Grantee details

Traveling Scholars Program Report

Ganesh Dangal, DR

Travel date: July 27, 2017

Name of Meeting/Event/Activity: Asia Pacific Hospice Conference

Origin: Kathmandu, Nepal / Destination: Suntec City, Singapore

How was this meeting/activity helpful to you?

The 12th Asia Pacific Hospice Conference (APCH) 2017 in Singapore, on 26 to 29 July 2017 was a great event where participants from all around the world were present in great numbers. Dignitaries and speakers unanimously embraced the need for appropriate, accessible and affordable palliative care programs for the country like ours.    Most of the deliberations focused on basic palliative care issues whereas the papers from experts detailed the public health approach to palliative care and advanced palliative care. The topics of discussions were diverse in nature reflecting local and international expectations and experiences ― a mix of pondering, aspirations and the reality on the ground. The conference deliberations promoted curiosity and interest. Basic clinical issues such as pain management and symptom management were also discussed. Delegates shared their experiences in their home care support program and we heard about spiritual support models also. The conference was unique and occurred at a time when palliative care has begun to find its place in the health care system of countries like ours. The conference not only helped raise the spirits of those who are engaged in this field in resource poor countries, but also increased awareness. The public health approach to this relatively new topic was most timely as we contemplate its future direction. In a broader sense, the public health issues have probably been underrated at the expense of fulfilling our needs and understanding. In conclusion, it was a milestone in the history of our endeavors and hopefully will inspire ongoing    program development in the country. 

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

I will share the positive experiences/ new insights of the conference with my colleagues in Nepal by organizing talk programs on ‘State-of-the-art in palliative care and supportive services’, a lecture on ‘Benefits of attending a Palliative care conference’ and also plan to develop and design an appropriate model of palliative care in Nepal and lobby for appropriate palliative care policy in Nepal; in collaboration with other colleagues/ international agencies.  It definitely helps in transferring technologies and skills especially in palliative care that are much needed here. I will make presentations/ lectures about palliative care at medical conferences/ workshops. Giving pain and palliative care classes at hospitals/ medical schools will bring awareness of palliative care to the medical fraternity in Nepal. I plan to train health professionals on hospice and palliative care and also make public aware on these issues. 

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

This is an excellent program and more such scholarships should be provided in the future for resource poor countries. 

Narrative summary highlighting the needs and challanges you face

Majority of cancer patients in Nepal are diagnosed in advanced stage but palliative care is not available in most part of the country. Pain is the most common symptom in patients with advanced cancer and is usually undertreated. Barriers to palliative care and pain management in Nepal are physician- practice behaviors, patient-related barriers, policy -related barriers, etc. Palliative care in the Nepalese context is still unaffordable and unachievable but there is a growing recognition that palliative care is an important component of care for patients with cancer.   Seventy percent of cancer patients in our country come at the late stage when no curative treatment can be given. Due to increase in cancer prevalence and elderly population, terminal illness is also increasing and thus there is now an increase in the number of patients needing palliative care. There is a trend of late presentation and thus late diagnosis because of the use of traditional remedies, herbs and alternative medicine instead of western medicine. Palliative care facility in Nepal is limited and grossly inadequate with few institutions providing basic palliative care in the capital city and none in small towns and suburbs. Opioid’s use and availability is also limited to big cities only and is under-prescribed due to fear of misuse, lack of awareness, shortage of financial resources and strict legal regulations.   Being a new specialty, palliative care is yet to be incorporated in the existing national health care system and there is no national policy or guideline on palliative care. It is not included in the medical curricula of Nepalese medical schools. But, there informal trainings and advocacy through workshops are going on mainly with the help of NGO’s/ INGO’s. There is also a significant lack of trained professionals in the field and shortage of pain and palliative care specialists.  Palliative care has been a need in Nepal. All should have access to excellent care during the course of a serious illness and at the end of life. By integrating palliative care in our existing health care system we can achieve the goal of expanding and upgrading it nation-wide. It needs combined efforts from all to establish state of art palliative care system in the country by making national policy and guidelines, by incorporating it in the medical curricula and by raising awareness among the providers and patients/public.  Participating in the conference further enhanced my knowledge, skills and technical expertise and thereby enabled me to provide excellent clinical care to our patients who are in need of such services. As we do not have enough oncologists/ palliative care providers in Nepal, giving me the opportunity was an important milestone to the health care system of Nepal.