Working together to improve pediatric palliative care in Nepal

Dr. Manon Ranger is the principal investigator for a team of health professionals who have travelled to Nepal to deliver training sessions.

Headshots of PCC Team
Pictured from left to right top row: PI: Dr. Manon Ranger PhD, RN Co-PI: Camara van Breemen MN, CHPCN©, NP Co-PI: Dr. Sudhir Sapkota, MD Co-A: Dr. Megan Doherty, MD, Program Director, Palliative Care, Children’s Hospital of Easter Ontario (CEO) and PPC

This story originally appeared on PHSA On Demand - POD (internal news site) on November 29, 2023. 
Global Health Research Nurse

All over the world, millions of children suffer from pain and other distressing symptoms as a result of serious illnesses. Sadly, most of these children live in countries where access to specialized palliative care is extremely limited. This is especially true in Nepal, where over 40,000 children need palliative care annually. Last October, an interdisciplinary team from BC Children's Hospital/Canuck Place Hospice, BC Children's Health Research Institute (BCCHR), and the University of British Columbia traveled to Kanti Children’s Hospital in Nepal to share their expertise in pediatric pain and palliative care.

Camara van Breemen, a nurse practitioner and enhanced community care lead at Canuck Place, and Dr. Natasha Datoo, a pediatric oncologist and palliative care physician at BCCH and Canuck Place respectively, have been providing education and mentorship in pediatric palliative care to clinicians in Nepal, India, and the Philippines for the last eight years as volunteers with Two Worlds Cancer Collaboration. Camara has been an active member of C&W’s growing community of practice in Global Health, which is supported by the Institute for Global Health at BC Children’s Hospital and Women’s Hospital+Health Centre (IGH-BCCWH). Camara had been exploring opportunities to expand and evaluate her and Natasha’s pediatric palliative care work in Nepal, which led her to connect with Dr. Manon Ranger, a nurse scientist at BCCHR and assistant professor at UBC School of Nursing, and Dr. Sudhir Sapkota, the head of pediatric oncology at Kanti Children’s Hospital. Together, this team was awarded a 2023 IGH-BCCWH Seed Grant competition to initiate a two-year training program and investigate facilitators and barriers to applying pediatric palliative care education into practice in Nepal.

With support from Kanti Children’s Hospital and Two Worlds Cancer Collaboration, the team coordinated the delivery of nine virtual training sessions in pediatric palliative care from May to July 2023. These sessions were extremely impactful for the Canadian team (including two BCCH nurses, Melanie Hameluck and Justine Behan) and the partners in Nepal. In total, 40 Nepalese healthcare practitioners participated in the training. Participants demonstrated increased knowledge and improved perceptions towards pediatric palliative care delivery after taking part in the training. The team then travelled to Kathmandu (Nepal) to deliver a three-day in-person workshop on pediatric palliative care topics including pain assessment and management, advanced care planning, communication skills, and play therapy, as well as grief and loss support. While there, the team also provided a half-day workshop to a captive group of acute care clinicians on pharmacological and non-pharmacological methods for managing procedural pain in children.

Over the next year, the team is planning to create and deliver a sustainable training program for Nepalese nurses in pediatric palliative care, led by trained healthcare practitioners from Nepal. This work, and the education this team is providing, will limit suffering for Nepalese children and families, and improve the care they receive in a sustainable way. Join us in congratulating this team on making steps toward global health equity!

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