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Palliative Care on the Move in Northern Province, Sri Lanka

News from Dr Ranjan Mallawaaarachchi, Founder and Coordinating secretary, Regional Association of Palliative Care, Northern Province. Consultant OMF surgeon, District General Hospital, Vavuniya and Teaching Hospital, Jaffna, Sri Lanka.

Dr Rangan Mallawaraachchi

Back ground information

The concept of palliative care is very new for Sri Lanka, with significant developments starting in 2013. This is true for the northern province. This province is one of 9 provinces in SL, and has 5 districts, including Vavuniya. The teaching hospital for the northern province is in Jaffna district, with a district general hospital in each of the other districts. Vavuniya District General Hospital is the second largest hospital in the province, has 20 consultants including pathologist, radiologist, anaesthetist, and Oral Maxilla Facial surgeon who serves the whole of the northern province. Daily, 800 people attend the hospital outpatient department and in my OMF clinic, 1000 patients attend per month.

My interest in palliative care arose as most of my oral/pharyngeal and other head and neck cancer patients present with Stage 3 or 4 disease. Meeting Dr Suharsha Kanathigoda was a turning point in my life and led me to explore the world of palliative care. Currently, there is not one palliative care specialist in SL, many doctors and nurses have misconceptions about opioids, opioid availability was minimal and policies resulted in restriction of availability of opioids for medical use.

The following initiatives have occurred in the northern province to date:
• Establishing the MDT discussion focussed on palliative care
• Establishment of palliative care clinic (H&N oncology)
• Forming the palliative care data collecting centre and referring centre
• Developing H&N oncological hospice, Cheddiculum Base Hospital, Vavuniya, Sri Lanka
• Learning and study in the field of palliative care
• Teaching doctors, medical students, nurses, nursing officers and allied health workers, through workshops
• Started to do small studies such as audits and research
• Founding the regional association of palliative care for the northern province
• Collaborative work with other institutions, professional bodies, agencies who are in the field of palliative care locally and internationally
• Started to sensitize peoples’ hearts, through an awareness program for non-medical people (corporate sector)
• Started home based palliative care services in northern province
• Establishment and strengthening of the hospital based palliative care services
• Promoting palliative care by directing and filming a documentary on palliative care
• Launching the web profile for education, awareness, and teaching in palliative care

Establishing the MDT and role at the General Hospital, in Vavuniya

At this meeting, both  non-oncological and oncological cases are discussed. The team consists of OMF surgeon, oncologist, radiologist, pathologist, pediatrician, psychiatrist, anesthetist, ENT surgeon, physician, general surgeon. Other members of the palliative care team may participate. Each case is discussed in detail in front of the patient and family. Social  issues are explored by the palliative care nurses and bring some solutions.  The  patient is categorized as for home-based, hospital-based or end-of-life care. Home-based palliative care cases are being referred to palliative care collecting centre , OMF unit, General Hospital, Vavuniya.

 

2015 MDT discussions

 

Patient examples (consent was given to publish these photos)

patient-1 patient-2 patient-3 patient-4 patient-5

 

Establishing the Hospital-Based palliative care service at General Hospital, Vavuniya

Initiatives include implementing a pain assessment and management chart  with a ward policy that this is started on every patient admitted.

 

Vavuniya

 

 

Education and training

This has been an important focus since our palliative care work commenced. We have conducted our first palliative care workshop attended by over 600 participants including medicine,  dentistry, allied health, councillors, students, volunteers and community workers. There were many local, national and international participants.

Vavuniya-3

Vavuniya-2

 Vavuniya nursing school, 22/12/2014

 

Cancer hospice in base hospital Cheddiculum ,Vavuniya

This will be the first head and neck cancer palliative house in Sri Lanka. The provincial government is directly involved in establishing this center. The plan is to have a palliative unit and hospice in Cheddikulum Base Hospital, Vavuniya with the support of north province health ministry, RDHS Vavuniya, PDHS, Shanthi Foundation Sri Lanka Cancer Care Association ,Sri Lanka Association of Palliative Care, and other charities. This will be free of charge to patients. It will provide long term care if needed. It will also be an education resource in palliative care practice for the region.

Research

Early research and audit reveals a lack of awareness about the use of opioids, a need for education about the management of patients with oral and pharyngeal cancers and a study of the mode of dying of patients with H&N cancers.

Community services

The Vavuniya region has the first ever palliative care nurses, some of whom are working in a voluntary capacity. Home visits by doctors and nurses in the team reveal the high level of poverty and suffering in this community.

