According to World Health Organization (WHO), Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. This care prevents and relieves suffering through the initial identification, correct assessment and treatment of pain including other physical and psychological problems. Palliative care is the prevention and relief of suffering of any kind – physical, psychological, social, or spiritual – experienced by adults and children living with life-limiting or incurable diseases. It promotes dignity, quality of life and adjustment to progressive illnesses, using best available evidence. Globally, it is estimated that palliative care is needed in 40-60% of all deaths. Palliative care is required for patients with a wide range of life-limiting health problems. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%) and diabetes (4.6%). Patients with many other conditions may require palliative care, including kidney failure, chronic liver disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies and drug-resistant tuberculosis. Each year an estimated 20 million people are in need of palliative care in the last year of their life, with many more requiring palliative care prior to the last year of their life. Of these people in need, up to 80% live in low- and middle-income countries. In palliative care, one of the most frequent and serious symptoms experienced by patients is pain. For treating the pain and other common distressing physical symptoms associated with many advanced progressive conditions opioid analgesics are very essential. For example, 80% of patients with AIDS or cancer, and 67% of patients with cardiovascular disease or chronic obstructive pulmonary disease will experience moderate-to-severe pain at the end of their lives.
The modern hospice and palliative care movement started in England in the 1960s with cancer patients at St. Christopher’s Hospice and Dame Cicely Saunders was the founder of the palliative care movement.
Palliative Care in Bangladesh:
The concept of active ‘Total Care’ for incurably ill patients and their families was first initiated in Bangabandhu Sheikh Mujib Medical University (BSMMU) as a small rudimentary service in October 2007. To take a pioneer role for the development of Palliative Medicine in Bangladesh, in 2011 the university authority decided to transform it into a Centre for Palliative Care (CPC). Since then the centre has been actively engaged not only in developing a replicable model service but also pursuing awareness creation amongst health professionals as well as community at large through education and training program, organizing seminar and workshops & taking a leading role in research activities. In 2015, Palliative Medicine recognized as medical specialty and University academic council approved the MD course in Palliative Medicine.
Now there are some public and private organizations who take initiatives to provide palliative care in Bangladesh like ‘Hospice Bangladesh’; Palliative Care Unit at ‘Dhaka Medical College and Hospital’, ‘National Institute of Cancer Research and Hospital’ and ‘Delta Medical College and Hospital’; Only one pediatric palliative care service provided by Ashic Foundation till now.
Bangladesh, world’s most densely populated country with a population of 160 million people, is estimated to have more than 0.6 million people in need of palliative care at any point of time. So for these huge population only institutional based palliative care concept not sufficient to provide palliative care for them. We must be including the community people and increase awareness among the community people about palliative care. There are some initiatives taken by some community people to develop community based palliative care in Bangladesh.
Palliative care is now an emerging issue throughout the world and WHO recognized palliative care as a public health need. With this intention, in 2014 the first ever global resolution on palliative care, WHA 67.19, called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on primary health care and community/home-based care. We believe that, a painless, less suffering at the end of life leading to a safe death in a helpful society should also be given due priority in the face of in-curability. Palliative care should be considered as a basic human right in Bangladesh.
Fazle Noor Biswas, a motivational speaker on Palliative Care and doing job as Clinical Pharmacist at Bangabandhu Sheikh Mujib Medical University (BSMMU). He is also a senior member and mentor at Palliative Care Society of Bangladesh (PCSB) and member at Palliative Care Pharmacist Network, Bangladesh (PCPNB). He is contributing articles on palliative care globally. He can be reached at firstname.lastname@example.org