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National Strategy for Palliative Care in Nepal

- Dr Dan Munday & Dr Ruth Powys Nepal, March 2016

Nepal - APLI

In Nepal over 112,000 people each year will be in need of palliative care.  An appropriate national strategy is an important step towards enabling palliative care to reach those in need. In recent weeks very significant progress has been made toward developing such a strategy.

In February 2016, the Nepalese Association of Palliative Care (NAPCare) was joined by Two Worlds Cancer Collaborative Canada (who have supported palliative care development in Nepal over many years), the Ministry of Health and Population, the WHO, International Nepal Fellowship (INF), and other stakeholders for an important 3-day Forum where 30 invited participants worked to develop a National Strategy for Palliative Care for Nepal.

Representatives from INF included Dr Dan Munday, Palliative Care Consultant, UK, living in Kathmandu, advisor to NAPCare and Dr Ruth Powys (Russell), Palliative Care Specialist from Australia, living in Pokhara, Western Nepal.  Ruth and Dan presented key input from a current INF/NAPCare survey demonstrating how palliative care is continuing to expand in government, NGO and private institutions and how many hundreds of healthcare professionals have received basic palliative care training.

A palliative care strategy will need to include all settings from rural districts to the national level, with appropriate service provision, training, resource provision, quality standards and research. Specialist palliative care at the secondary and tertiary care levels needs to be developed, as well as palliative care delivered by generalists, including GPs and mid-level health workers.

WHO is committed to enabling member states to develop palliative care appropriate to their national context, integrating it into their health services. The Declaration on Palliative Care at the 67th World Health Assembly in 2014 to which Nepal is a signatory, has committed WHO and the government of Nepal to be partners in this important process. NAPCare has committed to work with government and WHO to produce an agreed national strategy to be launched August 2016.

Project Focus

As some of you may be aware, in early 2016 the Asia Pacific Hospice Palliative Care Network (APHN) held four ‘APHN Dialogs’, in which clinicians across the Asia Pacific region could link in through Skype to attend a webinar. The following webinars took place:

- A discussion of palliative care service development in the Asia Pacific region, presented by Odette Spruyt
- Pain control in palliative care by Yoshiyuki Kizawa from Kobe, Japan
- Management of the cancer wound by Edward Poon from Singapore
- Bereavement care by Jun-Hua Lee from Taiwan

These sessions were well received and provided a valuable opportunity for clinicians in different countries to learn from an expert in that field and also to share their own professional experiences. Unfortunately, not all countries in the region have reliable internet coverage or sufficient bandwidth so some attendees were unable to join the meetings. In response to this, in recent months APLI has been looking at a new educational initiative in partnership with APHN.

Project Focus aims to set up online discussion groups between palliative care clinicians in specific countries in the Asia Pacific region and APLI mentors. Some nascent palliative care centres struggle with isolation, limited practitioner experience and variable institutional support. In effect, Project Focus would work towards similar objectives to Project Hamrahi: to improve the capacity for best practice patient care in the local setting and to reduce the isolation of palliative care providers in emergent services.

APLI is therefore calling for expressions of interest for mentors to volunteer their services to help support our regional partners. Project Focus would particularly suit clinicians who might otherwise find it difficult to travel overseas for mentoring work, as the contact will be online using a small group discussion format on the ‘Slack’ communication platform. APHN has already identified local clinicians in two separate services in remote and regional Indonesia who would like to be partnered with APLI mentors. In addition to this, there has also been some interest from doctors in Vietnam, Brunei and Nepal whose learning needs were unable to be supported by the APHN Dialogs.

Although the exact process will be flexible, it is proposed that education would begin with case presentations from the local APHN clinicians. These would then serve as a springboard for the APLI mentors to explain current evidence based practice recommendations. The subsequent discussion would then take into account local factors such as medication availability, local resources, staffing and other factors such that a viable and culturally appropriate management plan can be formulated.

I hope that you will share our excitement for this initiative. Project Hamrahi has demonstrated the value of teams of mentors made up of both doctors and nurses working together with local Indian clinicians over a sustained period of time. Project Focus has the potential to broaden the scope of such partnerships to other countries and so I invite you to contact me via chairman@apli.net.au with a short biography and reflection on why you would wish to work as a mentor.

- Anil Tandon

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Your donations to APLI help in the following ways:

assist with training of doctors and nurses in palliative care practice in developing nations

support nurses to travel and teach as part of Project Hamrahi

help with purchase of critical site resources such as essential equipment and supplies,  medicines and educational materials