‘Focusing on patients, not medicine’

At the 67th World Health Assembly in 2014, member states of World Health Organization (WHO) agreed to strengthen palliative care as a component of comprehensive care throughout the life course. However, this patient-focused approach is still under-addressed.

Each year, an estimated 40 million people are in need of such care globally, but only about 14 percent of them currently have access to it.

Recently, Dr Bimalangshu Dey, a world-renowned bone marrow transplant specialist, who is an associate professor of medicine at Harvard Medical School, USA, talked to The Daily Star in this regard.

Born in Chatak upazila of Sunamganj in Bangladesh, Dr Bimalangshu was among the pioneers in setting up the only bone marrow transplant unit in Dhaka Medical College Hospital.

TDS: Palliative care is a comparatively new branch of healthcare. It is also not so much familiar in Bangladesh. Please, tell us about it.

Dr Dey: There are many diseases that are incurable. In fact, there are millions of people around the world who will ultimately become seriously ill. Palliative care is for terminally ill patients. This concept started with cancer treatment. However, it can be applicable to patients with advanced cardiac, lung and kidney failures; advanced stroke patients and patients with advanced stage sicklemia and thalassemia -- all non-communicable diseases.

TDS: How useful is it for patients?

Dr Dey: Many patients, yes, [perhaps] they will die in three, six or twelve months. The purpose of palliative care is to relieve their pain or sufferings. This pain could be physical, mental, cultural, psychological or emotional. The function of palliative care is to make the patients [and family members] understand that death and dying are universal; we have no choice but to accept them as a phase of life rather than the end. If we could accept it, we will be able to use our imagination, love and compassion. This would eventually ease the dying process.

It is all about helping an ailing person die with dignity and peace.

Death doesn’t have to be defeated. Rather it should be given a human touch through adding soul to the dying person.

Palliative care focuses on patient, not on medicine… and family. It not only heals but also increases life span.

TDS: Originated in 1984 in the United Kingdom as a life care discipline, especially focusing on cancer patients, this kind of treatment is yet to be expanded. What is the global situation currently?

Dr Dey: The situation is improving now as many are getting involved with this specialised medical care to improve quality of life for both the patient and family. For example, in Massachusetts General Hospital, where I work, we have a strong palliative care team. As a result, many of us have to attend a special course once in every six months to remain focused and updated.

TDS: There are only two palliative care units in Bangladesh -- one in DMCH and another in Bangabandhu Sheikh Mujib Medical University (BSMMU). Besides, there are several private care centres. What is your opinion on palliative care services in Bangladesh?

Dr Dey: Many things are being done in Bangladesh in this regard. There’s Ayat Education; Prof Dr Nezamuzzaman at BSMMU and Dr Rumana Dowla,  renowned palliative care physicians in the country, who are working tirelessly… I think the tide is turning.

But much more needs to be done to improve the situation. The palliative care unit in DMCH is not up to the mark yet, but it will be. BSMMU is doing a good job under Dr Nezamuzzaman. All of the units and centres have to be brought under a single umbrella. There is also a need for brainstorming.

TDS: Palliative care is yet to be adopted in medical and nursing curricula in Bangladesh. How important is it?

Dr Dey: Palliative care is a holistic approach -- patients, their families, nurses, community healthcare providers, doctors -- everyone will have to join hands in this regard. But it is also a part of medical science like cardiology or haematology; a certain level of schooling is needed for that.

So, it must be adopted in medical and nursing curricula. There should be four to six weeks courses for fifth-year medical students. Besides, doctors, nurses and healthcare providers have to be properly trained. We have prepared an action plan and submitted it to the prime minister.

Palliative care unit has to be set up in all medical college hospitals, proposed divisional cancer institutes and in community healthcare centres across the country.

TDS: Medicines like morphine is an essential drug to reduce pain of patients who need palliative care. However, physicians often say the permissible amount is not sufficient in Bangladesh. What is your assessment?

Dr Dey: There is a crisis in Bangladesh. In the west, the aim is that no one should die in pain. A dying patient who needs morphine is allowed to take 55,000 milligrammes in the US and 65,000 milligrammes in Australia. But it is only 55 milligrammes in Bangladesh as of 2015. Can you imagine the excruciating pain a patient has to go through? There’s an inequality here.

If the government steps forward, like it did by setting up a bone marrow transplant unit in DMCH, nothing is impossible.