Universal Health Coverage includes Palliative Care for All, especially Poor People.

Last week the Lancet Commissions published their report on Palliative Care and Pain Relief.

The report showed that the Essential Package of palliative care and pain management interventions is affordable in low-resource countries, yet this Essential Package is barely available in these settings.

Here's what the report said:

"The fact that access to such an inexpensive, essential, and effective intervention is denied to most patients in low-income and middle-income countries (LMICs) and in particular to poor people—including many poor or otherwise vulnerable people in high-income countries—is a medical, public health, and moral failing and a travesty of justice." 

"Unlike so many other priorities in global health, affordability is not the greatest barrier to access, and equity-enhancing, efficiency-oriented, cost-saving interventions exist. "

Implementing this Essential Package offers a huge opportunity improve the lives of poor people, at a modest cost. We must start to implement this, especially in Bangladesh, in slums (where we have already started) and in the refugee camps and settlements where the Rohingya have arrived recently.

Here is the essential package and the full report http://thelancet.com/commissions/palliative-care

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. 

http://www.thedailystar.net/star-weekend/health/going-gently-good-night-1472035

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.

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.

https://childrenspalliativec.wixsite.com/cpcib

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.

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.

http://www.ehospice.com/internationalchildrens/ArticleView/tabid/10670/ArticleId/17243/language/en-GB/View.aspx