Providing Palliative Care in Pakistan – The Difficulties

Written by Fr. Robert McCulloch, Home-Based Palliative Nursing at St. Elizabeth Hospital, Hyderabad, Pakistan

In Pakistan terminally-ill patients are treated as sources of income by the medical profession and the hospital culture. Their illness is not relieved and the financial situation of their families is wrecked as they seek for a cure or for pain relief.

In 2005 the administrative council of St. Elizabeth Hospital, of which I was chairman until November 2011, began discussing the need for and the possibility of commencing home-based palliative care for the terminally ill at Hyderabad, a city of 4,000,000 in the south-east of Pakistan. Its introduction has enabled St. Elizabeth Hospital to continue to offer in a very new way the best possible care at the lowest possible cost to those in need and to manifest compassion and mercy in a practical and outstanding way in Pakistan. At St. Elizabeth Hospital, we are convinced that the best and only answer to violence is compassion.

As of November 2014, St. Elizabeth’s Palliative Care visits 30 terminally ill patients. Nineteen are in terminal condition stage 4, nine in stage 3, and 2 are undergoing chemotherapy and radiography. 20 are male and 10 female. 18 are Muslim, 9 Christian, and 3 Hindu.

An important benefit of St. Elizabeth’s home-based palliative care service is that it facilitates inter-faith harmony through the caring ministry of committed Christian nurses, male and female, in the homes of people of different faiths, and through the meeting and mutual support of the religious ministers of Muslim, Christian and Hindu patients. The palliative care team comprises four male nurses, one female nurse, and a doctor.

In preparation for beginning the palliative care at St. Elizabeth Hospital, one of the nurses, Patras Inayat, completed a year-long Certificate in Palliative Care Nursing at Calvary-Bethlehem Hospital, Melbourne, in 2011. Members of St. Vincent de Paul conferences arranged accommodation and hospitality for Patras in Melbourne. Another nurse, Eric Siraj, completed his specialized Certificate in Pediatric Nursing in Hyderabad and further course-work in pediatric oncological nursing at the Children Cancer Hospital in Karachi. He went to Assisi Hospital, Singapore, in March-May 2012 for further palliative care training. This training and linkage has been on-going. St. Elizabeth Hospital is a member of Singapore-based APHN [Asia Pacific Hospice Network]. In August 2014, the administrator of St. Elizabeth Hospital, James Francis, and the head of the Palliative Care Department, Patras Inayat, attended the Catholic Health Australia annual conference in Brisbane. An outcome of their visit is that professional development linkages have been established with Cabrini Hospital, Melbourne.

The Palliative Care Department at St. Elizabeth Hospital depends on donations. The Melbourne Overseas Mission of the archdiocese of Melbourne helped to purchase a small car to enable the palliative care nurses to visit patients. Some of the equipment such as syringe drivers for continuous pain-killing medication is expensive. The families of patients have little, there is no insurance cover, and the government gives nothing.