Palliative care was non-existent in the health and social services of Bangladesh, until a decade ago when a few isolated initiatives started taking place. These were all in the capital city, Dhaka, and mostly took an institution-based approach following western models.
Besides developing a small service facility with much resource constrains, all the palliative care initiatives here, independently and collaboratively, are also engaging themselves relentlessly to buildup awareness among the health care professionals as well as amongst the general population.
They have also been trying to convince the policy makers to incorporate palliative care into national healthcare programmes, although this is yet to take place.
The Centre for Palliative Care
The most remarkable breakthrough amongst these initiatives took place when the only medical university of the country, Bangabandhu Sheikh Mujib Medical University (BSMMU), recognised palliative care as one of its services in 2007, and started the Centre for Palliative Care (CPC), taking a nationwide pioneer role in 2011. Palliative Medicine was recognised as a specialty in 2016.
Most of the efforts of CPC remained confined within and amongst the institutions and amongst professionals, with some volunteer training programmes and engagement as the only example of people’s involvement.
Nevertheless, since its inception, staff at CPC have been waiting eagerly to take up a programme of public health approach of palliative care involving and empowering the community at large.
So, when the first opportunity came in April 2015 with the support of the Worldwide Hospice Palliative Care Alliance (WHPCA) to initiate a palliative care project for elderly people in the largest slum of Dhaka, the Centre readily accepted the challenge.
From the very beginning, the programme emphasised the involvement of the slum community people and worked through gradual engagement of the community based organisation (CBO), an elected body of 32 representatives of the slum dwellers.
The Children’s Fair
So, when the chief of the CBO approached the university Center for Palliative Care to participate in a Children’s Fair within the slum, the centre did not waste time wondering the relevance, but readily accepted it.
The fair was held at the Ershad School playground of Korail slum and organized by BRAC, a local non-governmental organisation (NGO). The theme of the fair was ‘Children’s Rights’. Different events such as songs and music, cultural dance, drama, rhymes, cultural fashion show, comics and courageous speech were organised.
NGOs working in different fields including education, health, and income generation of Korail, participated in the programme and opened up stalls to showcase their activities. Members of the Community Based Organization (CBO) took the leadership to help all these organisations.
The Momotamoy Korail team provided information about palliative care in general, peadriatic palliative care, and the Compassionate Korail project activities.
Korail is the largest slum in Bangladesh. The people living there are mostly migrants from rural Bangladesh, and form a significant section of Dhaka’s work-force in the garment, transportation, construction, land development, domestic help, waste management and informal sectors.
As it was a children-oriented programme, so along with the elderly people, children of different age groups were the main participants. Professionals from other NGOs were interested to know about palliative care and the activities of Momotamoy Korail.
Discussing palliative care with the children
Every time we meet the public to discuss palliative care in any awareness programme, we return with many different experiences, and the children’s fair was no exception.
The children initially showed more interest to collect colourful leaflets and posters, but then began asking why we were there. Then often they hurriedly went to another different stall and collected some more leaflets. I asked one, who visited several times: “In which class do you read?”
“OK, then multiply 9 and 8”
“It’s so easy,” with a smiley face, “its 72!”
“Then tell me what’s your name?”
By the time a few introductory remarks were exchanged, a few more gathered around our conversation, after few minutes suddenly someone asked me: “What is palliative care?”
Ah….. At last they began showing interest to know about palliative care.
I gave the answers as simply as I could. To make it understandable, I gave the example of an incurably ill cancer patient in the slum, and showed them a picture.
A few of them already knew the patient. Here they took another point, and showed an interest to know about cancer.
They asked a lot of questions like: “Does smoking cause cancer!?” Even: “How one can remain free of cancer?” Many of these questions were possibly not linked to palliative care, but we were so happy because someone asked us why we were there!
The children also asked which types of patients we take care of. One of them told about his grandfather, who has been paralysed for few years and asked us whether we can do something for him.
Another one said he had seen us with a doctor visiting his uncle’s house. When we started, the people of Korail didn’t know where we came from, or why we came to Korail slum. But today the story is changing, while the Palliative Care Assistants and volunteers walk through the slum, many of them know that they are from and for ‘palliative care’ and do something for the incurably ill dying patients.
We all are waiting for the day to come when the slum people will come forward and say that they want to run a palliative care centre by themselves, like they run a number of community schools, mosques and take initiatives for community facilities like safe water supply and electricity.