Special report written by Dr. Zohora Jameela Khan, Assistant Professor (Dept. Ped. Hematology &Oncology), Incharge (Pediatric Palliative Patient Care, PCU), Dhaka Medical college & Hospital; Visiting Consultant (ASHIC palliative Care Unit)
The burden of childhood cancer and other life limiting diseases for children is increasing everyday in Bangladesh. However, the needs of child palliative care are not addressed properly. The population of Bangladesh consists of more than 159 million with 64 million being under 18 years of age. Yet, there are only two centers for child palliative care which focuses on children with cancer. This puts Bangladesh in group 3A according to the WPCA categorisation. Currently, ASHIC Palliative Care and the Palliative Care Unit of Dhaka Medical College Hospital have been providing services to the pediatric palliative patients since 2006 and 2014 respectively. From my personal experience, the most prevailing symptoms observed are: Pain, bleeding, constipation, bowel or bladder incontinence, pressure sores, respiratory distress, convulsion and perianal abscess or anal fissure. The quality of life is particularly hampered with perianal problems such as perianal abscess or anal fissures which we will discuss briefly below.
The probable causes of these problems are as such: Patients tend not to cooperate or agree to relax their buttocks for proper cleaning of the perianal region. Moreover, caregivers are also sometimes reluctant and unwilling to motivate the patient to do so. This results in inappropriate management of constipation.
When conducting local examinations, the gluteal furrow and area around the anus often becomes stained with streaks of stool. Digital rectal examination is also very painful and fissure is present in some patients. Unfortunately, this process is a vicious cycle. The painful perianal problems accompanied by the patient’s incooperation results in inappropriate cleaning and the growth of micro-organisms. The condition hence worsens.
In our setting, we ensure that after defecation, the patient’s perineal region is first cleaned with plain water. Next, the area is washed thoroughly with liquid soap of neutral pH. It is then dried gently with tissue. In the end, both the caregiver and the patient’s hands are washed with liquid soup. This technique is used on all patients who are getting chemotherapy and who are in the palliative stage. Fortunately, such a method is very effective.