SHC-LCPC September 2017 – Perinatal Palliative Care

Register online at https://www.duke-nus.edu.sg/lcpc/shc-lcpc-multidisciplinary-forum or email lcpc@duke-nus.edu.sg for more information and enquiries.

LCPC-APHC-SHC Workshops 2017

LCPC-APHC-SHC Workshop 2017 - A Holistic Assessment of PatientsLCPC-APHC-SHC Workshop 2017 - The Role of a Pharmacist in Palliative Care

Dear colleagues

LCPC will be hosting two conference workshops during the APHC 2017 in July. Registrations are opened now!

33rd SHC-LCPC Postgraduate Course in Palliative Medicine

33 SHC-LCPCThe SHC-LCPC postgraduate course in palliative care is back this year!

Taking place on 26-28 April 2017, this 3-day foundation course is designed for doctors across all settings and covers basic principles and practices of palliative medicine. Read more about this course here. Registration opens today and will end 5 April 2017.

Impact of APHN-LCPC movie “Life asked Death” – Part 1

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“Relief of suffering is an ethical imperative.  We cannot walk away from suffering when we know we can do something about it,”

– Associate Professor Cynthia Goh, project leader of the Lien Collaborative

Following the warm reception of the primere of the APHN-LCPC movie “Life asked Death” in Bangladesh, Sri Lanka and Myanmar, the movie has also touched the hearts of the audience at the screenings in Australia, Barbados, India, Malaysia, Philippines and Singapore. Riding on the wave of interest surrounding palliative care, there are plans to expand the reach of the movie. The upcoming activities are as follows:

  • China – We are planning on launching a campaign to promote the movie.
  • Thailand – We are working with the local champion for advocacy of palliative care to promote the film to all the Department of Medical Services (DMS) hospitals.
  • America, Europe and Africa – We will be extending the reach of the “Life asked Death” movie by working with the Union for International Cancer Control (UICC) to use the movie as a resource material for World Cancer Day on 4 February 2017.

View the movie at http://lifeaskeddeath.com/

Handling Death Anxiety in the care of patients receiving palliative care

From LCPC Newsletter

Dr Lee Geok Ling, Assistant Professor with Department of Social Work in NUS, was the speaker for the SHC-LCPC Multidisciplinary Forum on 30 August 2016. She is also registered with the Singapore Association of Social Workers and a certified member of thanatology.

Death anxiety (DA) is the state in which an individual experiences apprehension, worry or fear related to death & dying (Carpenito-Moyet, 2008, p. 39). The most common form of DA, also the least level, is fear of death. Not only does it affect the patients, it could affect their caregivers and healthcare providers.

It is predicted that older adults living in institutional settings, seriously ill or low in “ego integrity” have higher DA, whereas hospice patients who enjoyed social support are predicted to have low DA. The forum ended with Dr Lee stressing on the importance of assessing DA in individuals with psychological distress and behavioural problems. She concluded by reminding healthcare providers to assess their own DA when facing death, pain or suffering in their clinical practice.

Read the full article here.

Palliative care: financial catastrophe avoided?


Impoverishing health expenditure

A World Health Organization and World Bank Group report shows that 6% of the population, across 37 countries, was tipped or pushed further into extreme poverty because they had to pay for health services out of their own pockets. When the study factored in a poverty measure of $2/day, 17% of people in these countries were impoverished, or further impoverished, by health expenses.

Read the full article here.

How palliative care helps families avoid financial catastrophe?

In the face of a life-threatening disease, what are you thinking of? The acute pain from the disease, the high costs of the treatment, the financial strain the treatment will cause to your family? A financial catastrophe can be avoided when one knows the realities of the situation. The huge debts which may have been incurred from the extensive treatments, will leave most families struggling financially. Instead of pursuing futile treatments, pain relief and symptom control are administered to let the patients feel better.

What is palliative care?

