Lien Collaborative for Palliative Care – Bhutan Module 2 of 6

Lien Collaborative for Palliative Care – Bhutan Module 2 of 6, Trip Report for 28 Jan to 2 Feb 2019

Written by: Ms Joyce Chee, Assistant Manager, APHN

Edited by: Dr Shirlynn Ho, Lien Collaborative faculty country lead for Bhutan

The 2nd Module of the Lien Collaborative for Palliative Care – Training of Trainers in Palliative Care Programme for Bhutan was conducted from 28 January to 2 February 2019, at the Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in Thimphu, Bhutan. The course was taught by a 5 member faculty team consisting of Associate Professor Cynthia Goh (Project lead), Dr Shirlynn Ho (Country Lead), Dr Jamie Zhou, Ms Saw Nandar Nwe and Ms Jan Philips.

A total of 23 participants, consisting of 8 doctors, 10 nurses, and 5 allied health professionals attended the course. Key topics covered during the 2nd module was built upon the topics taught in the 1st module, and they include the following:

• Pain assessment & management
• Use of opioids and co-analgesics
• Breathlessness
• Nausea & Vomiting
• Constipation & Diarrhoea
• Clinical ethics
• Alternative routes of nutrition & hydration
• Communication
• Navigating Cancer
• Care at the end of life

There were 3 sessions of clinical bedside teaching, which allowed the participants to practice their newly learnt skills. Unique to this module was that each topic was tailored to the participants’ needs. The aim was to provide them with relevant knowledge and skills which will impact their practice. To meet this goal, the faculty were very flexible in adjusting the training to the local context and participants’ feedback at the end of each training day. Three topics were added to the module and the contents of the other topics were modified. These were “Subcutaneous medications available in Bhutan”, “Cost comparison based on equianalgesic dosing” and “Caring for ourselves”.

Overall, the 2nd module was a success. The participants felt more confident in their communication with patients and caregivers. They were excited to share the knowledge and skills learnt during the course with their colleagues and to apply the palliative care approach to their daily work.

During this trip, the team from the Asia Pacific Hospice Palliative Care Network (APHN) was extremely honoured to be given an audience with His Majesty the King of Bhutan, Jigme Khesar Namgyel Wangchuck and to meet with His Excellency Dr Lotay Tshering, the Prime Minister of Bhutan. Both of them recognised the palliative care need in Bhutan and were very supportive of initiating palliative care in the country. The pictures below have been republished with permission from the relevant authorities in Bhutan.

From left: Ms Saw Nandar Nwe, Dr Zamie Zhou, His Majesty Jigme Khesar Namgyel Wangchuck, Dr Cynthia Goh, Ms Joyce Chee (APHN Assistant Manager), Ms Jan Philips, Dr Shirlynn Ho, Mr Christopher Lim (APHN Volunteer)

From left: Mr Sonam Tobgay (participant of the course), Mr Christopher Lim (APHN volunteer), Ms Jan Philips, Dr Shirlynn Ho, A/Prof Cynthia Goh, His Excellency Dr Lotay Tshering Ms Joyce Chee, Dr Jamie Zhou, Ms Saw Nandar Nwe, Ms Yangden Paki (participant of the course)

The APHN hopes to continue to engage and support the development of palliative care in Bhutan via an official partnership with JDWNRH, the nation’s main national referral hospital, to train its core palliative care team, and to establish it as the first teaching centre for palliative care in Bhutan.

Team photo of Faculty and participants

The APHN will like to thank the Director of JDWNRH for providing the training venue, logistics and lunch for the training, as well as hosting dinner for the team. We will also like to thank Ms Phub Zan, President of the Bhutan Chamber of Commerce & Industry and the Fu Lu Shou restraurant for their hospitality in hosting dinner for the team.

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