Teaching about palliative care and pain management needs to be included in standard medical school curriculum, so that physicians can be trained to safely prescribe opioids and manage pain.
Dr Megan Doherty, a paediatric palliative care physician living and working in Dakha, Bangladesh, writes about both the encouraging developments and barriers to accessing palliative care for children in that country.
Imagine treating pain in children with advanced cancer using only paracetamol? This was the situation when I first started working on the children’s cancer ward at Bangabandhu Shiekh Mujib Medical University (BSMMU) in Dhaka, Bangladesh. BSMMU is the largest specialist pediatric oncology centre in Bangladesh, providing care to over 1000 children with cancer. Cure rates for children treated at this center are estimated to be around 50%.
Until August 2013, there was no paediatric palliative care service at this hospital, despite the significant need for these services. Recently, with the support of World Child Cancer we have started to develop paediatric palliative care services within the department of Paediatric Haematology and Oncology at BSMMU. Currently the service consists of myself (a paediatric palliative care physician) and an oncology trainee doctor. While providing clinical services, we are gathering data about the palliative care needs of children at BSMMU, in order to advocate to hospital administrators for the provision of more resources to provide these services.
Children’s palliative care in Bangladesh is in the early stages of development. A single hospice, Ashic Foundation, located in the country’s capital, Dhaka, provides palliative care for children with cancer, but the need for children’s palliative care is overwhelming. Bangladesh has a population of 164 million, and an estimated 64 million are children. Due to a lack of awareness about the signs and symptoms of cancer and the belief that childhood cancer is not curable, many children with cancer are diagnosed very late, when curative treatment is not possible.
Sustained advocacy efforts bring some pain relief for children
A lack of access to opioids has been a significant barrier to providing palliative care in Bangladesh. When I first started working at BSMMU, it was not possible to prescribe morphine or any other strong opioids. The sustained advocacy efforts of several key palliative care physicians in Bangladesh, resulted in oral morphine becoming available. However, initially despite being available, the pharmacy at BSMMU was not allowed to dispense these medications, forcing patients to travel to another hospital on the other side of the city to actually obtain morphine. Starting last week, morphine tablets and syrup are available directly from the dispensary within the children’s cancer department at BSMMU. Finally, rapid and effective pain relief is available for children with cancer at BSMMU.
There are still many children with cancer who will not receive adequate pain control; the availability of morphine is not enough to ensure all children with pain receive adequate treatment. The majority of physicians in Bangladesh remain afraid to prescribe opioids due to widespread misconceptions about the risk of addiction. Clinicians continue to incorrectly believe that opioids should only be used in patients who are dying. Teaching about palliative care and pain management needs to be included in standard medical school curriculum, so that physicians can be trained to safely prescribe opioids and manage pain. With local partners, we are organizing training seminars, workshops and conferences across Bangladesh to educate health care providers about pediatric palliative care and pain management.
Read more such articles from the International Children’s Edition of ehospice.