By Dr. G.V.M. Chamath Fernando
Family physician; Lecturer, Faculty of Medical Sciences; Palliative Care Lead & Coordinator, National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Sri Lanka; WHO Primary Health Care Young Leader
Universal access to palliative care is not only considered part of the human right to health,1 it is also enshrined in the spectrum of primary health care inscribed in the 2018 Astana Declaration.2 People around the world can claim a right to access equitable palliative care, under the United Nations’ high-level Political Declaration on universal health coverage.3 Although some countries have integrated palliative care into their public health systems over the past few decades, the majority have not yet introduced this unique discipline.
It is noteworthy that most sustainable health systems that boast of offering the best “quality of death” 4 to their citizens have something in common: primary through to tertiary care health professionals work in a complementary manner delivering unfragmented palliative care.5-7 The World Health Organization, in its publication titled “Integrating palliative care and symptom relief into primary health care," emphasizes the indispensable role that primary care clinicians—including general practitioners—play in ensuring public access to community and home-based palliative care.8
The College of General Practitioners of Sri Lanka has recognized the utility of giving primary health care providers the knowledge, attitudes, and competencies that are essential to provide palliative care in the community. Hence, the college is currently in the process of developing a comprehensive curriculum for their brand new postgraduate diploma in palliative care for general practitioners envisaging “the delivery of user-friendly, community-responsive, quality palliative care competently and compassionately by general practitioners to patients, their families and carers who consult them in their practices, and in the communities they serve.”
Sri Lanka is most commendably paving the way to produce internal physicians specialized in palliative medicine in the foreseeable future, which is an essential requirement to provide predominantly secondary and tertiary institutionalized care. Concomitantly, the college intends to produce a complementary network of GPs scattered throughout nooks and corners of this island who, collectively, will ensure equitable community access to affordable, basic palliative care.
A tremendous shortage of nurses and allied health professionals employed in primary care exists on the island, a deficit that ought to be rectified in tandem with the training of doctors. Therefore, I advocate for and urge health policymakers to “bake-in” the palliative care training of all primary health care professionals into the National Strategic Framework for Palliative Care Development in Sri Lanka. The college has opened its arms to support, share resources, and collaborate with colleges of nursing and allied health sciences intending to develop similar graduate or postgraduate programs.
To my utmost pleasure and motivation, IAHPC Advocacy Officer Dr. Katherine Pettus introduced me to globally renowned elite clinicians and academicians active in primary palliative care. As a result, many have now joined hands with us as an overseas panel of experts: Professor Emeritus Scott Murray, Professor Julia Downing, Dr. Mhoira Leng and Dr. Daniel Munday from the UK, Professor Emeritus Geoff Mitchell from Australia, Dr. Steven Radwany from the USA, Dr. Alan Bernard from South Africa, Dr. Dingle Spence from Jamaica, Dr. Tania Pastrana from Germany, and Dr. Sebastien Moine from France. The delivery of palliative care in different territories of the world has historically demonstrated unique adaptations nuanced with societal, cultural, policy, and resource attributes. Respecting this, the panel of global experts hopes to aid the Sri Lankan College of General Practitioners toward the development of palliative care training in a manner that is appropriate and sensitive for Sri Lankan milieus.
At this point, I look back at palliative care enthusiast Dr. Kurshedjee Jamsdjee Rustomjee, a contemporary and a colleague of Dame Cicely Marie Saunders, who established the first modern hospice in Colombo, Sri Lanka (then Ceylon) on November 19, 1962.9 His courage to transcend is a source of inspiration to us to resurrect and build palliative care sustainably in Sri Lanka—the Pearl of the Indian Ocean.
1. Brennan F. Palliative Care as an International Human Right. J Pain Symptom Manage 2007; 33(5): 494-9.
2. Pettus K, Moine S, Kunirova G, De Lima L, Radbruch L. Palliative Care Comes of Age in the 2018 Declaration of Astana. J Palliat Med 2019; 22: 242.
3. United Nations. Universal Health Coverage: Moving Together to Build a Healthier World. Political Declaration of the High-level Meeting on Universal Health Coverage. September 2019.
4. 2015 Quality of Death Index. Perspectives from The Economist Intelligence Unit (EIU). Available online: https://eiuperspectives.economist.com/healthcare/2015-quality-death-index. Accessed on December 4, 2020.
5. Rangachari D, Smith TJ. Integrating Palliative Care in Oncology. Cancer J Sudbury Mass 2013; 19(5): 373-8.
6. Filbet M, Schloss J, Maret J-B, Diezel H, Palmgren PJ, Steel A. The use of complementary medicine in palliative care in France: an observational cross-sectional study. Support Care Cancer 2020; 28(9): 4405-12.
7. Court L, Olivier J. Approaches to integrating palliative care into African health systems: a qualitative systematic review. Health Policy Plan 2020; 35(8): 1053-69.
8. Organization WH. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers. World Health Organization; 2018. Available online: https://apps.who.int/iris/handle/10665/274559. Accessed on December 24, 2020.
9. Dr. Saunders and Dr. Rustomjee – an early example of #hpmglobal. End of life studies, University of Glasgow, 2015. Available online: http://endoflifestudies.academicblogs.co.uk/dr-saunders-and-dr-rustomjee-an-early-example-of-hpmglobal/. Accessed on December 4, 2020.