The need for palliative care
Mariha, a 13-year-old girl who was happy with her life, was diagnosed with leukemia. After discovering that her stage four disease was incurable -- she was completely broken.
To keep her alive a few days longer, her doctor treated her with chemotherapy but sadly, it didn’t work for her. Mariha, despite knowing that nothing can cure her, didn’t just want to die counting her remaining days to live.
One day, out of the blue, her father entered her dark room with a colorful leaflet in his hand -- and it changed her life. She stopped passing her days crippled with depression and anxiety, and she slept better.
In spite of having cancer pain in her body, she was happy because she got the proper care -- all of which happened because of palliative care.
Now the question is: What is palliative care? It 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.
Anyone can receive palliative care at any age and any stage of illness -- cancer, coronary obstructive pulmonary disease, Parkinson’s, heart failure, AIDS, kidney failure, dementia, and the list goes on.
Now in Bangladesh, we can find so many cancer patients, and the number is increasing rapidly. Most people are unaware about palliative care as the number of palliative care units and activities is almost negligible in our country.
In 2015, the Quality of Death Index overall score showed the position of Bangladesh 79th out of 80 countries based on the availability of palliative care service. Bangladesh is a signatory of the World Health Organization (WHO) resolution 67.19 which recommends the integration of palliative care into national health systems.
Palliative care is a model of care that focuses on relieving the suffering of patients with life-threatening diseases. Palliative care offers the following things:
• Relief from pain and other symptoms like insomnia, weakness, depression
• Regarding dying as a normal process
• Assistance to families to talk about sensitive issues
• Links to other services such as home help and financial support, reducing 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
Palliative care services were introduced in Bangladesh for both children and general patients by ASHIC in 2006 and by BSMMU in 2007.
At first, only outdoor care in a 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 palliative care addressing policy and training matters. BSMMU opened the Department of Palliative Medicine in June 2017.
Now in Bangladesh, there are three public institutions providing palliative care services -- Bangabandhu Sheikh Mujib Medical University, Dhaka Medical Hospital, National Institute of Cancer Research and Hospital; private institutions include ASHIC Foundation, Treatment At Home Bangladesh, and more.
According to Dr Mostafa Kamal Chowdhury -- the most important steps the government can take are by including an introductory course for medical students on palliative care, providing a good amount of funding to this sector, and by advertising on world hospice and palliative care day so that people can learn about palliative care.
In Bangladesh, every four persons out of 1,000 need palliative care, but most are unaware of this service and few are taking advantage of this treatment.
So, we can spread awareness about the benefits of palliative care through various media. We can propose for developing a national policy and allocating a yearly budget and establishing a palliative care department in every government hospital -- motivating and recruiting volunteers.
The government can make the facility of palliative care available in rural areas through volunteering services and volunteers must be well-trained. The government should include palliative care in the secondary and higher secondary education system.
Palliative care is a human right. To overcome the barriers and successfully implement palliative care, we need continued efforts, and it is our moral obligation to do whatever we can for increasing the facilities of palliative care.
Noor Ashfi Ahmed, Kazi Moumita Mustary, and Mahjabin Nahid Monal are freelance contributors.