Parthiban was displaced from his village during the long and protracted Sri Lankan civil war. This year, he finally came home. He decided to build a house on his property. One day, he climbed a tree, lost his footing, and fell down. Life as he knew it would never be the same. Parthiban has been at the Vaikarai Rehabilitation Centre in Vavuniya for the last 6 weeks. He is paralyzed from the neck down and lies on a bed in a 12-bed unit. He looks up at us and smiles.
We are an 8-person team from Two Worlds Cancer Collaboration (TWCC), a non-profit Canadian organization whose mission is to assist healthcare professionals in resource-constrained countries to reduce the burden of cancer and non-cancer palliative care. Palliative care is the active total care of patients with advanced progressive diseases, aimed at controlling pain and other symptoms and providing psychological, social and spiritual support. In the developing world, palliative care is mostly overlooked. Yet, patients at the end of life deserve our compassion. They deserve every chance to preserve their dignity no matter where they live.
One year ago, I helped organize the 2017 Develop North-East Conference. The conference’s goal? To find solutions to challenges within the health, education and economic sectors of the war-affected Northern and Eastern Provinces of Sri Lanka. Through contacts gained at the conference, we were introduced to Two Worlds Cancer Collaboration and their impressive work in Nepal and India. TWCC leaders listened to our plea about this war-affected population and agreed to start a Palliative Care project in Northern Province.
Our schedule, in November 2017, is ambitious, but then, so are we. We cover 3 districts – Jaffna, Kilinochchi and Vavuniya. We meet doctors, nurses, hospital administrators, government officers, university officials, politicians, drivers, counsellors, volunteers, patients and family members. They discuss their frustrations. We hear about what is working and what is not. They tell us their fears. They tell us where they want to see things going. They ask us how we can help. They listen to our ideas and we listen to theirs. All the while, we formulate in our minds what we can do to make things better.
Doctors at Tellippalai Trail Cancer Hospital tell us about shortages of pain medications and the lack of specialized palliative care training among medical and nursing staff, despite the fact that much of the care provided there is palliative. A CANE Jaffna Board member shows us around the hospice and expresses a hope that the hospice might soon become a centre of excellence for palliative care. At the Vanni Rehabilitation Organization for the Differently Abled (VAROD), young volunteers tell us that they are doing the best they can to manage the complex and differently-abled. At times, they wonder if outside training might enable them to provide more comprehensive care. We meet with the Kilinochchi and Mullaitivu mobile units that go out in the community to serve disabled and palliative patients in their homes, a vital service in a region where transportation in remote areas is problematic. Both teams rely on funds from Tamil Canadians, and worry about losing this funding.
There is much work to be done. But I am hopeful. We are now making plans to: form the Northern Province Palliative Care Association to address the needs of the palliative patient population, run palliative care webinars for hospital staff, send doctor-nurse teams from Northern Province for palliative care training, work with officials to improve the availability of common palliative medications, and look into funding mobile units in Northern Province, empowering them with further training and support
Dr. Meera Selvakone, Northern Province Palliative Care Initiative