Reports

2012; Volume 13, No 12, December

Reports

IAHPC Traveling Scholars’ Reports—Romania, Nepal, and India

A report by Cocea Corina, MD (Romania)

Hello! I want to begin my traveling scholar’s report by thanking the IAHPC for their generosity, it was such an honor for me to receive this award – it was a great experience.

I attended the 19th International Congress on Palliative Care in Montreal, Canada in October this year; it was my first time as a young physician at a large event. During the congress, I met many professionals in palliative care. It was very interesting to hear how they manage the various clinical problems of their patients.

This Congress was a big boost to my career in oncology and palliative care. I learned so much in a short time and most importantly I recognized how much I must be very dedicated and compassionate in order to truly help my patients.

Many delicate subjects, not taught in medical school, were addressed during the meeting, e.g. whole person care, burn-out, and others. I also learned about the use of new opioids, opioid induced hyperalgesia and cachexia – essential issues in day-to-day practice.

As a bonus I had the chance to visit the city of Montreal with its interesting history, beautiful buildings, and gorgeous lights at night. It was my first time in Canada and I was fascinated by the culture, and the friendly people who made me feel at home.

Thanks to the IAHPC for their generosity that resulted in this great experience that helped to broaden my knowledge as a physician and as a person.

Kind regards,

Cocea Corina Elena
Medical Oncology Resident Physician
Palliative care master student
Regional Institute of Oncology Iasi, Romania

A report by Ganesh Dangal, MD (Nepal)

Nepal has very few cancer hospitals, and seventy percent of cancer patients come for help at a late stage of their illness when no curative treatment can be given.

Palliative care is still unaffordable and unachievable with local barriers that include physicians, patients and policies. Opioid use and availability is limited to only large cities and there they are under-prescribed due to fear of misuse, lack of awareness, shortage of financial resources and strict legal regulations.

Palliative care has not been incorporated into the existing national health care system and there is no national policy or guideline on palliative care or is it included in the medical curricula of Nepalese medical schools.

But things are slowly changing and there is a growing recognition that palliative care is an important component of care for patients with cancer and there are a number of hospice organizations providing basic palliative care in the capital city, but none in small towns and suburbs. There are informal training and advocacy workshops offered mainly with the help of NGO’s/ INGO’s.

I traveled to Italy to participate in XX World Congress of International Federation of Gynecology and Obstetrics (FIGO) on 7-12 Oct 2012. I actively participated in all the FIGO sessions including the Pre-Congress Workshops.

I made a presentation on the status of palliative care in Nepal. The participants appreciated the work we do in Nepal; they were curious and had questions which I addressed; they were interested and enthusiastic to learn that even developing countries we are doing the best we can.

I learnt a lot and hope to use the newly acquired information to advance palliative care in my country. I plan to network with world experts in palliative care and to engage in collaborative research in the field.

By integrating palliative care into our existing health care system we can achieve the goal of expanding and upgrading it nation-wide – this requires combined efforts at all levels of our society to develop a national policy, guidelines for care, incorporate it in the medical curricula and raise awareness of the benefits of palliative care among the providers, patients, and the public.

It will be a long and hard journey, but palliative care is needed in Nepal

Attending the FIGO Congress through the financial award of the International Association for Hospice and Palliative Care (IAHPC) provided a great educational experience for me and I am very thankful that I was chosen to receive this award. The conference was an important opportunity to learn, share research experience, and network.

Thanks again.

Dr. Ganesh Dangal
Specialty Gynecologic Oncology/ Palliative Care Consultant
Kathmandu Model Hospital and Thankot Hospice, Nepal

A report by Lalchhanhima Ralte, MD (India)

I work as a medical officer at the Grace Home, an HIV hospice started in 2004 under the Mizoram Presbyterian Church Hospital and MSACS (Mizoram State AIDS Control Organization). Grace Home has a 30 bed hospice unit. It was the first in the region and in the capital of Aizawl. It received a grade of B+ by NACO (National AIDS Control Organization of India).

