INCTR Canada, Annual Report (Nepalese Component) 2016

Program: Palliative Care
Coordinators: Stuart Brown, Fraser Black, Surendra Shrestha, Richard Love
Other INCTR Participants: INCTR (Brussels) in the first 10 years or so of the relationship

Robin Love
Collaborators: Dr Pradeep Vadjya (Hospice Nepal)
Dr Stuart Brown
Dr Fraser Black
Dr Richard Love
Dr Simon Sutcliffe
Dr D Munday, University of Warwick
Branch(es): INCTR/NNCTR, INCTR Canada
Location: Single Country
Country(s): Nepal
Institutions: Bhaktapur Cancer Hospital, Bhaktapur,
Hospice Nepal
Nanaimo Hospice
U.Victoria Nursing Program
BPK Memorial Hospital, Chitwan, Nepal
Scheer Memorial Hospital, Bhactapur
Kanti Children's Hospital, Kathmandu
Khoirola Cancer Hospital
Hospice Nepal
Victoria Hospice, Vancouver
University of Virginia
Nepal Cancer Relief Society
Qinghai University Tibetan Medical School
Background Information: The Nepalese Branch was one of the earliest to be established (in 2000). It is located in a small town called Bhaktapur, situated just outside Khatmandu and its first President was Dr Surendra Surestha, an agronomist by training, who has been involved in cancer control for many years, being the vice-president of the Nepalese Network for Cancer Treatment and Research. It boasted a full time research assistant, Rhada, and good relations with the Tribuvahn Teaching hospital and the Scheer Memorial Hospital in Kathmandu. It is most generally referred to as INCTR/NNCTR to ensure that its association with INCTR is clear. In addition, however, various other health professionals working in Kathmandu have offered their services in various ways to assist in the development of a cancer control program for the Kathmandu valley, a largely rural region which has one hospital (Scheer Memorial Hospital) where patients could go for cervical screening or palliative care, the first projects undertaken by the Branch. Another early project that was undertaken was education of school children (ages 11-14 or so) about cancer and its risk factors.
Objectives: 1. To establish an organized program in the early detection of Cervical Cancer (and later, HPV vaccination)
2. To develop a network of centers which will provide education and training in palliative care
3.To develop an education program about cancer in schools within the Khatmandu valley, particularly Bhaktapur
Methods: Provide teaching to doctors and nurses in the VIA method of detection of cervical cancer, and arrange for biopsy (additional treatment if required) at the Scheer Memorial Hospital or the Khatmandu Gynaecological hospital, as well as providing courses in the early detection of Cx Cancer from outside Bhaktapur.Site.
Visits by palliative care specialists from Vancouver. Courses, Workshops in palliative care
Annual visits by health care teams, including students & residents (MD & nursing)
Send Nepal Delegates to MNJ Oncology Institute
Development of infrastructure for education of palliative care doctors and nurses
Progress: Two Programs have been established
1. Victoria Hospice and BPK Memorial Cancer Hospital have developed a twinning program in which palliative care physicians spend several weeks of each year in Bhaktapur helping to train nurses and Doctors in palliative care
An NGO (NapCare) has been established to continue to support the ongoing efforts in developing the palliative care program in both the Khatmandu valley and BPKoirola Hospital in Chitwan. A palliative care Hospital: Hospice Nepal has also been built.
At the present time, the program includes
a. exchange visits
b. support for program planning
c. free medications for “the poor”
d. high-speed internet
e. Staffing: MD (1); Nurses (12); Social worker (1); Physio (1);Dietician (1).

The Hospice itself consists of a 15 bed in-patient unit, an OPD clinic & IP consult service, Home and community palliative care services.

Activity Statistics (2015):

• OPD visits 1050
• admissions 236
• consults 86
• community/home visits 40
• total morphine use in PCU: 417 gms.
• Future Plans:
• increased medication fund
• add counsellor to team
• PC training for additional

The second program is located at the The Himalayan Centre for Research Excellence in Palliative Care. This was funded by a grant from NIH and includes

This program was made possible by a grant from the NIH (US) R.F.A: Planning for Regional Centres of Research Excellence in NCDs in LIC and LMIC (P20).
This program involves the U. Virginia, NAPCare. Qinghai U Tibetan Med.School and is working towards the development of:

• a sustainable Centre for Research Excellence in PC in Nepal & Tibet
• a partnership has been established between U. Virginia (UVa),Two Worlds, NAPCare & Qinghai U. Tibetan Medical School.

> 60% of awarded funds go to Nepal & Tibet and is dedicated to the establishment of infrastructure support for health services research.
Grant submission: due 28-8-2016. P.I. Dr Aaron Yao (UVA) CAO: Ms Elizabeth Olmstead (UVa).
Future Plans: Future Plans:
• -Dedicated Palliative Care Physician
• -Department of Palliative Medicine
• -Home Care Program
Duration: Ongoing project of indefinite duration
Publications: INCTR Handbook of Palliative Care
Month: 01
Year: 2016
Last Update: 01/16

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