Community

 

 

Mr .M is a 60 year old Muslim man with oral cancer. I operated on him about one year ago, followed by radiotherapy and chemotherapy treatment. Now he cannot open the mouth at all and able to swallow only liquids, with associated weight loss.

Mr M  Mr M-2

Mr M-3

 

 

Poverty and Pain

This elderly woman lived with her daughter in very poor conditions.  The roof of their hut leaked, the toilet was 50m away, there were two plastic chairs, water from the well was unhygienic and had high salt content. Her daughter’s fiancé was asking for a high dowry. She worried about her daughter’s future and not being there to  help her.

Poverty and Pain

 

Forming professional body and the association

I started the regional association of palliative care for the northern province. It was  launched on 13th March 2015.  Dr Kanathigoda,  Director of Shanti Foundation, and WHO are international  patrons. The National Cancer Control Program and Cancer Care Association, Sri Lanka, are national patrons.

Our association has an MOU with the Shanthi foundation of Australia, the Mental Health Society,  Vavuniya and rehabilitation  centre in Base Hospital, Cheddiculum.  It has close working relationships with the Palliative Care Association of Sri Lanka, as well as its national patrons.

Sensitization of the public

We made a documentary on palliative care which was released on the 18th March, 2015 in Vavuniya. 600 free DVD copies were given to the public. It can be viewed on you tube, search for “palliative care documentary , Sri Lanka” or on the official website of the Regional Association of Palliative Care, Northern Province ( www.rapcnp.com)

video

 

Future Plans

We hope to develop our knowledge through visits from and links to international experts, and conduct collaborative studies with international associations, professional bodies and institutions and palliative care specialists. Our dream is that Vavuniya hospice and palliative unit will become an international and local treating center for palliative care. We aim to expand home-based palliative care services to other parts of the country. We will continue to raise public awareness about palliative care and work with charities and  NGO’s to assist the welfare of our patients and  families.

 

APLI Annual Forum

Members and non-members alike are warmly invited to attend the 2016 Australasian Palliative Link International Forum on 22 June. This year the APLI Forum will be in Adelaide for the first time, adjacent to the Multinational Association for Supportive Care in Cancer conference. Last date to register: 13 June, 2016. Read More

International Update on Pain Management and Palliative Care Advances 2016

The International Update on Pain Management and Palliative Care Advances 2016, is being organized at Dehradun, Uttarakhand, India by the Pain and Palliative Care Unit, Shri Guru Ram Rai Institute of Medical and Health Sciences and the Indian Medical Association on 25-26 June 2016. Read More

National Strategy for Palliative Care in Nepal

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. Read More

Palliative care in Kolkata – a lesson for us all.

Working as a volunteer in India I always seem to learn more than the stated intention of travelling to India to teach others. In October 2015 I was fortunate to spend a week in Kolkata with my good friend and colleague, Santanu Chakraborty, and this trip reaffirmed this. Read More

With a champion, anything is possible

I hope you will let me tell you a story about Lakshadweep, a group of islands in the Arabian sea, off the coast of Kerala, India.
A teacher of art at a government girls’ college in Kavaratti, one of the 10 inhabited islands of Lakshadweep, leads a grassroots palliative care project, Thanal. Read More

Kosish the Hospice, India:

Koshish10 - APLI

Karen Anderson, Lecturer & Unit Coordinator, Edith Cowan University writes about her recent visit to Koshish the Hospice, and IAPCON Pune 2016. Read More

Palliative care for India e-learning modules launched by ecancer

20 open access e-learning education modules about palliative care in India were launched at the Indian Association of Palliative Care Conference, 2016, in Pune, India. Read More

‘Need of the Hour’

Click here to read Brief notes from Indian Association Palliative Care Conference (IAPCON2016)

Return to the Valley: Cachar Cancer Centre, Silchar, Assam, India

Cachar 2

The visit made in December 2015 was the third visit to Cachar Cancer Centre undertaken by members of APLI in the last three years. The visits have been part of Project Hamrahi, a collaboration between APLI and Pallium India. Read More

Fear is the key!

Working with the dying reveals two aspects of our nature…the first being our sense of compassion, which is bountiful and healing; not only for the patient and their family and friends, who too suffer, but also for our own self; for by practicing compassion, we are being kind to our self and fortifying our compassion. Read more

PCA Award for Project Hamrahi

At the Gala dinner of the Palliative Care Australia (PCA) conference on the 3rd September 2015, Project Hamrahi was awarded the Innovation in Palliative Care award by PCA.

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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