Palliative Care aims to improve the quality of life of a patient facing a life-threatening illness and his family. It is an approach of addressing the physical, emotional and spiritual needs and practical concerns of patients. Palliative care also emphasises on pain relief and symptom control, and through that, increases the quality of life for both the patients and care-givers.

 “No one should die alone… each human should die with the sight of a loving face.” – Mother Teresa

Screening of the APHN-LCPC movie “Life asked Death” in the region

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Thank you for the support towards the screenings of the APHN-LCPC movie “Life asked Death” in the region!

The highly anticipated movie “Life asked Death” was shown in regions such as, Dhaka, Myanmar, Philippines and Sri Lanka in events held in conjunction with the World Hospice and Palliative Care Day.

Bangladesh

The screening on 8 October 2016 in Dhaka, Bangladesh, part of the LCPC project,  attracted 450 people, where the Director General of Department of Narcotic Control and the President and Secretary-General of the Bangladesh Medical Association attended. Many of the audience and media present at the screening were emotional upon seeing the pain of patients featured in the movie. Palliative care, which was previously little known among doctors in Bangladesh, is now starting to gain awareness as Dhaka Tribune was also present to cover the screening. Read their articles here and here.

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Sri Lanka

4 October 2016 – A joint event between the Sri Lanka Medical Association and the National Cancer Control Program Sri Lanka screened the trailer for the “Life asked Death” movie as part of their effort in bringing awareness of palliative care to the medical personnel in medical association.

6 October 2016National Cancer Institute, Maharagama organised a series of talks by Dr Suraj, Dr Sujeewa, Dr Hemantha, Dr Ranjan, Dr Samadhi and Dr Kosala on various topics pertaining to palliative care. A primere of the “Life asked Death” movie was also screened at the event, which left 115 staff members of the Institute motivated and willing to contribute to palliative care.

8 October 2016 – Creating awareness on palliative care, the Pain Clinic at National Hospital Sri Lanka held a walk as part of the World Hospice and Palliative Care Day 2016. Palliative Care Association of Sri Lanka also commemorated the day with the screening of the “Life asked Death” movie.

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Myanmar

The movie screening event in Myanmar was jointly organized by U Hla Tun Hospice Foundation and The Myanmar Society for the Study of Pain in Myanmar. There was an audience of about 400, including the media. Many of the audience were teary at the end of the movie and gave positive feedback, showing that an awareness on the importance of palliative care has been created through the movie.  The event was reported by Myanmar International TV at this link.

   

 

Five more days to APHN-LCPC movie Life Asked Death Online Premiere

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The Lien Collaborative is a project by the Asia Pacific Hospice Palliative Care Network (APHN) and Lien Foundation to enhance palliative care leadership and capacity in developing countries.

New palliative care services have been started at key government hospitals and cancer centres in Bangladesh, Myanmar and Sri Lanka by participants of the Lien Collaborative.We turned the camera on the remarkable work being undertaken by the International teams and local stakeholders from this initiative.The result is Life Asked Death, a breathtaking documentary film that delves into the world of building palliative care capabilities in Asia.

On 8 October 2016, in conjunction with World Hospice and Palliative Care Day, Life Asked Death will premiere in a free Global Event at www.lifeaskeddeath.com

Watch the Life Asked Death trailer now and spread the word about the release of this important film!!

 

 

LCPC Myanmar Module 6: It is not the last …………….. It is the beginning

Written by: Dr Wah Wah Myint Zu, Radiation Oncologist, Radiotherapy Department, Yangon General Hospital, Myanmar

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Our last module of the Training-of-Trainers in Palliative Care Program for Myanmar is from 11.1.16 to 15.1.16.

It is quite a coincidence!

