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Public health approaches to palliative care in India and Bangladesh discussed by regional practitioners

Author: Mridul Sarker and Krisna Roy, Coordinators in Centre for Palliative Care, Bangabandhu Shikh Mujib Medical University
16 May 2018

The World NCD Federation and Postgraduate Institute of Medical Education and Research (PGIMER) hosted the Pre-Congress Workshop on Public health Approaches to Palliative Care on 3rd November 2017 in Chandigarh, India.

The purpose of this workshop was to hold an interactive discussion where stakeholders from different region of India and Bangladesh could discuss the different aspect of public health issues regarding palliative care, including Developing Community Based Palliative Care programs and sharing their knowledge, how they initiated the program and overcome potential obstacles, as well as the impact of their initiative in a community.

Participants explored planning strategies, adaptation options, and new procedures for integration and management of palliative care program in primary level of health care system.

Dr Suresh Kumar (Director of the WHO Collaborating Center for Community Participation in Palliative Care) and Dr Gayatri Palat (Associate Professor, Pain and Palliative Medicine, at the MNJ Institute of Oncology and Regional Cancer Center) was the chair of this workshop.

Most of the participants of that workshop were nurses and volunteers from Chandigarh.

Facilitators were: Dr Jugindra from Manipur, India; Mohan Venkat from Pondicherry, India; and Professor Nezamuddin Ahmad from Bangladesh who is a pioneer of palliative care in that country.

The objectives of the workshop included:

  • Global Perspectives Public Health Approach in Palliative Care and Dying Well.
  • Practical Approach of volunteering/student volunteers in palliative care/training programs for community based palliative care
  • Lessons from different regions regarding Public Health Approach in Palliative Care, and
  • How to develop locally relevant Community Based Palliative Care programs.

The World Health Organization (WHO) Collaborating Centre in Community Participation in Long Term and Palliative Care, Kerala, India, has released a workbook, "Palliative Care—A Workbook for Carers", to support training of carers in palliative care which was distributed among all the participants.

Throughout the workshop, participants were asked to think critically about the ‘Good Death and Bad Death’. Death is an unpredictable guest. Why should one think about death much before it comes, when one is busy with life?

In this workshop, Dr Gayatri Palat was conducted a session on Dying Well. She, in particular, focused on social tradition of accepting the natural death.

She explained her observation about this issue by giving an example of true event of bank of Pashupati river, where older people and dying people stayed for their last days of life for accepting the death by realizing their religious point of view.

Death is not only a medical issue, it also a public health issue. Our culture, family religious view and also comes into consideration during death of someone. At the end of her session she said a good death occurs when individual makes their wishes know about their place of death place and the process is fulfilled.

Dr Suresh mentioned the major barriers, such as lack of national policies, inadequate education and training, inadequate medication availability, psychological/social/cultural barriers, financial issues, to developing a sustainable palliative care program.

He also indicates the way to overcome the barriers. Life expectancy is increasing day by day and people will suffer from various non-communicable diseases and problem of ageing. As a result, in the near future palliative care will be a big public health issue. We need to think broadly and develop a strategy to take continuous and meaningful care of these people within limited resources.

The ‘Practical Approach to Volunteering’ session is conducted by Saif Muhammed. He discussed the role of volunteers in the care of the incurably and terminally ill. The role of volunteers must be carefully considered.

Volunteers often enrich a community palliative care service and sometimes are the mainstay of manpower, so training and coordination are necessary. The training of volunteers can improve knowledge and attitudes to palliative care in the community.

The necessity and importance of a basic training program for palliative care professionals was discussed in the panel discussion session and Dr Suresh mentioned the WHO recommendation for training program.

All the facilitator and participants agreed to the one point that, "Charity begins from home”, asked by a Student from Chandigarh.

Dr Jugindra from Manipur and Mohan Venkat from Pondicherry shared their experiences, how they involve the community participation. They mentioned about different type of awareness programs art and painting competition and cycling. Prof. Nezamuddin Ahmad shared the unique experience about the ‘Compassionate Korail’ project, an urban based slum project supported by Worldwide Hospice Palliative Care Alliance (WHPCA), in Dhaka city.

He explained the initiative to incorporate the slum dwellers in this project, especially recruiting Palliative Care Assistants (PCAs) from slum and buildup a committee joined by slum dwellers to make sustainable of this project. Everyone appreciated him after knowing that slum come forward to make this project sustainable.

Learning topics:

The workshop presentation and handouts used in the workshop provided basic information throughout this workshop, as a participant I gained a better understanding of the following

  • The importance of a public health approach in palliative care more appropriately.
  • how to increase awareness in people about palliative care.
  • how to incorporate community people to make a success of a palliative care project.
  • various types of training options for palliative care professionals.
Whatever I have learned from this workshop, I would like to apply those new knowledge and skills to incorporating the community people and volunteer in palliative care and improve my work in the near future.
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