present very late and cannot be cured. In this situation palliative care can have a huge impact on the suffering which they and their families experience.

We found that 7 out of every 10 patients reported having pain and that it was most often severe.  When we asked whether their pain was adequately treated, we found that 75% still had moderate or severe pain after treatment.  Very few were able to get morphine, which the WHO states is the most appropriate treatment for this type of pain. 

Please check out the new website of the Children's Palliative Care Initiative in Bangladesh which brings together all of our work in one place.

Friday, July 21, 2017

18 Months of the Children's Palliative Care Initiative in Bangladesh

I can't believe that it has been 2 years since my last post!  Life has been quite busy, with the birth of my second son and moving back to Canada.

In addition, in November 2015, I was approached by World Child Cancer to develop a project to specifically address the Palliative Care needs of children in Bangladesh!

This project, officially called the Children's Palliative Care Initiative in Bangladesh (CPCIB), has kept me busy for the past 18 months!  The project launched in January 2016, as a pilot project for 1 year. With the experiences that were gained in the first year, we have now been able to expand and further develop the CPCIB and the first phase of this project will run until 2020!

Here is an info-graphic which we prepared to share about the project and it's goals in the beginning.

Sunday, November 1, 2015

World hospice and palliative care day

Recently, we celebrated World Hospice and Palliative Care Day in Bangladesh.  This is an annual global event to highlight Palliative Care.  

Did you know that less than 98% of children who need palliative care in developing countries don't have access to it? 

There are 29 000 children in Bangladesh who don't get the need palliative care that they need every year. 

What this means for an individual child is that the strongest pain medication they might get is paracetamol, no morphine. In many cases no one ever tells them or their families that the child is dying. And when a child dies, there is no one to help the family cope with their grief. 

In Bangladesh, less than 1% of children get the specialized palliative care that they need at the end of their lives. It often means that a child is left alone with their fears and anxiety as no one tells the child what's happening. 

In Bangladesh, doctors often don't know how to explain to a family that their child is dying. The doctor may be nervous or unsure of how to have this discussion, because they've never been trained in how to communicate with families about serious illnesses.

I'm reminded of a 10 year old girl that I cared for last year.  I'll call her Yasmin.  When she came to the hospital, she had a very advanced cancer in her leg, and I knew that it wouldn't be possible to cure her. I was able to control her pain with morphine and to answer her questions and calm her fears.  

As she understood that she wasn't going to get better, she shared with us that she wanted to go home and be surrounded by her friends and family.  We were able to make this happen.  She went back to her village in the countryside.  She died surrounded by the love of all of her friends and family.  She didn't die in a hospital far from home, in pain, afraid and confused.

Research has shown that when children receive palliative care, the quality of life for them and their families is vastly improved. In fact, good quality palliative care, may even extend their life. 

The reality is the majority of doctors and nurses in Bangladesh never receive training in how to provide palliative care, they don't receive training in medical or nursing college and they don't receive training in their post-graduate training. With training, health care workers can be taught how to prescribe morphine safely for children, how to talk to children and families and how to support their emotional and spiritual needs. 

When a child is in contact with just one health care professional who is trained in the basics of palliative care, the child's pain is relieved, their emotional and spiritual needs are met and their families feel supported as they face the unimaginable. 

Here's a link to the eHospice article about the World Hospice Palliative Care Day Event which was held at BSMMU recently.

Wednesday, October 21, 2015

Quality of Death Report

Did you know that the Quality of Death Report was recently released?  The best place to die is the UK.  Canada can in at number 11.  Bangladesh was ranked 79th out of the 80 countries surveyed.


Here are the details: (From a recent editorial which I wrote on the subject)

The recent 2015 Quality of Death Index, published by the Economist Intelligence Unit, released on October 6th, describes the status of palliative care in 80 countries from around the world.

The Lien Foundation, a Singapore-based philanothropic organisation, commissioned the Quality of Death Index, based on in-depth research and interviews with local and international palliative care experts.

Palliative care is an approach that focuses on improving the quality of life for patients with life-threatening illness and their families. The goal of palliative care is to relieve physical, psychological and spiritual suffering.

