Grantee details

Traveling Scholars Program Report

Sunita Panta, MD

Travel date: May 18, 2017

Name of Meeting/Event/Activity: 15th European Association Palliative Care Conference

Origin: Kathmandu, Nepal / Destination: Madrid, Spain

How was this meeting/activity helpful to you?

This was the first international conference on palliative care that I attended. The topics for oral and poster presentation were very diverse due to the inclusion of topics from developed as well as developing countries. The conference offered me the chance to widen my horizon on various aspects of palliative care as well as build network with practitioners from all over the world. The meeting with IAHPC members as well as the fellow grant winners at the pre-congress event was very positive part of the program. lt enabled us to share our experiences of palliative care practice and gain insight into the recent advances in developed countries. lt was a privilege for me to meet Ms. L De Lima, Ms. G Napier, Ms. K Pettis, Ms. A Jackson and Ms. L Rozo. With Ms. K Pettis's initiative I got a chance to present overviews on opioid prescription in Nepal with Sue Collins from Moonshine and hope the availability and prescription opioids would be easier in Nepal in the days to come.

How will you new knowledge & acquired skills help in furthering your work in hospice and palliative care in your program/city/ or country?

In Nepal, the concept of palliative care is still new and is limited to only a few centers. Palliative care mainly deals with pain and other symptom management. Till now morphine is the drug for chronic pain management but I learnt about methadone in the Congress and will use it in my clinic available in Nepal. Palliative care is mainly hospital based and based on medicines in my country. Now I understand the psychosocial and spiritual aspect of palliative care and will incorporate them in my hospital. My poster was based on pain and palliative care during disasters. Nepal is disaster prone and many people are disabled due to natural and human-made disasters as well as the decade-long conflict. I attended a presentation of inclusion of a diasble person in palliative care research. Such prospects will be useful in our situation too. One of the drawbacks in our country is the maintenance of database and research with my newfound knowledge on palliative care research network. I want to advance palliative care research in Nepal.

How IAHPC Traveling Scholars Program be improved in order to help other future traveling scholars?

Traveling scholarship is very beneficial program especially for people like us from developing world.  It gives us an opportunity to present the situation of palliative care in our home country at a professional platform like EAPC I attended.  Such congresses do not happen in our country and even to attend congresses in our region the financial constraints impede us.  IAHPC grantees network is also a valuable tool which will come handy when we reach leadership and decision making level in our country.  The Traveling Scholarship program is very well implemented by IAHPC.  I only want to request that we get a chance to avail it again in future.  If possible please give me a chance to attend Palliative care conferences in other continents and benefit from the proceedings.  If possible please reduce or eliminate the time frame of 3 years to apply for traveling scholarship since we do not have financial means to attend conferences.  I want to request you to allow us to benefit from Traveling Fellowships where we can attend a palliative care center for few weeks and get trained and updated so that we can apply our knowledge in practice at home country.

Narrative summary highlighting the needs and challanges you face

Nepal is a developing country with limited health resources.  Natural disasters, political instability, poor socioeconomic status and low literacy rate are the factors limiting health care facilities. Many governmental hospitals are understaffed and with minimaI resources. The priority of health is on communicable diseases, reproductive health and nutrition.  Palliative care is fairly a new concept in Nepal.  Only a few of the hospitals provide palliative care but the number of hospices is very les.  Even the personnel are not trained in palliative care.  However the medical personnel are recognizing the need to uplift palliative care in Nepal. Nepalese association of palliative care (NAP CARE) is established to promote palliative care practice, education and awareness.  Diagnostic facilities are available only on urban regions.  Most of the chronic illnesses like cancer go undetected till the disease progresses to terminal stage.  Patients seek hospital care only when the symptoms are so unbearable to carry on the daily activities.  Pain is the commonest symptom for which treatment is sought.  I am working in Shree Birendra Hospital (SBH), Chhauni, and Kathmandu, Nepal for the past 17 years.  Palliative care started in SBH along with oncology ward and clinical services in 2010.  Department of anesthesia and critical care started pain management to the inpatients and gradually extended the services as pain management clinic.  Now the clinic offers service to chronic pain patients like cancer, prolapsed intervertebral discs, migraine, tension headaches, fibromyalgia and arthralgia.  We follow WHO pain management ladder as a guideline to treat pain.  Opioids are difficult to obtain and prescription of morphine is limited to a short duration for outpatients, one week in my hospital.  However the practice of palliative care need to progress from pain and other symptom management to a holistic care.  The management needs to shift from hospital based to hospice based approach where the patients are managed by personnel trained in palliative care.  Availability of opioids in district and zonal hospitals need to be worked on.  Focus of hospital shifts to disaster mode during mass casualties.  Hospitals are evacuated and chronic wards are converted to make space for trauma victims.  In these situations treatment of pain and other palliative care is interrupted compromising the situation of chronic ill patients.  Hospitals should have a dedicated center with staff to provide palliative care even in crisis.   Awareness, education and training in palliative care are mandatory to promote palliative care in Nepal.  Palliative care training is lacking in health workers.  A module of palliative care should be implemented in all the health care facilities initially before aiming for palliative care degree.  I want to conclude by stating that IAHPC gave me an opportunity to attend EAPC 2017 and gave insights to the practice of palliative care globally.  I want to promote palliative care by conducting palliative training in health institutions in association and financial support with International Palliative care organization and want to request the distinguished IAHPC personnel to guide and support me in this venture. lf IAHPC opens a chapter in Nepal we would be able to bring about this dream of palliative care possible in Nepal.