Palliative Care At Hospice Nepal

Prof. Pradeep Vaidya, Medical Director, Hospice Nepal

It is painful to see our loved ones die, but it is even more distressful to see them suffer. So, palliative care is an approach that improves the quality of life of terminally ill patients and their families facing the problem associated with the illness. Prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain are desirable but such things have not been happening in Nepal. So, we have started providing terminally ill patients with palliative care for the physical, psychosocial and spiritual relief.

Palliative care:
•    Provides relief from pain and other distressing symptoms;
•    Affirms life and regards dying as a normal process;
•    Intends neither to hasten nor postpone death;
•    Integrates the psychological and spiritual aspects of patient care;
•    Offers a support system to help patients live as actively as possible until death;
•    Offers a support system to help the family cope with the patients’ illness and their own bereavement;
•    Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
•    Will enhance quality of life, and may also positively influence the course of illness;
•    Is applicable early in the course of illness in conjunction with other therapies such as chemotherapy or radiation therapy that are intended to prolong life, and includes those investigations needed to better understand and manage distressing clinical complications. (WHO Definition of 2002)

Seventy percent of cancer patients in our country come at the late stage when no curative treatment can be given. Doctors confirm the status of the disease and tell the patient’s relatives that they should take the patient home, as nothing more can be done. The patient would usually be pale, thin, with distended abdomen, loss of appetite and severe pain, and that is why they are brought to the hospital.

Our whole approach has been to the preventive and curative aspect of cancer, which is good. Considering the practical situation in Nepal, we should also have advanced palliative care. Unfortunately, probably due to lack of return, and lack of knowledge or due to many other reasons it has never been in anybody’s interest to see such a thing is available.

Hospice Nepal has been established in Nepal in year 2000 with the goal to provide patients at the end of their lives, their family members and other significant people with state-of-the-art palliative care and supportive services 24 hours a day, seven days a week both at home and facility-based settings. Physical, social, spiritual and emotional care are provided by a clinically-directed interdisciplinary team consisting of patients and their families, professionals and volunteers:
1.    Throughout the duration of the disease;
2.    Mainly in the last stages of an illness;
3.    During the dying process; and
4.    At the bereavement period.

Hospice Nepal’s sacred mission has been to provide high quality compassionate care that addresses the physical, emotional and spiritual needs of patients and their loved ones and also to promote understanding of hospice service to community and medical personnel. To this end, it has an inpatient hospice service at the Hospice Nepal with nine beds for cancer patients with all the modern facilities and 24-hour palliative care service. In addition, it has also started Community Service means staffs will go to a patient and help him/her at his/her home.

To create awareness of palliative care, members of Hospice Nepal have been making efforts on presenting and lecturing about palliative care at conferences and clubs. Giving pain and palliative care classes at different hospitals has also brought awareness of palliative care to the medical fraternity. Now, there is more close cooperation among different hospitals on palliative care and we get more and more referred cases.

In cooperation with the Patan Hospital, Hospice Nepal also conducts a two-day Palliative Course for Medical Personnel regularly. It also holds a sensitizing program of about 4 hours for laypersons.

December 30, 2009