“Only we do it.” Palliative Care in Pakistan

Nurses Headly Creast & Sheraz Suleman give palliative care to a patient. Photo: Eric Siraj

Nurses Headly Creast & Sheraz Suleman give palliative care to a patient. Photo: Eric Siraj

In Australia and New Zealand, is it that terminally ill patients are candidates for euthanasia? That is the fruit of a secular and secularized society where family structures have become fragile and are unable to take up the challenge of enabling sustained care. In Pakistan, however, faith in God is as close and real as having a jugular vein. Sick family members never cease to be part of the caring family circle. Euthanasia is as logical as a square circle. However, the problem in Pakistan is that terminally ill patients are treated as sources of income by the medical profession and the hospital culture. Their illness is not relieved and the financial situation of their families is wrecked as they seek for a cure or for pain relief.

In 2005 St Elizabeth Hospital, of which I am the Board Chairman, began discussing the need for and the possibility of commencing a free Home-Based Palliative Care (HBPC) nursing service for the terminally ill in Hyderabad, a city of four million in the south-east of Pakistan. It has been a powerful way of expressing our Catholic commitment to the dignity of life even in the presence of the reality of death. Its introduction has enabled St Elizabeth Hospital to continue to offer the best possible care at the lowest possible cost to those in need and to manifest compassion and mercy in a practical and outstanding way in Pakistan.

Dr Ghazanfar Hassan Taqvi, head of the Maxillofacial Surgery Department at Liaquat University of Medical & Health Sciences (LUMHS) Hyderabad, said that it is only since a meeting at St Elizabeth Hospital on May 8 this year that he came to realize the “dimension and dynamics of palliative care for my patients.” He said that St Elizabeth is the only hospital that he knows of that provides free Home-Based Palliative Nursing Care. He said it is a blessing for Hyderabad to have such a facility and hopes that it will develop further to cater to the needs of poor patients.

At St Elizabeth, we know the financial situation of the people and will work closely with Dr Ghazanfar and other doctors through Dr Sajid Naqvi, the Chief Medical Officer at St Elizabeth, and Mrs Farah Anil who is the Clinical Services Director.

St Elizabeth Hospital is the only hospital in Pakistan that provides Home-Based Palliative Care. The palliative care nursing given by St Elizabeth is free. A very few other hospitals have in-hospital palliative care, but it is anything but free.

As of May 2021, 28 terminally ill cancer patients are receiving free palliative care in their homes from our HBPC nursing and medical team. Twelve are in stage 4 and 8 are in stage 3. Due to nursing logistics and financial budget limitations at the hospital, we have had to restrict palliative care to cancer patients. The nurses and doctors also have shift timings and responsibilities in the hospital. We need more resources and a purpose-dedicated financial base to be able to widen the palliative care nursing, to meet the increasing requests and demands from people in need of palliative care, and to replace the small car in constant palliative care use since 2014.

Nurses Headly Creast & Sheraz Suleman give palliative care to a patient. Photo: Eric Siraj

Palliative care nurse Sheraz Suleman attending to a patient in his home. Photo: Eric Siraj

There are now four male nurses, one female nurse and two doctors in the palliative care team. It is a 24-hour on-call emergency service as well as regularly scheduled visits. The team is headed by Fariyad Inayat who is a palliative care nurse and the fully qualified Infection Control Officer at St Elizabeth Hospital. Over the years, nurses from St Elizabeth have gone to Assisi Hospital in Singapore and Cabrini Hospital in Melbourne for clinical attachments in palliative care and we look forward to renewing this ongoing training in post-COVID days. It is urgent to increase the HBPC nursing team at St Elizabeth to be able to care for the growing number of patients.

Most cases are lung and oral cancer, due to cigarette smoking and the common practice of chewing betel nut and leaf, and advanced breast cancer, which is culturally hidden and not spoken about until too late. St Elizabeth’s HBPC nursing team have prepared multimedia presentations in the Urdu language on both topics.

An important benefit of St Elizabeth’s Home-Based Palliative Care service is that it promotes interfaith harmony on a very rich human and personal level through the caring ministry of committed Christian nurses who go into the homes of patients who are Muslim, Christian and Hindu. Nurses from the HBPC team always attend the funerals of the people for whom they have been caring. They wear their uniforms. The grieving family welcomes them as if they are family members.

One man after the death of his father described the palliative care nurses as the people who kept coming for months and gave some hope when he and his family did not know what to do. For others, the confusing stages of a terminally-ill patient in palliative care and the equally long grieving of the family and death and compassion and good healthcare seem to come together to say something very powerful in Hyderabad for which words are not needed.

The pity is that free Home-Based Palliative Care Nursing in Pakistan is found only in Hyderabad. To its great credit, it is the Catholic Church through St Elizabeth Hospital that makes it happen there.

Columban Fr Robert McCulloch is the Rector of Collegio San Colombano, Rome.

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