ehospice has previously reported on the activities of the Lien Collaborative, a groundbreaking training initiative, run by interdisciplinary volunteer faculty from the Asia Pacific region, which aims to strengthen palliative care provision in several Asian countries with little or no palliative care development, through identification of and capacity building among local palliative care leaders.
The Lien Collaborative started their training activities in Bangladesh and Myanmar last year. In Sri Lanka, the third country to join this round of teaching, the group of 50 students includes 39 doctors and 11 non-doctors (nine nurses, one social worker and one clinical psychologist), many of whom are leaders in the Sri Lankan Ministry of Health and the country’s public hospitals.
For Associate Professor Cynthia Goh, Worldwide Palliative Care Alliance co-chair, chair of the Asia Pacific Hospice Network and Lien Collaborative Faculty Leader, this indicates a growing interest in palliative care in the country. She says: “It really seems as if the time for palliative care has come for this country; everyone seems to want to find out more about it.”
The Lien Collaborative in Sri Lanka aims to help the country develop a mainstream health strategy incorporating palliative care. It will scale up palliative care training and support the expansion of palliative care services to nine major cancer centres across Sri Lanka.
18 oncologists from the National Cancer Institute and its regional branches form part of the group to take part in the training. In a country with only 31 cancer specialists, this means that following the training the majority of Sri Lankan oncologists will be equipped with palliative care skills and knowledge.
Participants bring different levels of experience to the course. Some have spent years in Australia doing palliative care at registrar level, and so have a thorough knowledge of the discipline, while others have not come into contact with it at all. Prof Goh commented on this, saying: “There’s a great range (of experience) and this is what made it really challenging when we were planning the training.”
The group also includes non-clinicians, working as educators in Universities and colleges, who may have had very little contact with the concept of palliative care. For Prof Goh, it is essential that these people take part. She says: “I feel it’s very important, because these are the people who are going to bring palliative care into the medical, nursing, and social work curricula and who will train the future undergraduate and postgraduate workers, and while we had originally meant to train clinicians how to set up palliative care services and work in them, I feel that we can’t exclude these people simply because they’re not clinicians.”
Asked about the impact this training will have, Prof Goh sounds encouraged, firstly by the high placement of the participants within national institutions, and secondly by the initiatives already in place that will provide an ideal setting for the implementation of the skills learned in the course.
“What is particularly exciting is that the National Cancer Control Programme is trying to coordinate the care and actually plan the service,” she says. “They’re talking about setting up services in some of the regional centres of the National Cancer Institute in some of the other major cities as well. The other exciting thing is that they are also training community palliative care services and looking at ways to link the cancer centres to the community, so if you follow a patient’s journey from home to referral in a provincial hospital and to a national tertiary referral hospital, getting their treatment there and then going home again, they’re looking into services that can link up the patient in all these three places.”
Environmental concerns, coupled with an over stretched healthcare system have increased the need for palliative care in Sri Lanka. Groundwater contamination has meant that a generation of young farmers are dying from renal failure as their bodies try to process these poisons. For Prof Goh, this adds a sense of urgency to the training efforts: “In central Sri Lanka they have a big problem, because the groundwater is contaminated, so they have a lot of people in the young working population with renal failure. Dialysis facilities are nowhere near available to the majority so all of these people need palliative care and renal palliative care is something we have to help set up pretty quickly,” she said.
Support from the Lien Collaborative is set to run for three years, with international faculty visiting six times within that period. Prof Goh clarifies this methodology, saying: “We teach the participants for the first week, then we encourage them to go and make use of that knowledge in their everyday practice so that they learn how to do palliative care. Because palliative care cannot be done as a theoretical course. You learn it by doing it, by taking care of patients and learning from the patients themselves exactly how to provide the care. So what we hope is that these clinicians will go back and use these skills, and then we’ll come back in six months and by that time, they should know a little bit more and then we build on the knowledge they’ve gained and mentor them to help build up their skills and capabilities.
“We’re really right at the beginning of the whole process,” she says. “How quickly the participants progress will depend on the opportunities available, so one of the first things we’re encouraging is that they set up palliative care teams in their hospitals. We’re working with government hospitals and we’ve identified three sites which look the most promising in terms of manpower and people coming onto the course and so on. And we hope that by the time we come back next time, they will have some form of palliative care services up and running in two or three of their hospitals, because these will then be their future training centres.”
A secondary benefit of this training is that these sessions allow capacity building not just among local clinicians and educators, but within the Lien Collaborative faculty themselves. Prof Goh says: “Whatever experience we gather working in these countries, we can always bring back into our own work and this makes us better teachers as well in our own home countries.” So this training not only improves palliative and end of life care in the targeted countries, but has further-reaching benefits for the quality of palliative care education in the region as a whole.
Learn more about the work of the Lien Collaborative in Sri Lanka online.
Visit the Lien Collaborative website to read about the background of the initiative.