Mizoram, with a population of about a million, shares an international border with Burma and Bangladesh and is at the forefront of a cancer and HIV epidemic. It has the 3rd highest HIV prevalence rate in India (0.81%) and has one of the highest rates for carcinoma of the stomach and esophagus in India.

The first case of HIV was detected in Mizoram during the early 90’s when the route of infection was through heterosexual contact and IV drug use. There are nearly 7000 cases with nearly half of them on antiretroviral therapy (ART). We have started seeing cases of ART failures, poor adherence, and multiple opportunistic infections that will eventually lead to an increase of the need for hospice care.

Palliative care is still in its infancy. We are a close knit society where everybody seems to know everybody else. The care of the dying means aggressive treatment until the very end. The concept of death with dignity is something new -- most of the time the scenario during the last stages of life occurs in a hospital with aggressive treatment including CPR even as a person is about to die. Relatives and families are forced outside the patient’s room or curtain.

It was a great experience for me to travel from our small north eastern Indian state of Mizoram to Montreal? Working in a hospice can be stressful, so this was a good opportunity to travel away from work and provided time for me to get re-energized and return more inspired. It was amazing to see and hear about what is occurring in various parts of the world. Coming from a limited resource setting with palliative care in its infancy, it was definitely uplifting and educational to hear from so many other workers in the field.

There are times when I feel like giving up on our palliative programs, a sense of feeling beaten down but again, attending a conference like this reaffirms my calling to the care of the dying. Yes, our care may not be on par with that in developed countries, but the things we do with limited resources will lead to further development in the future.

Presently, I’m overloaded with information gained from this conference. As the only hospice providing palliative care to HIV patients in my region, attending this conference reconfirmed my calling to provide an opportunity for a dignified death to those with HIV. I plan to take it slow and begin giving talks on palliative care to my hospice staff. I will also discuss the issues of palliative care at programs/meetings I am asked to speak at in colleges, church meetings and other nongovernmental organizations. Sensitization about the topic among our medical doctors and the general population is necessary. I plan to offer educational programs on palliative care to our doctors/nurses in the near future. With the proper education, awareness and sensitization Mizoram can be a role model for India.

I am sincerely grateful to IAHPC for giving me the opportunity to attend the 19th International Congress on Palliative Care at Montreal, Canada.

I pray that your organization will continue to offer scholarships. Your efforts are great and indirectly affect patients who suffer and die especially in resource limited countries.

Dr. Lalchhanhima Ralte
F118A, Khatla South, near Khatla South Yma Hall
Aizawl, Mizoram, India

IAHPC Traveling Fellow’s Report

A report by Maureen Gill , RN (UK)

Visit to Kemerovo Region

Maureen Gill, a nurse specialist in palliative care, visited the Kuzbass Region of Siberia FSU from October 1st to October 13th October 2012. She presented 2 papers at the conference that was held in the city of Kemerovo celebrating the 20th Anniversary of Palliative Care in the Region.

Maureen’s papers were “Emergencies in Palliative Care” and “Quality Care in the Last Days of Life.” She opened the conference by reading a message from Dr Robert Twycross (UK), who congratulated the staff for their achievements over the years. With respect to the lack of oral morphine in the country, he asked health authorities to make the provision of this vital medicine a priority for the treatment of pain in cancer patients – this message/request was forwarded to the local, regional and national health authorities.

Maureen then began a course of lectures to several groups of staff in Kemerovo City, including over a hundred social workers who showed a particular interest in the support of children facing bereavement.

She was also able to work at the bedside with doctors and nurses in the Regional Hospice in Kemerovo and discuss symptom control as well as the psycho-social aspects of patient care. She had the opportunity to have a round table discussion with about 14 senior nurses on many aspects of palliative care.

Maureen visited the hospice at Prokopyiesk, and gave a lecture to doctors and nurses from Hospital # 1 in Prokopyiesk. While in Prokopiesk, she made a TV documentary on palliative care that was broadcast to a vast audience.

All the stakeholders in the region are extremely open to continuing the collaboration and co-operation that has developed over the past 15 years between Russia and the UK.

I thank the IAHPC for their financial contribution to my to visit to the Kemerovo region.

Maureen Gill, RN
UK

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