I am a pediatric oncologist from Varna, Bulgaria!

I am Y Shailaja from Fellowship 2026

Im a resilience person

I am Lakshmi, a radiation oncologist from India. Grateful to be part of the Fellowship in Palliative Care 2026.

hello

I am really excited to be a part of this incredible and diverse team!

-Community Physician

Trying to use Padlet.

It is great to start this journey with you all.

I am an occupational therapist in the UK with 10years experience working in an acute hospital.

I am looking forward to understanding more of palliative care and the unique insight across the globe.

Thanx

Hi , I’m Nisha from Hospis Malaysia, one of the palliative care nurse working in the community. Pleasure to meet all of you.

Nice to meet all off you

Hello everyone, Myself Dr Swagata Biswas, from India. I am a practicing Onco-anesthesiologist and leading the department of palliative care in a corporate hospital. I joined the course to learn about the capacity building of such unit and expand community level services.

I am Dr. Navya from Kerala, India.....

Happy learning guys

From IRAq

I am Dr.Nasir Uddin Mahmud Shuvo

From Bangladesh

I am an Oncologist

Belongs to magenta team

Very happy to be part of this amazing community

Hello everyone. Glad to be here and learning.

Happy to be part of cohort 10

emergency, rehabilitation, home healthcare, oncology and school health settings in Cameroon and the UAE.

Currently serving as a Staff Nurse / School Clinic Nurse at Fakeeh University Hospital, Dubai, UAE. I have Strong

interest and hands-on experience in oncology and palliative nursing, including one-on-one post–cancer

survivorship care. Selected Fellow, Fellowship in Palliative Care (2026) and Foundation Course in Palliative Nursing ( Pallium India) Committed to delivering patient centered, culturally sensitive, and evidence-based care.

meaningful

interest

It is more inclusive and involves all aspects of palliative care and all ages ,including all stakeholders . It is to alleviate suffering, ensure comfort and support to the patient looking at the whole-person in a holistic approach.

SIMILARITIES: Improves quality of care for the patient, holistic approach though WHO further expands on what is holistic ie pain , etc

DIFFERENCES: WHO: An approach, how we do it

I’m team blue. My name is Ouchy BON. I’m from Cambodia. I’m worked at Khmer Soviet friendship hospital of Phnom Penh, Cambodia. I’m so interested and happy to join this course. I hope to continue this course smoothly and successfully, to be further improved nursing care and health care at my hospital. Thank you.

^{Now when we compare it with other definition of IAHPC after a gap of 16 years, we can identify the key differences in scope, timing of onset of care and focus.}

^{However, as we move forward, we can think of including community participation, addressing the grief / bereavement support to the family and care giver in the palliative care scope.}

^{Y Shailaja: a compassionate nurse and professional social worker}

1.Most of the team members identified that palliative medicine is mostly restricted to tertiary hospitals and greatly lacking at community levels.

2. There is derth of trained physicians and many countries doesn't allow non physicians to prescribe opioids. Lack of availability of essential narcotics also is a major challenge!!

3. Talking about finances, at most of the countries palliative care services are still not covered by insurance policies. These cause a lot of problems while distributing the services equatiably.

4. Last but not the least, early or timely integration of PC is still not the standard of practice. Adequate structured hospice is lacking making quality of end of life care poor.

Possible solutions:

1. Integration of PC at district level health care services.

2. Training paramedic staffs for safe opioids prescription for community level PC.

3. Govt policy for integration of PC.

Am Gladys, a Critical Care Nurse Specialist

•⁠ ⁠Many patients are very sick. Some in ICU. Some taking chemotherapy. They have pain, breathing problem, weakness, fear. We treat pain and other symptoms.

•⁠ ⁠Family love patient very much. Many times they say “do everything.” So we must talk slowly and clearly. We explain disease and future in simple words. No false hope. No harsh talk.

•⁠ ⁠In our culture, family is very important. Decision is taken together. So we involve family in every discussion.

