This course is a five year residency or post-graduate training program in Palliative Medicine. The curriculum has been developed to train physicians to become specialists in Palliative Medicine, to become leaders and role models in this newly emerging field in Bangladesh.
The course is divided into two phases: Phase A is a two year core program of training in General Internal Medicine. The aim is to focus on developing core knowledge and skills, providing a foundation for consolidation and further study.
In phase B, the education program will focus more directly on Palliative Medicine. In this phase, allied subspecialties related to palliative medicine (oncology, intensive care, pain medicine, etc.), research methodology and basics of medical education will also are covered. Additionally, all residents will prepare a clinical research project.
We are fortunate to have excellent faculty supporting this training program; drawing upon the strengths of the local faculty, and enhancing their efforts with regional and international faculty to ensure that this program can deliver a high quality education and training.
A turning point for palliative care in Bangladesh
Specialty recognition can be seen as a turning point in the evolution of the palliative care movement of a country. A residency program will allow us to develop a core group of specialists with expertise in palliative care in Bangladesh. This will raise the profile and awareness among physicians about palliative medicine as an emerging and vital discipline.
Additionally, it is estimated that 600 000 patients in Bangladesh require palliative care at any point in time, so there is an urgent need to train more health care professionals in this field.
These specialists will be the leaders, mentors and trainers for the large number of nurses, support workers and other health care providers who are needed to care for this large number of patients. Besides, this should have an overall impact on other spheres of palliative care development.
The work so far
Palliative care activities were first started at BSMMU in 2007 and then, in 2011, we were able to open the Centre for Palliative Care (CPC), with a pioneering role as a national centre which will impart training and provide leadership in palliative care for the whole of Bangladesh.
Palliative care remains poorly understood among physicians and the general public, so the creation of this residency program will allow us to continue our awareness raising activities about the role of palliative care and its importance for people in Bangladesh.
The CPC was awarded funding from University Grant Commission under the Higher Education Quality Enhancement Program (HEQEP). We were able to use some of this funding for the development of the residency program in Palliative Medicine.
The funding allowed us to bring four international faculty members to Bangladesh, along with the twenty local faculty members, for several curriculum development workshops which ultimately led to the creation of this residency program.
Palliative care in Bangladesh
Palliative care is in a very early stage of development in Bangladesh. Recently, in partnership with the National Institute of Population Research and Training, we have done an Assessment of Palliative Care in Bangladesh and found that there are seven palliative care services operating within the country.
However, many suffer from a lack of resources and are only able to provide care for a small percentage of those who need it.
We know that there are many patients who have difficulty in accessing these services. Children and the elderly are two vulnerable groups which suffer from reduced access to palliative care resources.
I take this opportunity to acknowledge support received in the past from organisations such as the Worldwide Hospice Palliative Care Alliance (WHPCA), and the Institute of Palliative Medicine (IPM) in Kerala.
In different phases we received support, morally and substantially which has helped growth of development from a rudimentary service provision to present day development.
At home in Bangladesh, a number of individuals and organisations like The Rotary Club of Metropolitan Dhaka, and The Afzaluunnessa Foundation have also supported us.
Very lately the support from WHPCA for initiating the project to help older people in urban slums has enabled us to take the initiative out of the institute to community level.
Through this project, we have been able to extend palliative care services into two slum areas around Dhaka, providing community based palliative care for elderly and home-bound patients.
We hope that these services will serve as a model for how to incorporate palliative care into community level care and public health throughout Bangladesh.
A painful death
I would like to share the story of one patient. In the very beginning of the palliative care service at BSMMU, I remember one young girl with advanced cancer, who was suffering from terrible pain.
She was writhing on the floor of the bathroom, screaming, and asking her mother to pour water on her to try and relieve the pain.
At that time, we did not have access to any morphine to relieve her suffering. After her death, her mother was haunted by her daughter’s suffering. I know that this is still happening every day across Bangladesh.
A long way to go
The post-graduate residency program in the university has brought us to a state where we can claim that palliative care has come to stay in the academia.
But, still it is a long way to go before each and every person in need of palliative care in Bangladesh can be assured of such care. The effort will continue to go on and nothing can stop it.
To find out more about palliative care in Bangladesh, email Dr Nezamuddin Ahmad.