Now we can all hear you…” – palliative care tele-education for the Rohingya humanitarian crisis by Dr. Hunter Groninger

by Dr Hunter Groninger, MD

One of the many challenges presented by the ongoing pandemic has been the need to pivot from traditional (and therefore comfortable) in-person teaching to the virtual world. Although I did not realize it at the time, I experienced this transition in real time. In early February 2020, I sat with two palliative care colleagues in a café in Cox’s Bazar, Bangladesh. We were approaching the end of a two-week journey to teach primary palliative care skills to local clinicians committed to providing humanitarian medical aid to the Rohingya refugees in nearby camps. In the wake of colleagues who had paved the way for us, we had lectured on symptom management, opioid titration, psychosocial/spiritual assessment, discussing goals of care, and so on. Now, over a coffee, we watched the news of a virus moving from Wuhan, China, to Germany and elsewhere. First, we wondered if these events were as serious as the news suggested – then, we worried whether we would be able to fly home to our respective countries.

Temporary dwellings in the Rohingya Refugee Camp area.

Months later, as the pandemic unfolded, addressing the deep suffering of the Rohingya people 1 clearly required a pivot in strategy. Project ECHO presented a path forward. Project ECHO (Extension for Community Healthcare Outcomes) is an online technology-enabled learning system designed to strengthen the knowledge and skills of community-level health care providers by providing remote teaching, guidance, and mentorship. It has been successfully implemented in other palliative care education settings 2. Here, an international multidisciplinary core, importantly including Bangladeshi faculty, developed and tested education content aligning general palliative knowledge and skills with local clinical and cultural concerns.

Through colleagues in Cox’s Bazar, we advertised, encouraged, recruited clinician participants from local health organizations and NGOs. The first cohort (56 participants) completed the pilot course in fall of 2020; with a second and third cohort completing the course in Feb and August 2021 respectively. In total more than 200 health care professionals have participated. Interactive learning sessions lasting about 75 minutes, are structured around a didactic presentation by one or more faculty members and a related case discussion. Participants are encouraged to bring challenging clinical cases and questions for group discussion.

We measured participants’ experiences with this learning program through online self-assessments, which show improvements in palliative care knowledge and skills – this is encouraging. Still, there is room for improvement. Most teaching occurs in English (with summaries and clarifications in Bangla). Internet connections are not always reliable, muddying opportunities to connect or mentor. And, we have not yet assessed how the teaching has translated into changes in local practice.

“palliative care is a human right” – Dr. Farzana Khan

As international palliative medicine expert and partner in this project, Dr. Farzana Khan reminds us, “palliative care is a human right.”3. So, the work continues, as it must – a mission of PallCHASE (Palliative Care in Humanitarian Aid Situations and Emergencies), a mission of our shared vocation. I certainly hope one day to travel back to Cox’s Bazar to work alongside our new palliative colleagues to continue to deliver on Dr. Khan’s message.

Thank you to Two Worlds Cancer Collaboration, PallCHASE and Fasiuddin Khan Research Foundation for partnering to support this education program.

References:

1.         Doherty, M. et al. Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study. PLOS Med. 17, e1003011 (2020).

2.         Doherty, M. et al. Using Virtual Learning to Build Pediatric Palliative Care Capacity in South Asia: Experiences of Implementing a Teleteaching and Mentorship Program (Project ECHO). JCO Glob. Oncol. (2021) doi:10.1200/GO.20.00481.

3.         Khan, F., Ahmad, N. & Anwar, M. ‘Palliative care is a human right’. J. Bangladesh Soc. Anaesthesiol. 21, 76–79 (2009).

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