The PAX Program is presently developing regional palliative care centers in Nepal, India, and Brazil and will begin developing a regional center in Tanzania in 2010.
In a joint effort between INCTR Brazil and PAX, a regional palliative care center is being developed at the Santa Marcelina Hospital in São Paulo, Brazil. The palliative care services have grown from a doctor and nurse consultation service to a 6 bed ward with a comprehensive palliative care team in place – two physicians, a nurse, social worker, psychologist, pharmacist, physical therapist and nutritionist. The team now provides ambulatory and internal consultations in other parts of the hospital and trains any staff member at the hospital wishing to learn more about palliative care. Palliative care has been integrated into the pediatric oncology service and work is underway to develop a community-based program through the 67 primary health care centers affiliated with the hospital.
The PAX team has worked in the Kathmandu area, initially with two centers. The Nepali program combines educational and technical assistance together with engagement with government officials to effect changes in health policy and ensure adequate supplies of essential medicines. This program includes the establishment of palliative care centers in addition to the provision of patient care and provides training courses and activities that raise awareness of palliative care throughout the community.
A regional palliative care center has been established in India that is based at the Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Center (MNJ) in Hyderabad, India. It is now recognized as a center of excellence in palliative care services and training in Andhra Pradesh and is one of the leading programs in India. This center offers both outpatient and inpatient consultations, home-based care of sick patients, and pediatric palliative care. It has had successful interactions with the government of Andhra Pradesh such that the procurement process for morphine for palliative care centers has been simplified and state sponsored health insurance now includes palliative care for patients with cancer living below the poverty line. MNJ also works on a national level. The MNJ team has collaborated with WHO-India and the Ministry of Health to develop guidelines on setting up palliative care services and procuring oral morphine. It has been approved by the Indian Association of Palliative Care as one of the regional centers that can offer classes for the “Essentials of Palliative Care” course for health professionals in India. It also provides certificate training in palliative care to nurses and doctors from Nepal.
Together with the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, the PAX team is developing a plan to address the enormous and growing unmet need for palliative care services. ORCI is the sole government funded cancer center and therefore, in a unique position to scale up services throughout the country. The ground work for establishing ORCI as a center of excellence for palliative care has been laid - sensitization workshops for heads of government health facilities have been held and training of health care workers has been performed. The palliative care program at ORCI will be further developed over the next several years.