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Providing palliative care skills to healthcare workforce

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Palliative care is a humanitarian response to the COVID-19 crisis. An online weekly programme offering palliative care skills is empowering healthcare workforce to deal with the patients in this time of pandemic

Palliative care, for a long time, has been effective in providing quality of life for patients and their families facing a life-threatening or terminal illness. In times of the COVID-19 crisis, palliative care plans become an essential tool to provide help and care to patients and their families. In the same light, Trivandrum Institute of Palliative Sciences (TIPS) initiated a weekly online training programme in basic palliative care a month ago to empower healthcare providers with skills necessary to relieve the suffering of patients with COVID-19 and their families.

Pallium India provides service delivery and training through TIPS, the flagship programme of Pallium India, which has been accredited as a WHO Collaborating Centre for Policy and Training on Access to Pain Relief. Services are provided through Out-Patient clinics, In-Patient services and home visits.

Providing support to the cause, the National Health Mission (NHM), Uttarakhand issued a directive on 16th May, 2020, for doctors, staff nurses, social workers and paramedical staff to undergo this training.

The NHM, in its order, said, “In view of the coronavirus spread, an online training session has been organised by Pallium India, in association with ECHO Project. All nurses, doctors, social workers, and paramedical staff need to undergo this training.”

The first batch of people was thus trained free of cost on 25th May, 2020. The trainers are a diverse group ranging from palliative care physicians as well as specialists from interventional pulmonology, psychiatry, neurology, anesthesiology, critical care and community medicine, who have undergone palliative care training and valued the palliative care approach in delivering comprehensive, holistic and compassionate care. At the moment, the faculty pool consists of 17 people.

So far, 253 people have completed the course, the bulk being from India – with participants from Uttarakhand, Kerala, Tamil Nadu, New Delhi, Maharashtra, Andhra Pradesh, Karnataka, West Bengal, Assam, Gujarat, Goa and Haryana, and a few from other countries like Nepal, Maldives, Sri Lanka, Ghana, Myanmar, Oman and Indonesia.

Webinars, e-book and interactive sessions

Elaborating more about the training programme, Dr M R Rajagopal, Chairman, Pallium India, said, “The current online weekly training is being conducted to empower healthcare providers with skills necessary to relieve the sufferings of patients with COVID-19 and their families. Open to all healthcare workers, it is based on a ‘flipped classroom’ methodology based on the Palliative care in COVID-19 Resource Toolkit for LMICs, (https://palliumindia.org/2020/06/resources-for-palliative-care-in-the-context-of-covid19) made up of nine standard webinars, an e-book and interactive sessions delivered via the ECHO platform. The resource toolkit is shared with all participants in advance, so that they may reap maximum benefit from the interactive sessions with experts. During the five-day training, the topics covered include: decision making and triage in COVID-19, symptom control in the context of COVID-19, basics of communication, end of life care in the context of COVID-19, making sense of distress in the context of COVID -19.”

He added, “We see this programme as a humanitarian response to the COVID-19 crisis and would like as many people to be able to access it. Understanding that suffering has many dimensions – physical, social, mental, emotional and spiritual – is vital to provide alleviation from any serious health-related suffering, which includes people who have COVID-19 too. These apply not only in times of crisis as we are undergoing now, but always.”

Kerala Government recognises PallicovidKerala’s e-book

The complete Palliative Care in COVID-19 Resource Toolkit for LMIC was submitted to the Kerala government recently, uploaded on Pallium India website and widely shared on national and international palliative care forum as a COVID-19 resource. The Expert Committee on COVID-19 management appointed by the Government of Kerala has recognised it formally and directed the Additional District Medical Officers of all districts and National Health Mission coordinators to use the Palliative Care in COVID-19 Resource Toolkit as the background training material for palliative care training programmes.

Dr Chitra Venkateswaran, Member, National Faculty in Palliative Care in India, the Indian Association of Palliative Care, notified, “The Kerala Government developed the COVID-19 Task Force quite early in the pandemic and included senior palliative care advisers in it. A total of 22 palliative care professionals got together to form PalliCOVIDKerala e-book in the last week of March 2020 with members working across health systems within the state, across India, and internationally. In response to the lack of capacity of the existing healthcare system to deliver these key palliative care interventions among frontline staff, the group brought a wide range of competencies including palliative medicine, internal medicine, anaesthesiology, critical care, paediatrics and psychiatry as well as experience in the implementation of projects during complex humanitarian emergencies. The goal was to develop training resources in the form of guidance algorithms in an e-book for frontline healthcare workers of relevance to low-and middle-income settings.”

She added, “A short time scale of two weeks was agreed followed by the development of a faculty pool that would deliver online training with periodic revisions of the e-book. Key priorities were agreed to and a working group was selected. The guidelines were drafted based on available evidence, robust discussion, brainstorming, adaptation to local milieu and mutual consensus, while also considering the local context, but options were included to enable adaptation to other settings, particularly low- and middle-income countries.”

Applauding the efforts of the PalliCovidKerala team, Dr Fareeduzzafar, State Nodal Officer, National Programme for Palliative Care, said, “We are happy that our healthcare workers are being empowered with the relevant palliative care tools to sustainably manage COVID-19. We have received good feedback from the participants and are grateful to the team providing the training.”

To further expand the scope of this training, Pallium India is also in talks with other state governments.

What attendees say

An attendee of the training, Dr Tanvi Joshi, Medical Officer, Allopathic Dispensary, Tehri, Garhwal, told that the training was about palliative care for corona patients, ward and ICU care, involving their physical and mental fitness. It also related to the care of patients with comorbidites.

“I attended a six-day free schedule comprising various topics on palliative care for corona patients. The approach was all-rounder as it brought every aspect of patients’ health in discussion – from deciding the treatment protocol to discharge (if well),” said Joshi.”

The session was equipped with unique challenges during covid pandemic that require adjustments of the practices of palliative care, shared Dr Taranjit Singh, Medical Officer, GPH, Dehradun. “The session also talked about the importance of use of opioids in patients dying with coronavirus and equipping all frontline health workers with training focus on sensitive and untouched topics like communication during grief and loss,” he highlighted.

Understanding the importance of palliative care while undergoing the training, he said, “Working at different health settings across the globe, the faculty was diverse, they were clear and precise in the topics they talked about. Multi-disciplinary sessions/discussions update the need of palliative care during the COVID-19 pandemic. This is a new topic for all of us and serves as a great way to keep ourselves updated informed about the protocols followed around different settings in healthcare.

As per Dr Imran Aslam Ansari, Medical Officer, CHC Baijnath Bageshwar, the course has enlighted him more in terms of being humane. In his opinion, the profession of being a doctor is lot more than just prescribing medications; it is about healing the soul. He emphasised, “In the times of corona epidemic, when the knowledge of the disease is just evolving day by day, and we don’t have any specific treatment yet, it is our duty to deal with the patients with utmost dignity and passion.”

Palliative care plan for COVID patients and their families can be effective in reducing stigma during this crisis and become a channel through which necessary care can be provided virtually. With healthcare workers also being sensitive to their patients, communicate with them, understanding their loss and grief, while providing them the required treatment and medication, will prove to be a boon for both.

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