Covenant Health and 2 Worlds – Lunch and

Learn

There are no relationships that pose a conflict of interest to declare AND this program has been developed

without support from commercial entities.

Covenant Health’s 25th Annual Palliative Care

Conference Faculty/Presenter Disclosure

The Two Worlds Cancer Collaboration Foundation: INCTR – Canada

Created 2011 – is INCTR PAX now based in

Canada

Currently focusing on palliative care in India, Nepal

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Our mission at Two Worlds is to work with professionals in resource-challenged countries to reduce the burden of cancer by building capacity for care, skill development and education , and to promote self-sufficiency

• 2.5 million people with cancer

• 0.4 million deaths/year

• Leading sites of cancer

– Men:

• oral cavity, lung, esophagus, stomach

– Women:

• cervix, breast, oral cavity

• Andhra Pradesh - 85 million

– One of highest HIV prevalences in India

– Hyderabad - pop. 7 million

Two Worlds Cancer Collaboration Foundation:INCTR - Canada and South Asia

• MNJ Institute of Oncology and Regional Cancer Centre (MNJ) Pain and Symptom Management and Palliative Care Program is focus of work in India

• Only gov’t funded Oncology Centre in the state – opened 1950s

285 beds, 74 pediatric beds

10,000 new pts/year - 50,000 f/u

• Surgery, Radiation & Chemotherapy provided free to all below poverty line.

• Pain Relief and Palliative Care

Program (PRPCP) began mid-2006

MNJ PRPC Program

• Clinical care –inpt, hospice and outpt

• Outreach –home care, rural program

• Teaching

• Advocacy

Clinical Service - Adult• 75% present in advanced stages

• Common problems – pain, nausea, family breakdown

• Extensive wounds also common

• Clinic runs 6 days/week

• 10 new inpt palliative beds in 2014

Pediatric Oncology

• 74 beds

• Parents sleep on floor

• Mostly acute leukemia

• High treatment abandonment

• Two Worlds with Pallium India and OSI funded and trained the first pediatric palliative care fellowship position in India in 2011

The two worlds healthcare “gap”

In high income countries

More than 80% of young peoplewith cancer survive

to live productive and fulfilling lives

However …in low income countries

More than 80% of young people die of their cancer before reachingadult life

All children diagnosed with cancer who transit through MNJ Cancer Hospital are seen by the Palliative CareProgram.

Kumudini Devi Hospice

• 26-bed hospice opened in July 2013 (Four pediatric beds)

Life at Your Doorstep Home Care Teams

Since 2008 - 1128 new pts and 3519 follow-ups seen

Rural Outreach Program

• 9 villages in Chevella Mandal - 90 minute drivefrom Hyderabad

• Screening, early detection, rehab, palliative care

• Trained village volunteers - partnered with foundation working to prevent child labor

Teaching

• PRPCP conducts an intensive month -

long Certificate Course every

2 months

• MNJ has become training centre for

other Indian cities/states and other

countries including Nepal, Ethiopia

and Somalia

• Since 2006, 140 MDs, 79 nurses,

32 healthcare volunteers and 11 social

workers as well as many students

have completed the Certificate Course

Health and Cancer Awareness Sessions in Schools

Advocacy• Convincing gov’t to amend opioid licensing regulations to improve access – national law passed Feb 2014

• Facilitated inclusion of palliative care in state sponsored Health Insurance Scheme for people below poverty line

• Working with State AIDS Control Program re: inclusion of palliative care training/services for people living with HIV/AIDS

Core Programs Supported by 2W in India

• Dr. Palat’s role both at MNJ and nationally/internationally for cancer and non-cancer palliative care for children and adults

• Dr J Reddy - Pediatric Palliative Care Specialist

• Life at Your Doorstep Home Care Team

• Rural Program

• Expanded pediatric program beginning 2015

Catholic Health Association of India

• 71 yrs of experience in India, particularly with pts with HIV/AIDS

• 3300 member institutions providing care for up to 200 million of the poorest people in India

• 2W/MNJ/CHAI providing training and

accreditation for palliative course and eventually

a Palliative Care Training Centre and 10 – bed

Hospice in Medchal, India

• Inaugural Course Aug-Sept 2014

• 23 RNs, 1 SW

Nepal • INCTR working in Nepal for a decade on

teaching, advocacy, twinning

• Two Worlds Projects include:

• Support for NAPCare led Palliative Care Course for nurses in 2013

• Nepali version of Essentials in Hospice Palliative Care for Nurses text and workbook

• Community development rural project

• What are the opportunities for collaboration?

Opportunities for Collaboration

• Current programs - ongoing support/expansion

• CHAI Training Program

• Young People with Cancer Project

• St Mary’s Hospital Palliative Care Program

• Nepal Programs

• New projects in India ie in the Punjab

Young People With Cancer Project will deliver:

• A new in-patient unit for 12 - 18 year olds with cancer who need treatment not only for cancer but also the physical, emotional, educational and social challenges of adolescent and teen years

• A new Palliative Care Program for children with illnesses such as HIV/AIDS, thalassemia and other non-cancer life limiting illnesses

• A dedicated Home Care Team for these children

• Expanded support for 0 - 5 year olds at MNJ and 0 - 12 year olds at Hospice House, MNJ and rural villages

The current children's program in Hyderabad is the regional leader in this field

and these new elements, through training, example and advocacy, will help

children far beyond Hyderabad

Palliative Care Project - St Mary’s Hospital, Malur, Karnataka

• Envisaged as “total care with a community approach” for Malur and surrounding villages

• In 1st year:

– Building of 2nd story on rural hospital devoted to pall care

– Outpt clinic

– Mostly seeing elderly with non-cancer and cancer

– Outreach and home visit program

Dr. Seshadri

Sr. Dr Lucian