Hospice, palliative care project to be launched in Islamabad.

By Shahina Maqbool
The News 12/19/2007 Islamabad

The Association of Physicians of Pakistani Descent of North America (APPNA) has announced the launching of a hospice and palliative care project in Pakistan, with Shifa International providing institutional support to the initiative.

Sharing details of the ‘APPNA Sukoon’ project at a press conference convened here on Tuesday, its director Dr Mahjabeen Islam said the project aims to introduce hospice philosophy and develop the practice of palliative care in Pakistan. The press conference was also addressed by consultant nephrologist and assistant dean of Shifa College of Medicine Dr Mujtaba Qadri.

A number of APPNA Sukoon hospices will be developed all over the country, starting with Shifa and moving on to Pakistan Institute of Medical Sciences, Pakistan Medical Association, Karachi, and Shaukat Khanum Memorial Hospital, Lahore. The project will be launched from the platform of Shifa today (Wednesday) with a seminar on hospice and palliative medicine.

The project will also involve building of linkages with the government for provision of long-acting oral morphine and other narcotics for terminally ill patients in Pakistan. “Four institutions pushing for oral morphine will be a historic chapter in the medical history of Pakistan,” Dr Mahjabeen said with a twinkle in her eyes. A terminally ill patient requires continuing doses of morphine to attain relief from pain. The media was told that morphine is already in use at both Shifa and SKMT.

The AAPNA Sukoon project will also advocate the introduction of hospice and palliative care in the medical college and nursing curriculum of Pakistan, thus filling the void of basic care in this domain. “The idea is to raise public, medical establishment and governmental awareness of the vital importance of quality care not merely in life, but specifically for a comfortable and pain-free death,” Dr Mahjabeen articulated. A template of APPNA Sukoon has been created for formation of further hospice programmes.

Going back to basics, Dr Mahjabeen defined hospice as a concept of care, not a specific place or building or structure where care is provided. Hospice care delivers palliative care to those at the end of life or with limited life expectancy. Hospice afires life and regards dying as a normal process. It neither hastens nor postpones death, but provides personalised services so that patients and families can attain the necessary preparation for a death that is satisfactory to them.

Palliative care, on the other hand, is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure. The goal is to prevent and relieve suffering and to improve the quality of life for people facing serious, complex illnesses.

Hospice services are characterised by a team approach involving a medical director, two physicians, nursing care manager, social volunteer, an imam and a recreational therapist. This team, which is entrusted with the task of optimising the comfort of patients, identifies patients, visits them, decides on the number of visits to be conducted, and provides cost-effective, home-based care, because as Dr Mahjabeen pointed out, “most people like to die at home.” The initiative also involves the gradual capacity-building of family members caring for the terminally ill at home.

Dr Mahjabeen said, hospice and palliative care is very cost-effective as compared to hospital-based care. Responding to a query, she agreed that nurses play a critical role in the success of this initiative because those involved in the process of dying have a variety of physical, spiritual, emotional and social needs that need to be addressed.

“Taking care of the dying requires a special attitude on part of the care-givers, particularly the nurse,” said Dr Mahjabeen, who is medical director of Odyssey Hospice and formerly medical director of St. Vincent Mercy Medical Centre Palliative Care Unit in Toledo Ohio. Many patients also suffer from acute emotional pain because they cannot come to terms with their illness. The visiting professional, who is a family physician in private practice, specialising also in addiction medicine, shared the story of how a 33-year-old girl getting radiation for cancer was relieved of her emotional pain through counselling, among other interventions.

Often, hospice care is understood in the context of cancer only. In reality, however, some of the key diseases treated with hospice care include congestive heart failure, chronic obstructive pulmonary disease, dementia, renal disease, stroke, comatose, HIV, debility, liver disease, and of course cancer too.

Earlier, Dr Mujtaba shared details of the long relationships between Shifa and APPNA. He said, with the launching of the project, Shifa will specifically focus on the home-based aspect of palliative and hospice care. He said many hospital admissions can be avoided if people learn the art of caring for the terminally ill at home or have access to home-based services.

Dr Mujtaba was confident that the current institutional collaboration between APPNA and Shifa will open the door for visiting faculty. A large number of physicians and nurses are expected to participate in today’s seminar, which will also be addressed by Dr Naheed Usmani, associate clinical professor, Department Paediatrics Division of Haematology/Oncology, University of Massachusetts Medical School/UMass Memorial Children Medical Centre.

The seminar will discuss issues such as scope of local palliative care services; narcotics availability in Pakistan in the perspective of palliative care; pain management in cancer patients; nursing issues in palliative care and principles of palliative care and hospice. Dr Mahjabeen will present the APPNA Sukoon template on the occasion.