Author: Karma Tshering.
In Bhutan, paediatric palliative care (PPC) is still an emerging concept. Although adult palliative care was introduced in 2018 at the adult oncology ward, structured support for children with life-limiting conditions has remained limited. As the number of children with chronic and life-limiting illnesses continues to rise, the need for PPC has become increasingly urgent, yet awareness remains low among both the public and healthcare professionals.
With the hope of changing this reality, I enrolled in the Paediatric Palliative Care Leadership Program 2025, supported by Two World Cancer Collaboration (TWCC). As part of this program, I initiated a project titled ‘Integrating Paediatric Palliative Care: Enhancing Knowledge among Health Workers and Raising Awareness among Family Members of Patients at the Paediatric Department, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH).’ The vision of this project is to conduct PPC awareness sessions for more than 50% of paediatric health workers at JDWNRH and to engage family members in awareness programs, ensuring compassionate, family-centred care for children with life-limiting conditions by December 2025.
This has been an amazing experience, and the project has been successful despite challenges and different barriers. Several of the key activities and achievements include:
Assessing Baseline Knowledge
An online survey was conducted among paediatric health workers to understand their awareness on PPC. The results revealed knowledge gaps among health professionals, particularly in recognizing when to initiate PPC, understanding the core principles of PPC, and the importance of involving
families in care planning. These highlight the need for education and support to strengthen PPC practice in the department.
Conducting PPC awareness session (CME)
A total of 36 health workers including 4 paediatric Doctors and 32 nurses participated in the PPC awareness CME sessions conducted in five flexible batches. These sessions improved their understanding of the concept of PPC, when to involve PPC services, and the importance of involving family in the care.
Family Engagement and Support
During the awareness phase, we also conducted face-to-face interviews with parents of chronically ill children, providing them with PPC information and emotional support. These conversations helped families feel seen, heard, and supported
Forming a PPC Core Team
To strengthen PPC at the unit level, three interested nurses from each unit (PICU, NICU, Pediatric ward) were selected to form the PPC Core Team. These members will serve as advocates and coordinators for PPC activities within the paediatric department.
Creating a Communication Platform
A WhatsApp group titled “PPC Core Team” was created to ensure quick coordination, case discussions, and planning among team members.
Supporting Families in Financial Hardship
The team organized a small monetary support initiative for five financially distressed families. Seeing the smiles on the faces of children and caregivers reinforced the importance of compassionate, holistic care.
Strengthening Pain Assessment for Hospitalized Children
Recognizing gaps in routine pain monitoring for chronically ill children, we placed pain assessment tools at each bedside in PICU, making it easier for nurses and doctors to perform consistent pain assessments and respond promptly.
The way forward
This project marks the beginning of a long-term journey toward strengthening pediatric palliative care in Bhutan. The PPC Core Team plans to conduct regular meetings and organize workshops to enhance the capacity of health professionals in the department. Sustained commitment from the PPC core team and support from JDWNRH management, the Department head, and the TWCC PPC Leadership Program will remain essential for continued progress.
In the coming months, we will also welcome a pediatric palliative care physician and look forward to collaborating closely with her to strengthen clinical guidance, mentorship, and service development. Additionally, we plan to collaborate with the adult PPC team to ensure better continuity of care, shared learning, and unified approaches across age groups. We also aim to work with community health workers, and other partners to improve awareness and strengthen referral pathways.
With these continued efforts, we hope to ease suffering, enhance the quality of care for children with life-limiting illnesses, and provide compassionate support to their families.
Congratulations Acho