Nanaimo Bhaktapur Hospice Palliative Care Twinning Project – Site Visit, October 19th through November 11th, 2010

A palliative care team from Nanaimo, Canada, led by Dr. Robin Love who serves as a consultant to INCTR’s PAX program, made their 4th site visit to Bhaktapur Cancer Center (BCC), Nepal from mid October to mid November in 2010. This visit was made as part of the Partners in Compassion Project – also known as the Nanaimo Bhaktapur Hospice Palliative Care Twinning Project. The primary focus of the trip was to assist in teaching a palliative care course hosted by BCC’s Palliative Care Program.

flickr:5404126413Dr. Robin Love teaches at the bedside with Nepali Doctors, and Nepali and Canadian nurses - Photo Credits: Richard Tran Venetia Mah

The major purpose of the visit was to conduct a 2 week course in palliative care. This course was attended by 47 participants, including 7 physicians and many nurses from the Kathmandu region. The course was comprehensive including a variety of topics - challenges in palliative care, ethics, pain and symptom management, palliation in cancer and non-cancer diseases, psychosocial aspects of care, development of a palliative care service including home care, care of the caregiver, and the roles of surgery, chemotherapy and radiotherapy in palliative care. Practical workshops and bedside clinical teaching were an important part of the course.

Separate workshops related to patient handling, transferring and positioning for comfort were held – not only during the course given at BCC, but also at 4 other hospices and cancer care programs. This is for patient comfort but also for teaching the staff safe patient handling to reduce the risk of injury to nurses and family members. It was very well received, and the team made the workshop fun and entertaining as well as useful. It is a goal to develop an online module for teaching these skills.

flickr:5404117879 A comfortable patient in the palliative care unit at Bhaktapur Cancer Hospital - Photo Credits: Richard Tran Venetia Mah

Another new initiative is a research project that is a qualitative study that explores the impact of the Partners in Compassion project and consists of structured interviews with some of the partners including Nepali physicians, nurses, patients and families, and some partners here in Canada including physician, nurses, administrators and nursing students. The main objectives of the project are to explore how this partnership has shaped end-of-life care in the host community, to determine whether the goals and vision of this project are being achieved, to document the experiences and outcomes of the friendship built between Nanaimo and Bhaktapur, and to identify the potential needs and barriers that still exist to the dying and their families in accessing quality and compassionate comfort care at BCC. The information obtained will be utilized as a learning tool for improvement and refinement of current and future hospice twinning projects and to develop a tool to increase awareness in the medical and general community of the concept of twinning and its utility in meeting global needs, in particular the development of palliative care internationally. It will be used to encourage and raise interest in other hospices for future implementation of hospice twinning partnerships and palliative care initiatives. The information will be presented as a documentary film.

The visiting team spent time working alongside medical and nursing colleagues in the palliative care unit at BCC in order to continue mentoring and teaching at the bedside and to continue to provide support for their work. It is envisioned that ongoing dialogue and education can continue through a shared Facebook page.

Discussions about the development of a palliative home care nursing service that will be part of the BCC program have been held and will continue.
The team was encouraged by the progress made in the further development of the Palliative Care program at BCC. The Medical Director, Dr. Sudip Shrestha, remains very supportive and committed to improvement, and Dr. Chadani Vaidya has been designated as the palliative physician for the unit. Laxmi Shrestha is the Matron of the Hospital and Nursing Leader of the PCU. Her leadership and commitment remain key features of the program. The PCU staff remains very dedicated to their work and they are more comfortable with the use of morphine and other medications and techniques for symptom management. Their role in developing and hosting the two week course helped to increase their sense of identity and responsibility as a “center of excellence” for palliative care in the Kathmandu Valley.

The team looks forward to their next visit in 2011.

flickr:5404721564 Dr. Robin Love and some of the Doctors and Nurses from the palliative care program at BCC - Photo Credits: Richard Tran Venetia Mah

The team consisted of :
- Dr. Robin Love Palliative Physician and INCTR PAX Program Consultant
- Isabel Flood, Palliative Care RN
- Lisa Engel, Occupational Therapist
- Diena Abdurahman, Physiotherapist
- Jennifer Wade, Kinesiologist
- Sue Overton, Home Care Nurse
- Karen Evans, Home Care Nurse
- Dr. Venetia Mah, Family Medicine Resident
- Richard Tran, Photographer and Film maker

Dr. Robin Love

More pictures of this visit are available on INCTR on-line picture gallery

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