The United Kingdom, where palliative care is well incorporated into the National Health Service, tops the ranking. Additionally, the UK demonstrates key measures which are instrumental in providing high quality and accessible palliative care, including comprehensive national policies, a strong hospice movement and extensive community involvement on the issue.

The report ranked Bangladesh in 79th out of the 80 countries surveyed, noting that palliative care remains an “unresolved hurdle” for the country’s public health system. Indeed many significant hurdles are present at this time in the development of palliative care services in Bangladesh.

The report demonstrates that, in general, income is closely correlated with high quality palliative care. High-income countries dominate the top 20 positions in the ranking. Australia and New Zealand rank second and third, the US is 9th, and Canada is 11th.

There are notable exceptions to this correlation, with several less developed nations demonstrating that integrating palliative care into the public health care system is possible and indeed a vital component of basic health care. Specifically, the report highlights the efforts in the Indian state of Kerala and Panama (31st) where innovative efforts have lead to the incorporated of palliative care into primary health care.

Palliative care can be a very cost effective form of health care. Palliative care can be delivered in homes and health centres, in addition to hospitals and hospices. Palliative care is most successful when it is initiated early in the course of illness, and early palliative care reduces unnecessary hospitalizations. Additionally, early palliative care has been shown to improve the quality of life for patients.

Recently, in collaboration with the National Institution of Population Research and Training (NIPORT), the Centre for Palliative Care at Bangabandhu Shiekh Mujib Medical University (BSMMU) completed an Assessment of Palliative Care in Bangladesh.  An estimated 600 000 patients in Bangladesh require palliative care any point in time. If family members, who often require psychological, social and spiritual support, are included, then the number of individuals who need palliative care may be as high as 2 million (20 lakh).

Globally, children suffer disproportionately from a lack of access to palliative care. The majority of low and middle-income countries, where 98% of the world’s children required palliative care reside, have very limited palliative care services for children. Unfortunately, the situation in Bangladesh similar, with very few children having access to the palliative care they require.

A lack of training and awareness of palliative care are major barriers to the provision of palliative care in Bangladesh. Education of physicians and nurses will be vital to improving local palliative care services.  Palliative care must be incorporated into the training curricula for all new health care professionals from primary health care workers in rural areas, to specialist physicians in Dhaka.

Palliative care is not only for patients with cancer. It is also required for a wide range of chronic and life-threatening diseases, including heart disease, chronic lung diseases, renal disease, diabetes, dementia, and other incurable and serious conditions. In Bangladesh, the majority of deaths are now due to non-communicable diseases (NCD). When developing National Policies for the management of these conditions, palliative care must be incorporated. Palliative care will not only relieve suffering and improve the quality of life of individuals with these conditions, it will also be instrumental providing cost-effective care and reducing unnecessary health expenditures. Frequently, patients with advanced cancer spend large sums of money on unnecessary treatments, which do nothing prolong the duration or improve the quality of life, and instead lead to significant financial suffering for families.

Pain management is an important component of palliative care. Pain is one of the most frequent and troubling symptoms experienced by patients with life-threatening conditions. The World Health Organization (WHO) estimates that 80% of patients with cancer will experience moderate or severe pain at the end of their life.  Opioids pain medications, such as morphine, are essential for the treatment of pain in many palliative care patients. Morphine is safe and effective for the treatment of pain and patients who require morphine for pain do not become addicted.

The WHO has included morphine and several other opioids on its list of Essential Medications. In the past several years, progress has been made in Bangladesh to ensuring that all patients who need these medications will have access to them.  Local production of morphine started in 2007, and there are presently 3 local pharmaceutical companies who are manufacturing morphine.

There are still substantial barriers to ensuring appropriate pain management in Bangladesh. Many physicians are unaware of that morphine is available locally, or are hesitant to prescribe opioids as they incorrectly fear that patients will become addicted.

Public and patient misconceptions about the safety of morphine compound the issues facing physicians. Patients are often unaware that opioids are a safe and effective option to treat their pain. 

Although there are many challenges for palliative care in Bangladesh, even the longest and most difficult journeys beginning with a single step. So we have taken our first steps, and the future holds much promise for the further development of palliative care in this country.