The World Health Organisation (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness.”
Palliative care focuses on providing relief from physical, emotional, social, and spiritual suffering.
Last week, we published the results of our research about the suffering of patients with advanced illness across Bangladesh. We interviewed patients in public hospitals in seven divisions, asking them about their symptoms.
We found that more than 70% of patients reported having pain, which was frequently severe. The WHO recommends strong opioid medications, such as morphine, as the gold standard treatment for severe cancer pain. Yet, despite this, only 14% of patients reported receiving this type of medication and most continued to have moderate or severe pain.
Palliative care is not taught in any undergraduate medical or nursing training programs
The WHO estimates that 80% of patients with cancer will experience moderate or severe pain at the end of their lives. 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 Bangladesh, our previous work has shown that knowledge among physicians of how to appropriately prescribe opioids is limited. Most professionals are unaware of the therapeutic potential of morphine, and many physicians do not know that morphine is available in an oral form and can be used for pain management outside of anesthesiology.
Our recent study showed that 92% of doctors did not have any prior training in pain management, despite the fact that 47% stated that they would see five or more incurably ill patients a month.
A lack of training and awareness of palliative care are major barriers to the provision of palliative care in Bangladesh.
Palliative care is not taught in any undergraduate medical or nursing training programs; this must change, to ensure that patients get the care that they need.
We celebrate World Hospice and Palliative Care Day on October 14 this year, to support palliative care around the world.
The theme for this year’s day is “Universal Health Coverage and Palliative Care -- don’t leave those suffering behind.”
The United Nations Sustainable Development Goals include a goal to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” This goal includes the need for palliative care for all.
In addition to relieving physical and emotional suffering, palliative care can reduce the financial suffering which often accompanies illness in this country.
Palliative care provides cost-effective care, reducing unnecessary health expenditures. Frequently, patients with advanced cancer spend large sums of money on unnecessary treatments, which do nothing to prolong the duration or improve the quality of life, and instead lead to significant financial suffering for families. Palliative care can reduce this.
Although we have described many challenges for palliative care in Bangladesh, even the longest and most difficult journeys begin 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.
Interested readers are invited to join the Palliative Care Society of Bangladesh and the Centre for Palliative Care, as we celebrate World Hospice and Palliative Care Day on Saturday, October 14.
Celebrations will take place at 9am in the Auditorium in A Block at BSMMU. Details can be found a https://www.facebook.com/palliativecare.info.
Dr Nezamunddin Ahmad is Professor, Dept of Palliative Medicine, BSMMU. Dr Megan Doherty is Pediatric Palliative Care Consultant, Children’s Palliative Care Initiative in Bangladesh. Dr Farzana Khan is Palliative Care Researcher and Physician, Fasiuddin Khan Research Foundation.