When we have the very first day of our 6th and last module in Yangon General Hospital, there was also the National Seminar on Comprehensive Oncology Services held at Nay Pyi Daw on 11 Jan 2016. This National Cancer Forum is attended by all  the admin person and policy maker from Ministry of Health, almost all the radiation oncologists and medical oncologists from both government and private hospitals, Academic Institutions involved in training the health professionals, NGO like Shwe Yaung Hnin Si Cancer foundation etc . The Chairperson of APHN and Lead faculty of the Lien Collaborative for Palliative Care project, Prof Cynthia Goh, give a speech on the  Implementation of Palliative Care in Cancer Service. We heard a good news that all the attendee are very much interest in Palliative care and they appreciate the hard work and enthusiasm of APHN for the establishment of Palliative care Service in Myanmar.  The meeting identified as a priority the setting up of Palliative Care services as part of Comprehensive Oncology Services in Myanmar. In addition, the World Health Organisation has identified the setting up of Palliative Care services as part of Universal Health Coverage and Non-Communicable Disease (NCD) management.

At training center, Yangon General Hospital,all the faculty members and the trainee are excited .and active since the very first day. We are thrilled to share knowledge and experience of our palliative practice within previous six months to the faculty members and each other.

During the last module of training of trainers, faculty members encourage and teach us the different methods of teaching like lectures, case-based discussions, large group and small group teaching and usage of role play. I think this is a good topic for the trainees who will become trainers in near future. We also discussed about spiritual care, spirituality, self-care and the ethical dilemma. Our faculty members cover a wide range of Palliative care topics and also revise about many important issues in Palliative care like Difficult Pain, wound care, colostomy care, communication etc. Dr Aye Aye Naing and I shared our learning and experience from the fellowship training program in Division of Palliative Medicine, National Cancer Center of Singapore as part of the Lien Collaborative for Palliative Care project. All the participants are interested to hear about the Palliative care service in Singapore.

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Prof Cynthia Goh said that the faculty members are like parents who are excited but concerned for their offspring who will now start to fly out from their nest but they know their children will be fine as their kids are well equipped and trained and parents are always there to support them. These warm words make us teary and touched our hearts.

Professor Myint Thaung , Head and Professor of Orthopedic surgical department and President of Myanmar chapter in ISEAPs, said that he will fully support the establishment of Palliative care service and Palliative care education and encourage us  to try our best in serving our patients with Palliative care.

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Upon thanking notes, I said we owe the deep sense of gratitude to the Prof Myint Thaung, Prof Cynthia Goh, all the faculty members and APHN for the difference made by Palliative care TOT program during three years training .We are changed by the knowledge of the value added Palliative care and we want to give Holistic and interdisciplinary Palliative care approach to our patients to promote their quality of life. We also want to share that precious knowledge and experience to all our health care personnel and so we are interested in palliative care education.

With deep sense of gratitude, we give our remarkable Myanmar traditional souvenirs to all the faculty members and project manager of APHN .The last module of TOT program is successfully concluded by proudly awarding the completion certificates to all the participants.

 

Although the training is the last module, I think it is the beginning of our Palliative journey. All the participants are excited and thrilled to have empowerment and dedicated for trying our best in establishing Palliative care service in our own hospitals.

 

Palliative Care Clinic starts in National Cancer Institute, Maharagama, Sri Lanka

Written by: APHN Editorial Team – Sri Lanka (Cancer Care Association, Sri Lanka)

This is a write up on the inauguration of  the Palliative Care Consultative Service & Palliative Care Clinic at the National Cancer Institute, Maharagama (NCIM).

Initial Discussions and Preparations

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After the third module of the LIEN Collaborative for Palliative Care Training of Trainers program held in collaboration with the National Cancer Institute Sri Lanka (NCI), National Cancer Control Program Sri Lanka (NCCP) and the Asia Pacific Hospice Palliative Care Network (APHN) held at the NCIM, the participants of the program commenced discussions to establish a Palliative Care Consultative & Palliative Care Clinic at the NCIM.

The articipants of the Training of Trainers Program from NCIM are, Dr Sujeeva Weerasingha, Dr Prasad Abeysinghe, Dr Kanthi Perera, Dr N. Jayakumaran, Dr Lakshman Obeysekara, Dr Sanath Wanigasooriya, Dr Mahanada Udukala , Dr  A. Parthiepan, Dr Samadhi Rajapaksa, Dr Sidath Wijesekara, Dr Ranjan Vidanage, N/O (Nursing Officer) Samindra Ranasinghe, N/O Priyanka kasthuriarachchi, N/O Nirosha Herath.

