INCTR Palliative Care Programme

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INCTR Palliative Care Programme

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The Problem

• 56 million people die every year
• 40 million of these in developing countries
• About 30 million need palliative care
• Only small number receive it

Sternsvald Clark, 1999
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Overall Strategy of PCP (PAX)

• To establish regional palliative care centers
  that both provide care (institutional and home)
  while
• Training and educating palliative care
  specialists and non-specialists health workers
• Engaging with the local government with respect
  to opioid availability and the development of a
  plan to make palliative care widely available in
  the region
• Promoting the development of local NGOs for
  palliative care
• Undertake relevant research in palliative care,
  e.g, optimal assessment of outcomes, obstacles to
  opioid use
• Work closely with other INCTR elements and INCTR
  partners in expanding the program via additional
  educational tools (clinical care guidelines,
  telemedicine)

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INCTR is Ideally Placed to Promote the
Development of Palliative Care in Nepal

• NNCTR/INCTR sponsored cervical screening program
  at Scheer Memorial Hospital, Banepa

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Nepal Network for Cancer Treatment Research
(NNCTR)
Headquarters, Banepa
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India 0.0769 (2001)
Tanzania 0.0259
U.S. 45.0822
Egypt 0.0651
Nepal 0.0010
Saudi Arabia 0.5323
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Since 2002
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Scheer Memorial Hospital

• 150-bed general hospital
• New palliative care unit 2004
• 10 to 15 beds

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Bhaktapur Cancer Care Centre

• 5 beds for palliative care
• Outpatient pain clinic

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Hospice Nepal
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Kanti Childrens Hospital

• 4-bed unit opened in 2004

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INCTRs Role
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Education Training
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Facilitating Discussions on National Medication
Policy and Availability

• WHO Foundation Measures for Implementing Cancer
  Pain Relief Programmes

Drug availability
Education
Government policy
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Professional Resources
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(No Transcript)
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• Funding for Vehicle for Home Care

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Future Plans/GoalsNepal
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Improve Quality of Care in Present Facilities
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10 Palliative Care Beds in New 75-Bed Unit at
Bhaktapur Cancer Care Centre
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Paediatric Palliative Care

• 5 palliative care beds for children at Scheer
  Memorial Hospital, Banepa

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Home Hospice Programme

• Expand Home Hospice Programme administered
  through Hospice Nepal, Patan

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Implement Web-Based Teaching and Support
Telemedicine system at NCI Liaison Office,
Brussels
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Outreach to Rural Areas

• Specialist visits
• Education of healthcare professionals
• Public health education, including cancer
  awareness

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• Improve Opioid Availability

India 0.0769 (2001)
Tanzania 0.0259
U.S. 45.0822
Egypt 0.0651
Nepal 0.0010
Saudi Arabia 0.5323
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Expansion of Programme to Other Regions of Nepal
B.P. Koirala Memorial Cancer Hospital, Bharatpur
Hospice, Bharatpur
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INCTR/ACS/Pallium Programme

• Initiated with funding from ACS
• Goal to establish palliative care centers in
  India which can both deliver care (institutional
  and home), and provide a center of excellence
  for
• Training of palliative care specialists
• Liaison with local government re issues such as
  opioid use and training of non-specialist doctors
  and nurses
• Development of civil society relevant to
  palliative care
• Outreach into other institutions and rural regions

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Project Initiation

• Appointment of Program Director (Dr. Gayatri
  Palat) in July 2006 at MNJ Institute of Oncology
  and Regional Cancer Center, Hyderabad, Andhra
  Pradesh
• Assessment of palliative care needs

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Andhra Pradesh

• Population 75,727,000 (census 2001) with 23
  districts.
• An estimated 200,000 people suffering from
  cancer.
• An estimated 2,350 people suffering from AIDS
• No formal palliative care in the state an
  estimated 1 have access via MNH IO

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MNJ Institute of Oncology

• Founded in 1955 in Hyderabad with donations from
  philanthropists, notably Mehdi Nawaz Jung
  Bahadur, after whom the 250 bed hospital is named
• Designated as a regional cancer center by the
  Government of India in 1996
• Presently attached to the NT Rama Rao University
  of the Health Sciences, AP
• Has telemedicine facility and digital library

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Existing Facility

• Department of Pain and Palliative Care exists at
  MNJ IO but no dedicated beds
• 120 patients seen in month of July with 15
  admissions for palliation
• Dr Durga Prasad nominally in charge 6 weeks
  training from Dr. Rajgopal, 1 month at MD
  Anderson, Train the trainer course run by Pallium
• Has other duties (radiotherapy), and runs
  department in his spare time
• Director of Institute very supportive of
  developing the program along the lines proposed
  by INCTR

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Dr Gayatri Palat

• Was Associate Professor, Department of Pain and
  Palliative Medicine at the Amrita institute of
  Medical sciences, Kochi, Kerala
• Initial trainee in anaesthesiology from 1996-1999
  (Medical College, Calicut, Kerala)
• Worked in Pain and Palliative Care Society with
  Dr Rajgopal in the WHO Demonstration Project MC,
  Calicut from 2000 2004, rising from registrar
  to Associate Professor (with Dr Rajgopal)
• From 2004-2006, Associate Professor in Pain and
  Palliative Medicine at Amrita Institute of
  Medical Sciences, Kochi (with Dr Rajgopal)

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Progress - July

• Productive meetings with met with Director of
  MNJ IO, Dr Prasad, local NGOs
• Director agreed to
• I month rotations for radiotherapy trainees
  through PPC dept
• Initiation of training program for palliative
  care nurses
• Meeting with Dean of Medical Education for the
  state to discuss state-wide palliative care
  training for undergraduates in all medical
  faculties
• Appointment of Dr Palat as Associate Professor
• Appointment of secretary to department
• Expansion of present palliative care facilities
• Initiation of assessment of opioid availability
  in P

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Initiation of Care
Pediatric consultation for child
Smiling patient after oral morphine
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More Tangible Progress

• Appointment of two nurses to department
• Society Pain and Palliative Care Society being
  formed to work closely with the department at NMJ
  OI
• Initiation of radiotherapy rotation and upgrade
  to 6 weeks certification course
• Initiation of palliative care Journal Club
• Development of research project, Symptom
  Prevalence in Patients with Head and Neck
  Malignancy, a Prospective Survey
• Meetings with Dean and Government officials

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Initiation of Home Care

• First patient elderly patient with Ca rectum

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School Visit

• Visit to class X students at Diamond Jubilee
  Public School to discuss palliative care

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Public Relations

• Interview with The Hindi a major national
  newspaper
• Presentation at World End-of-Life Care
  Conference, 26th to 30th of September, 2006, at
  Montreal.

Palliative clinic for terminally ill to be set
up. The Institute, which has been offering
palliative care for terminal cases for the last
three years, has recently received support from
the International Network for Cancer Treatment
and Research (INCTR). Along with the American
Cancer Society, the Network has also provided
grants and a consultant for the Institute.
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Tanzania

• Second meeting at ORCI to discuss an INCTR
  palliative care program August 2006 as component
  of PACT program