Closing ceremony: Left to right: Mr. Badrudoza, Additional Secretary, Ministry of Health, Dr. Rumana Dowla and Md. Neazuddin Miah,
Secretary, Ministry of Health and Family Welfare
Dr. Rumana Dowla represented the IAHPC at the WHO 67th session of the Regional Committee for South East Asia on 9-12 September 2014, when a draft was adopted to include palliative care in the national plan for noncommunicable diseases (NCDs). Dr. Dowla, who is Chairperson of the Bangladesh Palliative and Supportive Care Foundation, reports.
Following a request from Liliana De Lima, I had the tremendous opportunity to represent the International Association for Palliative Care at the WHO (World Health Organization) 67th session of the Regional Committee for South East Asia in Dhaka, Bangladesh. I was given an initial guideline of activities in collaboration with the Bangladesh Government representative from the Ministry of Health and Family Welfare.
In Bangladesh, with its population of about 160 million people, the burden of NCDs has been rising at an alarming pace. In a review of 23 developing countries, Bangladesh had the ninth highest age-standardized mortality due to chronic diseases, such as primary cardiovascular diseases and diabetes.
Unplanned urbanization is a conduit for unhealthy lifestyles, for example smoking and fast food consumption, while common risk factors give rise to intermediate risk factors: raised blood pressure, raised blood glucose, unfavorable lipid profiles, obesity and impaired lung function. Approximately 51% of deaths in Bangladesh are due to noncommunicable diseases and other chronic health conditions. In turn, the intermediate risk factors predispose individuals to the ‘fatal four’, cardiovascular disease, stroke, cancer, chronic respiratory disease and diabetes. Pain is often manifested as one of the symptoms of these NCDs, e.g. acute myocardial infarction and cancer.
Palliative care is an integral part of care for life-limiting and life-threatening diseases. Strategically it is known to improve quality of life of patients with NCDs. Hence, while we were targeting indicators for NCDs at the WHO regional committee meeting, our major work was to incorporate an appropriate indicator for NCDs in Bangladesh.
With the help of the IAHPC, and with the encouragement of Dr. Poonam Khetrapal, Director General of WHO South East-Asia Region, I was able to work with health ministry officials and succeeded in incorporating the following in the final draft that was adopted on 12 September:
“It was requested that WHO should review and, where appropriate, revise national and local legislation and policies for controlled medicines, with reference to WHO policy guideline on improving access to, and rational use of, pain management medicine, in line with the United Nations International Drug Control Conventions. Palliative care is an appropriate response for all NCDs, including ischemic heart disease, which is the biggest killer in Bangladesh. Our preferred indicator is “morphine equivalent consumption of strong opioid analgesics (excluding methadone) per capita consumption.” (SEA/RC67/31,PP-42.)
On behalf of 160 million people, I am grateful to Liliana De Lima and Katherine Pettus for guiding me through Skype and emails to prepare the draft. I would also like to thank my mentors at the Leadership Development Initiative (LDI), Ohio Health, USA, and the fellowship programs of the International Pain Policy Studies Group, Wisconsin, USA, who helped us to realize our potential.
Dr. Rumana Dowla, Chairperson, Bangladesh Palliative and Supportive Care Foundation
Email: [email protected]
A 70-year-old patient with melanoma died in the palliative care unit at the National Cancer Institute in Mexico City in August 2014.
He traveled for hours to reach the unit because palliative care was not available close to his home. © 2014 Ed Kashi/VII
Tens of thousands of patients with terminal illnesses in Mexico suffer unnecessarily from severe pain and other symptoms because they cannot access adequate end-of-life care, Human Rights Watch said in a report released on 28 October. The 122-page report, “Care When There Is No Cure: Ensuring the Right to Palliative Care in Mexico”, documents the lack of access for many patients to pain relief and other assistance known as palliative care. Although Mexico’s health law explicitly grants people with terminal illness a right to palliative care, the service is offered almost exclusively at large specialist hospitals. With palliative care mostly available only in major cities, thousands of Mexicans have to travel long distances to get this care, even when desperately ill. Many others have no access at all and die at home in desperate circumstances.
In the past year, the Mexican government has worked closely with independent groups to begin addressing barriers to getting palliative care. It has taken or announced a number of key steps to improve its availability. “These are important steps that will hopefully benefit thousands of patients,” said Diederik Lohman, associate health director at Human Rights Watch. “But they should only be the beginning of a concerted government effort to ensure that everyone in Mexico has access to good health services at the end of life.”
For more information:
‘Care When There Is No Cure: Ensuring the Right to Palliative Care in Mexico’.
View video clips and photos.
Contact:
In Mexico City, Diederik Lohman (English, Russian, Dutch, Spanish, French): +1-646-645-4902 (mobile); or +52-(1)554-758-9734 (Mexican cell);
or [email protected]
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