Increasing Awareness about Children’s Palliative Care in Bhutan: Reaching Beyond Thimphu

Categories: Education.

Bhutan is a tiny landlocked Himalayan Kingdom situated between China and India, with a population of less than 800,000. Palliative care is in its early stage of development in Bhutan, with one palliative homecare service at the National Referral Hospital which caters to adult patients within the capital city of Thimphu. There are no children’s palliative care services in the country as yet, that are needed to support the needs of children with serious illnesses who need holistic support to relieve their symptoms and improve their quality of life.

Palliative care for children involves active and holistic care of the child’s body, mind, and spirit. It includes supporting the family throughout the illness trajectory and beyond as grief and bereavement support. Children with cancer as well as those with non-cancer diagnoses such as congenital heart disease, neurological conditions, organ failure, premature births, congenital anomalies, and severe birth asphyxia are in need of palliative care. Every year more than 700 Bhutanese children are affected by these conditions, and having access to palliative care along with curative treatment is an essential component of their care.

Dr Tara Devi Laabar, a senior nurse from Bhutan, after completing her PhD in palliative care from Australia is set on a mission to increase the knowledge and skills on children’s palliative care among Bhutanese healthcare professionals. Following the first virtual training sessions conducted with the support of Two Worlds Cancer Collaboration ( , she is now using in-person lectures, case discussions and bedside teaching to interact with doctors, nurses and other healthcare professionals involved in the care of the children.

Recently, at the Eastern Regional Referral Hospital (ERRH) in Mongar, nine staff from the paediatric department attended an hour- long interactive session on palliative care for children, led by Dr. Tara Laabar. A second similar session was also conducted at the Central Regional Referral Hospital (CRRH) in Gelephu, with more than 30 healthcare professionals from the interdisciplinary team including administrative staff attending the education session.

During these sessions, clinicians were introduced to the concept of children’s palliative care, including how to identify children for palliative care; when, where and who provides children’s palliative care; pain management and symptom management; communication skills; end-of-life care; and grief support. The sessions included case discussions with the participants reflecting on how palliative care can be combined with potentially curative treatment to ensure the best possible quality of life and symptom control. At CRRH, Dr Tara demonstrated to the staff how to conduct family meetings, through clinical teaching on the ward.

Many participants in these recent trainings had previously attended the virtual ECHO course in 2023. Staff noted that following these virtual training sessions they have been able to identify the needs for palliative care and improve their management of pain in children with serious health-related suffering and now these in-person trainings provided an opportunity to reinforce the learning.

Dr Tara noted that “these trainings are important steps towards ensuring access to palliative care for all children with serious illness in Bhutan”.

Dr Spandana Rayala, who is the associate director of Sunflower Children’s Network (Two Worlds Cancer Collaboration) and a children’s palliative care specialist at Bayt Abdullah Children’s Hospice in Kuwait will visit Bhutan in July 2024 to provide further teaching on palliative care and support advocacy and awareness efforts.

An educational session on children’s palliative care at CRRH, Gelephu.

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