The need of hospice and palliative care in Bangladesh
Shahinur Kabir

Today is World Hospice and Palliative Care Day

  • Bangladesh needs better palliative care facilities  
    Photo- BIGSTOCK

Every year, on the second Saturday of the month of October, World Hospice and Palliative Care Day is observed. The theme for World Hospice and Palliative Care Day this year is “Hidden Lives/Hidden Patients.” There are “hidden patients” with “hidden lives” for whom the need for palliative care is not recognised.

This year’s theme will focus on those patients living in unique conditions who often struggle getting access to palliative care, including children, those with HIV, and those living in more rural settings.

The World Palliative Care Alliance and International Children’s Palliative Care Network jointly published a key message: 42% of the world had no delivery system for palliative care services, and in 32% of the world, service delivery reached only a small percentage of the population.

Around 80% of the world’s population lack adequate access to the medication needed for palliative care.

According to the Bangladesh Cancer Society, the economic burden of new adult cancer patients is Tk2.5 lakh per year, and the total cancer burden is Tk10 lakh per year -- this is an institutional-based statistic.

The actual picture is probably far from it, because, due to many barriers, the majority of the patients could not reach a final diagnosis or avail treatment facilities.

According to oncologists and referral hospitals, approximately 75% of cancer patients attending for treatment are incurable, and they get treatment in palliative settings. 30%-40% of these patients are in the last days of their lives, with a lot of them suffering, and their admissions refused by hospital as most of them are overloaded with patients of acute illness. 

According to the Society of Neurologists of Bangladesh, the incidence of stroke patients is 5-12 per 1,000 per year, and among them 35% become permanently disabled or dependent on care-givers. There is no hospital to support them on a regular basis.

Recently, the 2015 Quality of Death Index was released by the Economist Intelligence Unit (EIU). Bangladesh’s position is 79 out of 80. For a population of 160 million, there are just a handful of foreign–trained specialists in Dhaka. Our health infrastructure lags behind when it comes to basic needs.

Palliative care is a developing branch of health care that deals with the terminally-ill, the incurably-ill, and the chronically bed-ridden. A large percentage of patients who need palliative care are cancer patients in extreme pain; some of them are in the terminal stage.

Millions of others suffering from paraplegia, acute renal and respiratory problems, and many other incurable illnesses also benefit from palliative care.

Only 5-6 organisations are provided palliative care in Bangladesh. ASHIC Palliative Care Unit is the first such unit in Bangladesh for children.

A total of 30-40 in-patient beds are available for palliative patients, which are government and private resources combined, such as BSMMU, Ahmed Medical Centre, Delta Medical Centre, Bangladesh Medical College Hospital, etc.

Only 4-5 doctors are fully devoted, trained from abroad, and give full-time service. Some oncologists and anaesthetists also offer palliative care services on the side. Recently, we here at Hospice Bangladesh have started offering home care services. We have already served 60 patients, and 45 of them are cancer patients. But we are suffering from lack of manpower and other resources. It is the only centre in Bangladesh which provides 24-hour support for end-of-life care at homes for patients.

The evolution and growth of palliative care services and hospices should come from the combined effort of both the public and private sectors. Without community involvement, establishment of this sector will not be possible. The fact that should not be overlooked is that if specialists and facilities dealing in palliative care become more prevalent in the future, a big proportion of the total number of patients with incurable, progressive diseases will benefit from this care. 

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Shahinur Kabir

Shahinur Kabir is Palliative Care Specialist, Hospice Bangladesh.