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Project Hamrahi – Patna, Bihar March 2012

March 2012

Participants:

IGIMS, Patna

Dr Rajesh Singh, Oncologist & Palliative Care, IGIMS, Patna

Dr Vinod Verma, Anaesthetist & Palliative Care, IGIMS, Patna

Ms Sujita, ICU nurse & Palliative Care, IGIMS, Patna

Australasian Palliative Care International

Dr Odette Spruyt, Director, Pain and Palliative Care, PeterMac Cancer Centre, Melbourne

Ms Anne Adams, Project Manager, PeterMac Cancer Centre, Melbourne

Ms Sarah Rose, Palliative Care Nurse, Alfred Hospital, Melbourne

Pallium India

Professor Rajagopal, Chairman, Pallium India, Trivandrum

Summary

This second visit coincided with the 100 year Bihari celebrations in which the state was commemorating its centenary. The city of Patna was highly decorated with blue lights and there was a 3 day carnival in the city’s centre.

Our timetable was less structured than during the first visit. We attended oncology outpatient clinics and oncology ward rounds as before. The ward rounds were with Dr Pritanjali and her colleague, Dr Richa. We saw many patients with advanced c ancer, of all ages, in the same ward, attended by their family members. The condition of the hospital wards had not noticeably improved since last visit. However, in the outpatient areas, there was a well set up chemotherapy day ward.

The chemotherapy OPD was as busy as ever. We were told that over 3000 oncology patients are seen in OPD every month.

There was a CME organised by Dr Rajesh on the Saturday of our stay. This special event brought Indian palliative care leaders to Patna to teach and share their insights with the team from Patna. We were pleased to be able to participate in this event.

A particular concern on this visit was the continued failure to achieve an uninterrupted supply of oral morphine, one of the key standards of the Indian Palliative Care quality improvement standards. IGIMS is only government hospital in Patna with a licence to provide morphine and yet is unable to maintain its supplies due to many factors. A key factor is the lack of support of the Director of IGIMS in ensuring this is maintained. Without his action and support, the process stalls. Additionally, Bihar has not simplified its narcotic rules, in line with the Federal urgings to do so and the action of over 14 other states in India. Unduly complex regulations translate to unbearable suffering for patients and disempowerment of staff. We felt this was an urgent issue on this visit and attempted to advocate to the Chief Minister, Chief Health Minister, Principal Secretary and Principle Health Secretary during our week. We were pleased to have a brief meeting with the Principal Health Secretary with whom we are maintaining contact.

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