Creating a sustainable, participatory palliative care program in an urban slum in Dhaka, Bangladesh,
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1 Nezamuddin Ahmad Project lead ( Momotamoyee Korail ) Centre for Palliative Care Dhaka, Bangladesh Claire Morris Global Advocacy Director Worldwide Hospice & Palliative Care Alliances ( WHPCA), London, UK Shahaduz Zaman Research Fellow End of Life Care Studies Glasgow University, UK Creating a sustainable, participatory palliative care program in an urban slum in Dhaka, Bangladesh,
2 Bangladesh : lots of paradoxes All features of a developing of a developing nation. Prevention & Cure oriented mind set at both ends Primary health care has not yet been ensured for all its 170 million people
3 Bangladesh: PC Paradox < 8 Palliative care programs for an estimated 600,000 needy ( 3a) served fewer than 1,500 patients in % of cancer patients experienced pain Department established in only medical university Specialty status ( 5 years residency program) 90% of health professionals did not have any training in pain management or palliative care..khan et al.2014
4 Slum/Basti/ ghetto/shanty town More than 9000 slums accommodating > 2.25million people. Number of slum dwellers increased by percent in 17 years Only in Capital city > 300 slums
5 Korail :Largest slum in Dhaka
6 Momotamoyee Korail : 2015 A joint collaborative project of CPC, BSMMU & WHPCA, UK Funded by WHPCA additional contributions from 1. Palliative Care Society Bangladesh 2.Rotary Club of Metropolitan Dhaka of Run by the Centre for Palliative Care (CPC ), Bangabandhu Sheikh Mujib Medical University
7 Specific goals agreed upon : a rapid situation analysis in terms of need analysis of older people & their families Undertake sensitization programs to create awareness Developing an activist group & volunteers locally
8 Specific Goals. To train 8 eight PCAs using the Palliative Care Toolkit Establish a home care out reach program comprising nursing staff & PCAs under supervision of CPC. To provide treatment & Support to 100 palliative care patients & their care givers
9 Goals To identify & forge partnership with local organisation to take the forward with a COMMUNITY DRIVEN PUBLIC HEALTH APPROACH An independent evaluation after one year of piloting.
10 Sensitization programs
11 Sensitization programs
12 Sensitization programs
13 The PCAs recruits underwent a structured curriculum: six weeks of classroom teaching, followed by six weeks in the hospital ward and then 12 weeks supervised home care field work. provide home-based palliative care, including physical, social, psychological and spiritual care, Emergency health services were provided by nurses and doctors.
14 TRAINING OF PCAS
15 8 PCAs after six months training
16 Out reach Home Care Program
17 Home Care program Both of us are old now and there is no one to look after us. We take care of each other, but when both of us get sick, then there is no one left to take care of us in this shanty. Girls [PCAs] from the office visit our home regularly and look after us. They spend a good time with us, talk to us freely
18 Defining Palliative Care!
19
20 Medical Treatment
21 To provide medical management
22 Support & Care provided by the project Category Services & support provided Frequency Health support Care support Regular follow up,medicine supply,emergency Health service,routine check up Wound care,helping in bathing,nail cliping,home cleaning etc. Counselling to shock /bereaved family members Social support Rice 5Kg, Peas 2kg,Sugar 1 Kg, Salt 1 Kg, Edible oil 1 Kg Regular basis Based on nescessity monthly Festival support New cloths, Blankets, special food During festival time Additional support Exercise instruments, Cataract operation Based on nesceecity
23 Beneficiary profiles Total number of patients = 106 Majority Female =70 ( 62.3%), 33 male & Third gender 1 Average age = 65.5 years ( 20 to 111 yrs) Average family members 5 ( indirect beneficiaries) 80% were illiterate Average monthly income < US $ 180 / months
24 Challenges : Enormous!!! Its own dynamics own culture & rituals Mobile population Informal power structures
25
26
27
28 Any magic wand!! Gaining trust & understanding the language. Believing that COMPASSION is innate to human being. NOBODY s monopoly & can be ignited
29 Informal power structure
30 CBO & CDO Korail slum
31 WORLD HOSPICE & PALLIATIVE CARE Day celebration
32
33 SDG : UHC It would appear that slum dwellers and refugees are today s Huldufólk, the hidden people Why is that? Is it because they are the dirty ones? She just grabbed my hand and remained silent. even in the invisible community of Korail, there are hidden people whom nobody notices. Dr. Sahaduzzaman
34 THANK YOU
Zaman, S., Ahmed, N., Ur Rashid, M. and Jahan, F. (2017) Palliative care for slum population: a case from Bangladesh. European Journal of Palliative Care, 24(4), pp. 156-160. This document is held under
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