In Pakistan, various different kinds of cancers claim more than
100,000 lives each year. Majority of cancers are diagnosed when the disease has reached an advanced stage, which requires palliative care.
Despite the need for these specialised services for critically ill patients, the provision of palliative care in Pakistan is at best limited, and at worst non-existent. Availability of essential pain–relief medicines, especially oral morphine, is extremely limited.
The School of Nursing and Midwifery’s (SONAM) recently launched Palliative Care and Oncology Clinical Stream is mandated to work on initiatives that help overcome barriers in accessing palliative care in the country. In a recent seminar, organised to commemorate World Hospice and Palliative Care Day 2018, the stream gathered student nurses, practicing nurses, social workers, educators and psychologists with an aim to raise awareness on the physical, spiritual and psychosocial needs of cancer patients and their families. Experts from the field were invited to share their knowledge and case studies on dealing with patients and families in need of palliative care.
The lack of government policies to recognize palliative care as an essential component of healthcare is also a major problem in the country.
Ms Zohra Kurji, assistant professor and clinical stream head for palliative care and oncology says, “A National Cancer Plan was launched in 2002 with the support of World Health Organization, however, owing to budgetary issues, insufficient healthcare facilities, and inappropriate priority-setting practices, there has been no progress in its implementation.
She said that there is a clear lack of awareness on palliative care among healthcare professionals that further worsens the issue.
Speaking at the seminar, Professor Sameen Siddiqi, Chair of the department of Community Health Sciences at AKU noted that lack of effective national palliative care policy, absence of facility-based and home-based palliative care providers and scarce supply and distribution system of pain relief medicines are some of the biggest challenges to palliative care in Low and Middle Income Countries like Pakistan.
“Institutions, such as the Aga Khan University Hospital, can act as an agent of change. Backed by evidence-based research and cost-effective interventions, private institutions should take the necessary lead by modelling service packages and by collaborating to offer technical assistance and capacity building services”, says Dr Siddiqi.
Emphasising on the role of government in integrating palliative care into existing primary healthcare system, Dr Siddiqi said that “training of staff, availability of supplies, and strengthening of home healthcare system that reaches everyone in need of palliative care” are some essential steps.
Also present at the seminar were Dr Nasreen Lalani, postdoctoral research fellow at the University of Calgary who spoke on the concept of spirituality in palliative care; Ms Rehana Punjwani, nurse manager at the Paediatric Oncology, Indus Hospital and co-chair at the International Society of Paediatric Oncology, who spoke about the measures taken in the palliative space in developing countries; and Ms Salma Rattani, assistant professor at SONAM and doctoral candidate at the University of Alberta who shared a case study on access to palliative care in Pakistan.
The School’s clinical stream for palliative care also recently introduced community-based cancer support groups to improve the quality of life of individuals suffering from the disease. Not merely this, a course on palliative care has also been made part of the undergraduate nursing curriculum at SONAM where student nurses are trained using high-fidelity patient mannequins and technology-assisted interventions.