Palliative care: A light for the patients
Mariha, a thirteen year old school going girl who was happy with her life, suddenly diagnosed with Leukemia. After knowing her disease was incurable as it was in stage four, she was completely broken. Part of her treatment to live few days more doctor treated her by chemotherapy. But sadly nothing happened, it didn't work for her. Despite of knowing that nothing can cure her, she just didn't want to die in this beautiful world by counting her remaining days to live. Her time was passing extremely bad.
One day she was sitting in the dark room as usual, suddenly her father entered in the room with a colourful leaflet in his hand. After that day her life was changed. She was not passing her days in depression, anxiety and trouble sleeping just like before. In spite of having cancer pain in her body, she was happy because she got proper care. All of this happened because of palliative care. Now question is what is palliative care?
Palliative care is interdisciplinary specialized medical and nursing care with a focus on providing relief from the symptoms, including pain, and physical and mental stress at any stage of illness. The World Health Organization (WHO) defines palliative care as " An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual."
When someone should receive palliative care? You can have it at any age and any stage of illness such as Cancer, Coronary Obstructive Pulmonary Disease (COPD), Parkinson's, Heart Failure, AIDS, Kidney Failure, Dementia and many more. Now in Bangladesh we find so many cancer patients and the number of patients is increasing rapidly. Most people are unaware about palliative care. In Bangladesh the amount of palliative care units and activities are almost negligible. Bangladesh stands in '3a' position indicating the patchy activities for development of palliative care (Ref: Global Atlas of Palliative Care at the End of Life, 2014).
In 2015 Quality of Death Index overall score showed position of Bangladesh 79th out of 80 countries based on availability of palliative care service (Ref: The Economist Journal). Bangladesh is a signatory of WHO resolution 67.19 which recommends integration of palliative care into national health systems. Globally about 25.5 million of 56.2 million people who died in 2015 experienced serious health related suffering. Another 35.5 million experienced serious heath related suffering due to life threatening and life limiting conditions. Nearly 2.5 million children worldwide die in need of palliative care and pain relief.
Palliative care is a model of care that focuses on relieving suffering of the patients with life threatening disease and improve quality of life of patients and their families. Palliative care offers the following things:
* Relieve of pain and other symptoms like anorexia, vomiting, insomnia, weakness, depression etc.
* It increases survival time and regards dying as a normal process.
* Assistance for families come together to talk about sensitive issues and it offers the support system to the family.
* Links to other services such as home help and financial support and Reduces unnecessary hospital visits.
* Support for people to meet cultural organizations.
* Counselling and grief support.
* Puts the patient's desires, goals and decisions first and focuses on body, mind and spirit.
According to WHO, 600,000 patients of Bangladesh are in need of palliative care but most of them are unaware of this service. More than 90% of Health Professionals did not have any training in pain management of palliative care. Palliative care service was introduced in Bangladesh for both children and general patients by ASHIC in 2006 and by BSMMU in 2007. But at first only outdoor care in single room was provided in BSMMU. The then president Zillur Rahman inaugurated the Centre for Palliative Care in 2011.
In recent years, national and international collaborations are widening to improve the palliative care addressing policy and training matters. BSMMU opened the Department of Palliative Medicine in June 2017. Dhaka Medical College Hospital has also been operating a unit on palliative care since 2015. A few private initiatives are also available in Bangladesh. Now in Bangladesh there are three public institutions providing palliative care services these are Bangabandhu Sheikh Mujib Medical University, Dhaka Medical Hospital, National Institute of Cancer Research and Hospital. And private institutions are ASHIC Foundation, Treatment At Home Bangladesh etc.
Most important steps to increase palliative care in Bangladesh according to Assistant Professor Dr Mostafa Kamal Chowdhury (Adil) government should include introductory course for medical students because most of the doctors in Bangladesh do not have idea about palliative care. The government should start funding in a high number in this sector to fulfil the goal of SDG. Start more advertising on world hospice and palliative care day about palliative care so that people of all sectors can learn about palliative care. In Bangladesh every 4 persons need palliative care out of 1000. Most of them are unaware of this service and very few people are taking advantage of this treatment.
So we can spread about the benefits of palliative care through various media. We can propose for Developing of a national policy and allocating yearly budget and establishing palliative care department in every government hospital and motivating and recruiting volunteers and involving charities to donate fund need wide media campaign and arranging training for health workers and developing public education to build up expertise and creating awareness amongst general population. The government can make available the facility of palliative care in rural area through volunteering service. Volunteers must be well-trained. Government should include palliative care in secondary and higher secondary education system.
Palliative care is a human right. It is not much tough to increase the facility of palliative care in our country. Just a little awareness is enough to increase the service of palliative care. To overcome the barriers to successful implementation of palliative care we need continued efforts. And it is our not only ethical but also moral obligation to do whatever we can to increase the facilities of palliative care.
The authors are students,
North South University