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Project Hamrahi – Jamshedpur, Jharkhand November 2011

November, 2011
Second visit to Jamshedpur, Jharkhand

Participants

Palcare India Project

Meherbai Tata Memorial Hospital

  • Dr Master, Medical Director
  • Dr Urmila Patel, Senior Medical Officer  **
  • Ms Sunita Ekka, Staff Nurse, Meherbai Tata Memorial Hospital

Tata Main Hospital

  • Dr Madhusudanan, General Manager, Tata Main Hospital
  • Dr Koshy Varghese , Anaesthetist, Critical Care Unit **
  • Ms Jeseentha George, Staff Nurse, Tata Main Hospital **

(**Attended training in Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala in 2009)

Australian Palliative Link International

  • Dr Anil Tandon, Palliative Care Physician, Perth
  • Wendy Scott, Clinical Nurse Consultant,  Perth

Pallium India 

  • Dr. M.R. Rajagopal, Chairman,
  • Mr Anosh Varghese, Project Officer, CanKids Kolkata

Summary

It was identified after the first visit that the need to return in the ‘soonest possible timeframe’ was required to continue and enhance momentum in the most effective way.  It was agreed by the mentors that the second visit should be more specific and focused on individual mentorship of the palliative care team members. Due to the identification of learning needs and current service delivery gaps, it was felt that future planned education be focused on the assessment and treatment of pain. There was also a greater mentorship focus on the team at MTMH, and greater focus on nurse to nurse mentorship opportunities.

Meherbai Tata Memorial Hospital (MTMH) is a 72 bedded charitable cancer institute and was established by the Jamshedpur Branch of Indian Cancer Society.  MTMH treats all types of cancer cases and it has a well equipped diagnostic centre.  The hospital runs on a non-profit basis and 10% beds are reserved for those living below poverty line.  It is generally agreed that 70 to 80% of inpatients have a ‘palliative’ diagnosis for which many are receiving treatment.

The Outpatient Department (OPD) Palliative Care Clinic runs every morning, 6 days per week and is free of cost.  Dr Urmila also provides consultancy to inpatients, while she also completes her routine oncology medical officer duties. Sunita works on the female ward.

The neighbouring Tata Main Hospital (TMH) is a 900 bed hospital with all major specialties. Dr Koshy works in the very busy Critical Care Unit and Sister Jeseentha works on a male medical ward. She also coordinates the opening of ‘overflow’ wards on demand.  Palliative Care is provided on a consultative basis, throughout the hospital, following phone referrals to Dr Koshy.

Clinical

The total number of consults completed during the week was 60.  This was almost twice as many patient consults seen the previous year.  Only 4 of these were seen at TMH, in line with meeting the objective of prioritising the learning needs of Dr Urmila and her colleagues at MTMH.  On very few occasions were other staff able to join the patient consultations and reviews.  We had not been advised that Sunita had been absent from work on maternity leave for some time.

 

Some improvements were noted. Morphine ampoules were available at TMH on several wards, but oral morphine was still not available. Improved symptom control was observed eg dyspnoea, constipation. There was increased awareness of the benefits of truth-telling and the risks of fostering false hope. Patient privacy and dignity was still limited by the environment and lack of screens/curtains etc. Collaboration across the two hospitals was still limited by time and opportunity. There was evidence of further training and Dr Urmila was enrolled in Cardiff diploma course in Wales. There were as yet few opportunities to work with the ‘Mahadeo Education & Welfare Society’ to enhance psychosocial and supportive care.

 

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