LIFE ASKED DEATH
Developing Palliative Care in Asia - Short Film
More than half of all patients with cancer experience pain. In advanced disease, close to two thirds of patients report pain, about half of whom suffer pain of moderate-to-severe intensity. If cancer pain is not adequately treated, it can have devastating consequences that affect the quality of life of patients and their families. Palliative care improves the lives of patients and their families. Watch ‘Life asked Death’ now and learn how palliative care services can be developed in ALL countries.
About The Film
Produced by Moonshine Movies, LIFE ASKED DEATH highlights the scale of pain and suffering that needs to be urgently addressed in Asia, and offers insights into the positive outcomes that can be achieved even in resource-limited countries. The documentary brings viewers to Bangladesh, Myanmar and Sri Lanka to witness how Lien Collaborative’s specialist volunteers bring palliative care and training to these countries. When international experts and local stakeholders work together to develop palliative care capacity in the government-run health systems, the barriers to pain relief and humane care can be removed.
The short film reveals how palliative care helps to improve the quality of life of patients and uplift their families who are struggling to cope with the suffering and the practical and financial implications of a life-threatening illness. It also uncovers how essential pain medications such as oral morphine can bring relief to patients who are in agony, because of lack of access, awareness and availability of palliative care and pain relief medications. What is urgently needed are policy changes which will allow the integration of palliative care into health systems to provide patients with better care and greater access to pain relief medications.
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Yangon, Myanmar: Mr Sein Hla Aung wants to shout out in pain but controls himself in the crowded wards.
Financial stress is adding to the aching pain caused by his mouth cancer.
He has no access to pain relief medicines where he lives.
Can his situation be managed with limited resources?
”Until morphine is more widely available in Myanmar, patients will not be getting the most effective pain relief possible in hospitals.”
Colombo, Sri Lanka: fear of the unknown is causing 38-year old lung cancer patient Mrs Perera (not her real name) great mental anguish.
How can she plan for her future?
“Palliative care helps to improve the quality of life of patients in Sri Lanka. Though some headway has been made under the Lien Collaborative, we need to do more especially in the area of integrating palliative care into the healthcare systems.”
Dhaka, Bangladesh: 60-year old Mrs Sophia Khatun is in pain and in danger of chasing after futile treatment.
Is she able to spend quality time with her family in the remaining time she has left?
“Palliative care is about improving the quality of life for patients and their families facing life threatening illness.”
“Sensitive and honest communication between healthcare workers and patients is a vital aspect of palliative care.”
The Lien Collaborative
A Project to Enhance Palliative Care Leadership and Capacity in Developing Countries. The Lien Collaborative for Palliative Care draws on philanthropy, tertiary educational institutions, palliative care service providers and individuals to collaborate on a project designed to strengthen Palliative Care leadership and capacity.
What does this project aim to do?
The Lien Collaborative for Palliative Care project is co-developed by the Asia Pacific Hospice Palliative Care Network (APHN) and the Lien Foundation.
This initiative seeks to match the supply of expert resource and knowledge to the demand from developing countries for such skills and know-how so as to build Palliative Care capabilities in a systematic, impactful and sustainable way. It draws on philanthropy, tertiary educational institutions, palliative care service providers and individuals to collaborate on a project designed to strengthen Palliative Care capacity and leadership.
The project aims to help build Palliative Care capacity in the Asia Pacific region and to integrate this with the mainstream government health system. Its focus is on countries with little or no services.
How does the project achieve its objectives?
In-country programs were established in Bangladesh, Myanmar and Sri Lanka starting from 2013. The starting phase involves teams of volunteer faculty drawn from the APHN visiting each country to conduct a series of Training-of-Trainer in Palliative Care programs for a cohort of doctor, nurse and social worker participants. Complementing the in-country component is the overseas clinical attachment program to provide additional exposure to selected participants, as well as essential pain medications program to advocate for oral morphine to be made available, accessible and affordable.
By continuously demonstrating its value add through interactive and practical, hands-on training sessions as well as building relationships within each target country, there are increasing opportunities for the expert teams to facilitate, support, advocate and influence in key areas required for palliative care development, such as Training, Drug availability, Education-Curriculum and Policy. This applies as well to follow-on phases of the program as sustained engagement is needed for the proper setup of palliative care services in the hospitals and to make oral morphine available at each site, with the longer term goal of integrating palliative care into the mainstream government run health system.
Output and Outcomes
31 Volunteer Faculty comprising of Doctors, Nurse & Medical Social Workers from Australia, Canada, India, Malaysia and Singapore.
Bangladesh: 35 participants from 9 institutions
Myanmar: 28 participants from 12 institutions
Sri Lanka: 50 participants from 20 institutions
Training-of-Trainer in Palliative Care program
Bangladesh: commenced 2013, 4 out of 6 modules implemented.
Myanmar: commenced 2013, 6 out of 6 modules implemented.
Sri Lanka: commenced 2014, 5 out of 6 modules implemented.
Overseas Clinical Attachment program
To date, this has involved 7 doctor participants from Bangladesh and Myanmar (hosted in India and Singapore)
Essential Pain Medications program
Oral morphine and morphine syrup is available at retail pharmacies in Dhaka, Bangladesh.
Oral morphine is being made available by the government of Myanmar.
Outpatient prescriptions for morphine increased from 3 days to 1 month for Cancer Clinics, Palliative Care and Pain Clinics in Sri Lanka.
Support national opioid workshops and seminars in Myanmar and Bangladesh.
New Palliative Care services have been started at key government hospitals and cancer centres in Bangladesh, Myanmar and Sri Lanka by participants of the Lien Collaborative.
Sri Lanka has established a National Steering Committee on Palliative Care, chaired by the Director General of Health Services.
Policies to improve morphine availability are mentioned above.
In Bangladesh, Palliative Medicine is recognised as a speciality with the first Professor appointed and the first specialist program is underway.
India was recently added as the 4th country of the Lien Collaborative. A pilot program was launched in 2016 with the goal of developing palliative care services and making oral morphine available at these places. It involves 10 cancer centres, along with 12 volunteer faculty and 30 doctor and nurse participants.
Asia Pacific Hospice Palliative Care Network (APHN)
The APHN is a charitable non-governmental organisation registered in Singapore in 2001 which supports the development of palliative care in the Asia Pacific region.
The charity’s mission is to promote access to quality hospice palliative care for all in the Asia Pacific region. APHN members include some 230 organisations that support or provide palliative care and over 1,300 individuals working in the field in the Asia Pacific region.
The Lien Foundation is a philanthropic house in Singapore which works in the areas of water and sanitation, early childhood education as well as ageing and palliative care.