Special Advocacy Report: Bangladesh

Volume 23, Number 12: December 2022

The Road to Success Is Always Under Construction

By Farzana Khan, MD
Former IAHPC Advocacy Focal Point for Bangladesh

Dr. Farzana Khan and Dr. Claudia Mahler. Photo used with permission.

It was an honor to meet Dr. Claudia Mahler, the United Nations independent Expert on the Human Rights of Older Persons during her recent visit to Bangladesh. We had a thorough discussion on ongoing efforts for palliative care provision for older persons in Bangladesh, particularly in primary health care and humanitarian settings, such as Rohingya refugee camps. With 166 million people, Bangladesh is the eighth most populous country in the world. About 15 million people are 60 or older, a segment of the population predicted to increase to 42 million by 2050.

Home care needs integration into health policy

Multimorbidity among older persons in Bangladesh is common. Patients must often travel long distances to reach a hospital, and access to hospital care is becoming more difficult in rural areas. Moving care to the patient's home could be a solution. Home health care is less expensive and easier to facilitate, but needs to be integrated into health policy.

Older people in poverty, with low incomes, who lose their work and authority or who have physical challenges, are not new. Neither are changes to social norms and values, erosion of the family unit, and neglect of older persons.

Radical change is required.

This photo was taken two days after fire destroyed much of this refugee camp in Dhaka, where a community-oriented palliative care program has been run for years. Here, the team, a doctor and two assistants, talk a patient who was devastated by fire physically and emotionally, but is still ambulatory. Photo by Sayeda Quadir used with permission.
Respecting people, and their choices

Treating people with dignity and respecting their human rights is essential even at the last moments of life or while living in refugee camps. Health system strengthening—including universal health care—is key, as the COVID-19 pandemic clearly illustrated. We also need to take into account factors specific to communities, families, and home settings. We must not forget to respect the choice of refugees to live their day-to-day lives. Workforce shortages and insufficiency have been a constant problem, particularly in rural areas and also in refugee camps, where young workers are often unprepared for contemporary practice and lack training in palliative care and geriatrics.

What the human rights framework is missing

I wanted to learn about Claudia’s thoughts on palliative care, older people, and human rights. She said, “What we are missing in the human rights framework is also that long-term care and palliative care are not really spelled out.” They need to be acknowledged, she added, emphasizing that, “you need to go back to the Covenant on Economic Social and Cultural Rights [adopted in 1966] and the highest attainable standard of health. We need arguments to support a specific article concerning palliative care and a person-centered approach. The focus of my report to the Human Right Council, due next September, will be on these issues.”

I hope that some of our discussions on the challenge of access to essential opioid pain medications, such as morphine tablets, and lack of access to palliative care at the primary health care level throughout the country can trigger further discussion nationally and internationally. The road to success is always under construction: it is a progressive course, not an end to be reached.

I believe that Claudia Mahler’s work has the capacity to guide a definitive text pertaining to the enjoyment of human rights of older persons with palliative care needs.

Dr. Farzana Khan, CEO and president of Fasiuddin Khan Research Foundation, provides palliative care at the Kutupalong refugee camp in Cox’s Bazar, Bangladesh.

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