There was an initial discussion among the resource personnel held at the NCIM counseling center to ensure a wholesome approach towards the initiative. The staff of the NCIM who were supporting the initial preparations were the Director, Consultant Anesthetists NCI, Consultant Physicians NCI, all Other Consultants NCI, Medical Officer (MO) –Nutrition NCI, the speech therapist, counseling Unit, other nursing staff. The staff of Shantha Sevana Hospice also supported the initiative during this stage.

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After the discussions held during the initial gatherings, a final discussion was held with the Director, NCIM, Dr. G. Wijesooriya, where procedures and logistics for the establishment and the operations of the Palliative Care Consultative & Palliative Care (PC) Clinic was finalized. The consultant oncologist Dr. Sujeeva Weerasinghe was elected as the Team Lead of the Palliative Care team at the NCIM. The imperative points discussed were as follows:

  • How to establish a PC clinic, PC Unit & other PC facilities
  • To have an internal circular among the Consultants of NCI, regarding PC facilities available at the NCI
  • Circulate the referral form for the PC clinic to all Consultants & Medical Officers (MOs) at NCI and to get them familiarize with the form
  • Circulate an article about Palliative Medicine among MOs of the NCIM
  • Drafted a letter of request to the director NHSL, to get Dr. Hemantha Kumarihami (Consultant Anesthetist) and her team for consultation on Pain Management at the PC clinic
  • Conduct palliative care teaching sessions for the MOs/NOs at NCIM

The Commencement of the Service.

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After many rounds of discussions and preparation, the Palliative Care Consultative & Palliative Care Clinic at the NCIM was finally established on 25th August 2015 in Room No. 119 of the NCIM. The unit will be under the leadership of Dr. Sujeeva Weerasinghe. Consultation and registration of the first patient was also done by her as a mark to the opening of the unit.

The first activity of the unit was a visit to the Shantha Sevana Hospice, where most patients will be referred to. It is situated near the NCIM. Dr. G. Wijesooriya (Director, NCI), Dr. Ishani Fernando (Director, NCCP) and other attendees of the Master Trainer program graced this visitation trip.

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After the hospice visit, a week long training session on palliative care was conducted by the unit at the NCIM with the participation of 43 doctors, in order to raise awareness about the importance of palliative care to the medical community. During this training session, the attendees were taught the following:

  • To act as a team leader to provide palliative care in each clinical team /unit/ward under each consultant.
  • To arrange referral to the PC clinic through the consultant in charge
  • How to properly disseminate information across departments using the PC referral form.
  • How to co-ordinate and assist with the work at the PC clinic.
  • Active management of all symptomatic patients with help of other team members to improve the quality of life of each patient
  • How to improve awareness of the concept of palliative care among colleagues and co- workers
  • To continuously update their knowledge in palliative care

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This start of this clinic in Sri Lanka’s National Cancer Institute marked an important milestone in the palliative care movement in Sri Lanka. The APHN will also like to congratulate the team for their achievement in setting up the clinic.

Palliative Medicine accepted as a medical specialty in Bangladesh

The University of Bangabandhu Shekh Mujib Medical University (BSMMU) Dhaka in Bangladesh has recently approved the proposal for medical residency programme in Palliative Medicine. This approval was preceded by approvals of the surgical faculty which took the initiative to draft the curriculum. This is an important milestone for the country, as the approval confirms that that palliative medicine has become a recognised specialty in Bangladesh.

