About 570 people including cancer patients and caregivers have attended palliative care services at the national referral hospital in Thimphu in the last 10 months.

Bhutan Cancer Society (BCS) initiated the 12-month CSO grant project to institute holistic palliative care services in the country, for terminally ill patients and their caregivers in April last year.

BCS’s programme officer, Tenzin Yangden said palliative care was new in the country.

She said the main reason behind the initiative was to give the patients a good quality end of life.

“A majority of the terminally ill patients who avail the services in the country are from underprivileged background,” she said. “We support them in whatever way we can.”

The programme, being implemented in consultation with Jigme Dorji Wangchuck National Referral Hospital provides peer support through pain management, physical, nutritional and psychosocial interventions.

A senior dietician at the hospital conducts nutritional session every Tuesday and Thursday at 3pm. A clinical counsellor with BCS conducts psychological counselling every Tuesday, Thursday and Friday.

A clinical counsellor, Sonam Yangden Tamang said that when a person is sick in the family, the entire family was affected. “Palliative care is basically to improve the quality of life, instead of adding days to life, we want to add life to the days.”

When a patient undergoes chemotherapy, she said the attendant also does not get much movement because they have to be with the patient. “The attendant also has to be in the hospital and they don’t have any physical, mental and spiritual growth, so we have yoga sessions.”

Sonam Yangden said people generally understand palliative care as giving care towards the end of life but the wholesome definition was giving care to the patients as well as the caregivers from the beginning of the diagnosis throughout the process until death. “Even after death, we support during the bereavement.”

She said that psychosocial counselling is focused on caregivers because along with the patients, the caregivers were equally stressed.

Similarly, the nutritional session also focuses on caregivers because they are responsible for feeding the patients and they should know what diet is best for the patient.

About six to eight patients and caregivers attend each session.

“For peer support group, we have RENEW counsellor and the yoga session is being carried out by an instructor at the Nehru-Wangchuck Cultural Centre on Fridays,” Tenzin Yangden said.

Individual sessions are also held for patients and their attendants because patients with the different illness have different diet requirement.

Several information materials on palliative care and side-effective management have also been developed and printed. Based on the patients and caregivers’ feedback, a book on nutrition management and a guide for caregivers and families were developed.

The sessions help support the patients and the caregivers morally and emotionally. “We formed the peer support group for this reason,” she said.

Except for the peer support group, the other sessions are conducted for inpatients and their caregivers at the Oncology ward. “This is considering their convenience because the patients go to the hospital for chemotherapy.”

She said that although there was a space problem at the ward especially during yoga sessions, the participants adjust.

The peer support group is conducted at the BCS office, focusing on the outpatients. “Initially, we did not have many participants but it slowly picked up,” she said.

She said the hospital was also initiating a palliative unit and a team has been formed including an oncologist and nurses trained in palliative care.

The Faculty of Nursing and Public Health is also developing a module to integrate palliative care services in the future training of health care providers in the country.

Tenzin Yangden said the patients and caregivers have been giving positive feedback and said that the sessions have helped them.

Sukh Badhur, 59, from Dagana, who is currently in Thimphu accompanying his wife to undergo chemotherapy, said he attended the sessions for the past four months and found the nutritional sessions beneficial.

His wife was diagnosed with lung cancer in 2017 and was referred to Kolkata, India.

“I didn’t know that we have to give the patient five portions of meals a day until I attended the session,” he said.

The project supported by EU through Helvatas Bhutan also provides support to the underprivileged patients travelling to India for treatment.

Dechen Tshomo