Pakistan has 21 cancer hospitals, fifty general hospitals with cancer treatment facilities but only ten facilities provide palliative care


 Palliative Care Services in Pakistan

Pakistan has 21 cancer hospitals, fifty general
hospitals with cancer treatment facilities but
only ten facilities provide palliative care

Palliative care improves QOL, it should be included in
undergraduate, postgraduate training programmes- Haroon Hafeez

KARACHI: Pakistan spends just fourteen US$ per capita on health if we take into account the Government of Pakistan spending in public sector during the year 2021. This was stated by Dr. Haroon Hafeez a palliative care specialist from Shaukat Khanum Memorial Cancer Hospital & Research Center while speaking at the 3rd Annual Conference of Pakistan Society of Internal Medicine held at Karachi from May 6th to May 8th 2022. He was one of the invited speakers at the conference where he made a presentation on Palliative Care, Challenges, Terminal Illness and Future Directions.

Palliative care, Dr. Haroon Hafeez stated, improves the quality of life of the patients. To be a good physician, one has to treat the symptoms and psychological illnesses. Treatment of cancer, he further stated, is difficult and different. At times it is symptoms relief, it needs caregivers support and advance care planning. Patient satisfaction, he said, was most important. It is all life time disease. In advanced disease, symptoms management increases while curative role is reduced. Cancer patient’s whole family is affected. In case of children suffering from cancer, could even lead to separation. We need a National cancer registry in Pakistan.

Prof. Ejaz Ahmed Vohra (Centre) along with others charing one of the scientific
session during the PSIM 3rd Annual Conference held at Karachi.

Giving details of cancer treatment facilities in Pakistan, Dr. Haroon Hafeez said that there are twenty one cancer hospitals, fifty general hospitals have facilities for treatment but only ten facilities provide palliative care. CPSP started Fellowship in Palliative Care in 2022. Till today only one hospital in Pakistan is recognized for training in palliative care. CPSP recognized SKMT in 2022 for training in palliative care. Getting opioids, he said, was a major problem. When morphine is not available, patients suffer from withdrawal symptoms. We have draconian rules. There is lowest availability of morphine in Pakistan. We have no Hospice service, no palliative wards, and no community service for the cancer patients. Pakistan is the 8th biggest producer of opium but surprisingly we have no manufacturing unit. It takes six to eight months to get morphine supply. Even when we had the PTI Government we could not overcome these problems and ensure smooth supply of morphine for pain relief. He emphasized the importance of training healthcare professionals in communication skills, they should be good listeners. They must learn how to convey the bad news, often using sugar coated language. We also need to train palliative care nurses, Rehabilitation Medicine Nurses and cancer pathologists. We urgently need to build health infrastructure, include palliative care in undergraduate and postgraduate training programmes. Royal College of Physicians London can help in faculty training and support in preparing the curriculum. It is extremely important that we ensure that patient die with dignity, he remarked.

Prof. Aziz ur Rehman (Center) along with Prof. Tariq Waseem charing one of the
scientific session during the PSIM 3rd Annual Conference held at Karachi.

Prof. Aftab Mohsin was the next speaker in this session who spoke about Cardio Renal safety with the use of Teneligliptin. It was a sponsored talk by Dynatis Pharma. He discussed in detail metabolic syndrome, safety and efficacy of DPP4 inhibitors. Once daily medication is preferred in patients suffering from renal disorders. Many patients are treated with the combination of DPP4 Inhibitors and SGLT2 preparations. The adverse effects he said, are minimal just 3-4% but one should avoid these drugs in DKA, he added.

In the afternoon session Prof. Azizur Rehman spoke about Gut Microbia and potential therapeutics. In metabolic syndrome obesity and T2DM are the biggest challenges. Diet and environment also matters. He also talked about new therapies based on Microbiota and laid emphasis on healthy diet.

Prof. Wasim Jafari from AKU spoke about Hepatitis B and C: From discovery to eradication. As regards scenario in Pakistan, we are not yet anyway near elimination of HBV or HCV. HBV can be controlled but cannot be cured. CHBV, he further stated, was a global problem. Cirrhosis leads to HCC, We can prevent Hepatitis-B through vaccination, he added.

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