•⁠ ⁠Many families have money problem. So we must think before giving costly treatment which may not help. Avoid useless expense.

•⁠ ⁠Patient feelings are also important. We sit near them. We listen. We ask, “What is troubling you most today?”

•⁠ ⁠Education level and health understanding are different for each family. So we speak in easy language.

•⁠ ⁠Palliative care should start early, not only in last stage. Main aim is good quality of life — less pain, more comfort, more respect.

•⁠ ⁠In low resource setting, we improve what is already there. No need to make big costly new system.

•⁠ ⁠In our hospital, teamwork is very strong. Doctors, nurses, social workers, chaplains, community health workers — all work together.

•⁠ ⁠Budget may be less, but people are creative and helpful. We support each other and serve patients with heart.

In simple words, holistic care means caring with head and heart — less suffering, more comfort, more dignity.

it is an organization for palliative care services in Jordan providing home visits for cancer patients at end life and for elderly people with dementia and Alzheimer.

The second challenge relates to pain management, particularly the reluctance of healthcare providers to administer medication and the fear among the patients to use morphine due to perceived addiction or being in the last phase of the illness. At times, there is lack of morphine, which poses another problem in this regard.

There is an imbalance in the kind of services provided by health care facilities, where palliative care is primarily targeted at people living with cancer and not those suffering from other conditions such as heart failures, respiratory diseases, renal failure, and dementia. More people suffer from non-communicable diseases, but most palliative care programs are not directed to them.

Hospitalization is another obstacle faced by palliative care programs because in many cases, palliative care services are provided within hospitals, and hence there are multiple readmissions as the condition deteriorates. Patients are expected to receive services in hospices or at home and even in the community, but this option is underdeveloped in most cases.

There is no availability of trained personnel for palliative care in some countries. Lack of training can be seen from the fact that palliative care services are poorly incorporated into medical and nursing curriculum. Therefore, the health care professionals will not be adequately educated about pain management and end-of-life services. Also, in cases where the professional is not adequately trained, it becomes difficult to offer quality palliative care.

Other system-related challenges also exist. For example, there is a lack of integration of palliative care within the primary healthcare systems, ineffective referral processes, as well as the lack of policies and financing mechanisms that would facilitate its implementation. Moreover, in some countries, such as India, palliative care programs are either funded externally or are not considered in the framework of national health plans and budgets, which complicates its development and expansion.

On top of that, there are socioeconomic factors that hinder the access to necessary services. Financial issues, transportation difficulties, and weak infrastructure in some countries may prevent individuals from using appropriate resources. As a result, family members face mental, psychological, and even physical strain due to the lack of proper assistance and education.

However, there are several ways out of the situation. First of all, it is essential to implement palliative care within existing healthcare systems to recognize needs at an early stage. The promotion of the service will help to dispel common myths about it and encourage more patients to seek professional advice. Furthermore, encouraging home- and community-based services will reduce the load on hospitals and increase convenience. Let us work on embedding palliative care in NCD clinics as a standard of care for the patients who are eligible.

In addition, facilitating access to medications, particularly opioid-based ones, and enhancing education among healthcare professionals will also be crucial. While establishing the supply chain is important, addressing reasons for staff not wanting to prescribe or dispense morphine will be important by way of training, and also addressing the myths and fears by patients on morphine use. Additionally, its important to continue to empathize to complete evaluation of pain and its management- such as following the WHO step ladder model, using the adjuctsand  the non-pharmacological options.

Overall, while palliative care has been established in many countries, the core difficulties relate to raising awareness, integration into systems, training of staff, and engagement of communities. Addressing all of them will allow overcoming these obstacles.

Part of integration is to engage all peer and community networkds: Such as faith leaders, elders, extended families ( even children), patient or family alumni, etc

Exploring culturally appropriate ways of truth telling- as this will be context specific, and sometimes patient specific aswell…. And the focus shouldn’t be prognosis- but rather on the goals of care for the patient, while balancing as much as possible family desires.