Prof Dr Nezamuddin Ahmad from Bangladesh is pleased with this outcome and on behalf of the Univesity she would like to thank everyone for their suggestions and active participation in the development of this curriculum for the medical residency programme in Palliative Medicine. A special thank you is dedicated to the three workshops organized in April, September and December of 2013 with the support of the Higher Education Quality Enhancement Program (HEQEP) of the University Grant Commission (UGC) which greatly helped the development of the curriculum. The valuable suggestions and active participation drafting the curriculum by the attendees greatly helped us complete this task today. The University would like to sincerely thank all of those who participated and contributed to achieving this milestone.

On behalf of the Centre for Palliative Care, the University of Bangabandhu Shekh Mujib Medical University Dhaka look forward to your continued support in the future and  welcoming the first set of M. D Residents in Palliative Medicine.

The ehospice has also published an article on the Palliative Medicine Residency in Bangladesh. In the article, Prof Dr Nezamuddin Ahmad also mentioned that this will be a “turning point for palliative care in Bangladesh”.

The exerpt below originally appeared on ehospice article “WHPCA partner celebrates new Palliative Medicine residency in Bangladesh”

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“Specialty recognition can be seen as a turning point in the evolution of the palliative care movement of a country. A residency program will allow us to develop a core group of specialists with expertise in palliative care in Bangladesh. This will raise the profile and awareness among physicians about palliative medicine as an emerging and vital discipline.

Additionally, it is estimated that 600 000 patients in Bangladesh require palliative care at any point in time, so there is an urgent need to train more health care professionals in this field.

These specialists will be the leaders, mentors and trainers for the large number of nurses, support workers and other health care providers who are needed to care for this large number of patients. Besides, this should have an overall impact on other spheres of palliative care development.”..read more

Quality of Death Index 2015 Released – Need for palliative care outstrips services

QODThe Quality of Death Index, commissioned by the Lien Foundation, a Singaporean philanthropic organisation, is based on extensive research and interviews with over 120 palliative care experts from across the world.

It shows that in general, income levels are a strong indicator of the availability and quality of palliative care, with wealthy countries clustered at the top. The UK is top of the list, as it was in the previous index released in 2010. Australia and New Zealand take second and third place, as they did in 2010, while rich European and Asian countries dominate the top 20, along with the US in ninth place and Canada in 11th.

As expected, many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure. Yet some countries with lower income levels demonstrate the power of innovation and individual initiative.

For example, Panama (31st) is building palliative care into its primary care services, Mongolia (28th) has seen rapid growth in hospice facilities and teaching programmes, and Uganda (35th) has made huge advances in the availability of opioid painkillers.

For the first time The EIU has also compared the supply of palliative care – as revealed in the Index – with the demand for such care.

The demand analysis, based on countries’ demographic profiles and the burden of diseases for which palliative care is necessary, shows China to be among the most vulnerable from population ageing and the rising incidence of conditions such as cardiovascular disease, which accounted for one-third of all deaths in the country in 2012.

Many other developing countries will also need to work hard to meet rising future need as the incidence of non-communicable disease increases and their populations grow older.

David Line, the editor of the report, said: “Since the first Quality of Death Index was published this issue has certainly risen up the global agenda, as shown by the World Health Assembly resolution last year calling for improved standards of palliative care across the world.

“But much more can be done, even in countries that rank highly in the Index. It is an issue that will affect us all – a good quality of death should be regarded as a human right.”

The release of the report coincides with World Hospice and Palliative Care Day, a unified day of action organised by the Worldwide Hospice Palliative Care Alliance (WHPCA) and the International Children’s Palliative Care Network (ICPCN) to raise awareness of the need for hospice and palliative care worldwide.

Dr Stephen R Connor, WHPCA Senior Fellow, said: “This new report, released ahead of World Hospice and Palliative Care Day, will help highlight the enormous work that still needs to be done to bring palliative care especially to low and middle income countries where lack of education on palliative care, lack of essential medicines, and lack of government support continue to lead to unnecessary suffering.”

The report can be accessed at www.qualityofdeath.org. Besides the full report, it includes bite-sized country profiles and infographics.

Please feel free to share the findings with your stakeholders to further our collective goal of improving palliative care for communities around the world.