In this post, Dr Megan Doherty and Mr Scott Gunn write about the important work being done to provide palliative care in the Rohingya Refugee camps in Bangladesh.
The influx of over 900 000 Rohingya refugees from Myanmar into neighbouring Bangladesh poses many challenges to delivering humanitarian aid, and providing healthcare is one of the biggest hurdles currently faced. The majority of the healthcare sector’s response is focused on acute injuries and illnesses, and with very little focus on chronic or serious illnesses. In November 2017, a team from World Child Cancer and Fasiuddin Khan Research Foundation (FKRF, a local NGO) conducted a rapid situational analysis to assess the needs of these individuals, with a focus on their palliative care needs. We found that 58% of people with chronic illnesses were not able to access essential care required to manage their medical problems. We also found that 73% of people with chronic or life-threatening illnesses were not receiving the treatment necessary to alleviate their pain. Indeed, patients who could benefit from palliative care had been largely excluded from the health humanitarian response.
After these findings, under the leadership of Dr. Farzana Khan (President of FRKF), FRKF has implemented a pilot project community based solution for palliative care. The solution involves using trained community health workers to provide basic palliative care support, combined with a palliative care physician to develop treatment plans and provide medical oversight. Thus far, our team has supported more than 1000 patients with a variety of serious illnesses, including cancer, paralysis, cerebral palsy, tuberculosis, HIV, and other chronic diseases. Our team has developed a secure system to ensure that morphine and other essential symptom control medications are available for patients in their homes.
These community health workers – called palliative care assistants (PCAs) –deliver palliative care to patients with chronic or life-threatening illnesses in their homes. The PCAs schedule regular visits to patients’ homes and are available by phone should a patient require more urgent help. The PCAs support patients by delivering medications, providing basic nursing care, and monitoring symptoms. PCAs are supported by a palliative care physician who develops management plans for the patients and trains the PCAs to implement these plans.
Patients join the palliative care program through two main channels; the first is through health centre referrals. Our team conducted meetings with health centres and hospitals in the refugee camps to introduced this new palliative care service to these facilities and provide them with information about how to refer patients. Health facilities were very pleased to learn about our service, acknowledging the significant gap in the provision of care required for these types of patients. The second referral channel is through case finding by the PCAs. Since the PCAs are members of refugee community, they are often aware of those who are sick and who may need palliative care, or members of the community will approach the PCAs when someone becomes sick and may need palliative care.
Using a community based approach to deliver palliative care may reduce pressure from the main health centres by supporting patients requiring palliative care to remain at home. Frequently, patients requiring palliative care make visit health centres where they end up being turned away due to lack of resources and knowledge about how to treat their condition. Community health workers such as PCAs are valuable tools in the Rohingya humanitarian crisis that allow the healthcare system to better serve the needs of patients. After the success of this pilot project, a proposal for a comprehensive palliative care service from FKRF has been accepted by the World Health Organization as part of the Joint Response Plan for the Rohingya Refugee Crisis, recognizing the vital importance of this program. This means that FKRF requires increased financial support to implement a palliative care program which will provide palliative care coverage all of the Rohingya refugees and local host communities in the Cox’s Bazar district.