Getting Lost in the Crowd, Hidden Palliative Care Patients in Dhaka, Bangladesh

Getting Lost in the Crowd, Hidden Palliative Care Patients in Dhaka, Bangladesh

A WHPCA Pilot Urban Slum Palliative Care Project 

Palliative Care Assistants with an older person

Dhaka is an overcrowded city, capital of an equally overcrowded country, flooded regularly by three big rivers that release with ferocity murky waters and residue from the mountains as far as India and Nepal.  Every possible living space is occupied; even river banks and perilously unstable silt islands called chars. The presence of many older people is inconspicuous. They easily get lost in the multitudes; their presence and needs sadly go unnoticed within the hassle and bustle of urban life. Tucked away in slum communities that mushroomed, around and in the city, many live hidden lives.

Number is a sad thing in Bangladesh. The bigger it gets, the easier it is to ignore the few.  Bangladesh has a population of 160 million people. Every year 250,000 Bangladeshis require palliative care; of this number 160,000 are older people. Very few access pain and palliative care services. In 2012, for example, only 1,070 accessed these services. The country do not have enough facilities to respond to this burden as there are only seven hospice and palliative care providers according to a 2011 mapping. The country ranked 79 out of 80 countries in the Economist Intelligence Unit, “2015 Quality of Death Index, Ranking Palliative Care Across the World”. Only Iraq had a worst ranking at 80.

The Worldwide Hospice and Palliative Care Alliance (WHPCA) is implementing a modest yet invaluable project. It is running a pilot urban palliative care service for 100 older people in two slums, Korail and Agargoan, with support from 200 family members and eight palliative care assistants recruited from these slum communities. Support is also provided by the Centre for Palliative Care of the Bangabanghu Sheikh Mujib Medical University. The project is helping improve the quality of life and well-being of the older people involved and their families, and will lay the foundation for more urban slum care delivery not just in Bangladesh, but also in other resource poor countries. Modest as it is, the project is extremely relevant and necessary. Like a lone candle in the dark, it shines as a beacon in our efforts to promote palliative care services in Bangladesh.