“Across the globe, disease and death are intertwined with spirituality, and the Middle East is no different,” says Dr Azza Adel Ibrahim Hassan. “Besides, this is a region that is the birthplace of three major religions of the world; it goes without saying that conversations about palliative care or terminal illnesses – such as cancer – will be influenced by religious interpretations and beliefs.”
As the Programme Director of Supportive & Palliative Care Section at the National Center for Cancer Care and Research (NCCCR), and with more than two decades of experience in the field, Dr Hassan is well-placed to comment on the link between spirituality and terminal illnesses – and more.
“The World Health Organisation estimates that over 950,000 new cancer diagnoses will occur annually in the Eastern Mediterranean region – which includes the Middle East and Qatar – by 2030,” says the physician, who is also an Assistant Professor of Clinical Medicine at Weill Cornell Medicine-Qatar, a Qatar Foundation partner university.
“This means that this part of the world will have the highest relative increase of cancer of all regions in the world. This fact alone points to the need to accelerate the availability and accessibility of palliative care services across this region.”
In 2008, Dr Hassan was invited by Qatar’s then Supreme Council of Health – now the Ministry of Public Health – to set up the country’s first palliative care unit at what was then Amal Hospital, and is now the NCCCR.
She says it was a challenge, not so much because she was initially alone and had to start from scratch, but because she had to raise awareness about the real meaning of palliative care, and dispel misconceptions associated with it – even among healthcare professionals.
“When I first arrived in Qatar, I noticed that people, including physicians, mistook palliative care for end-of-life care; that there was almost a sense of phobia and dread linked with even hearing or saying the word ‘palliative’,” she explains. “This was – and still is – misleading.
“Palliative care addresses the physical, emotional, social and spiritual suffering of patients and families facing the consequences of any life-limiting illness, not just cancer. End-of-life care is only one part of palliative care. So that was my first goal – to educate health practitioners as well as the public on the meaning of, and need for, such services in the health sector of this country.”
Through workshops and direct meetings with key stakeholders, Dr Hassan made steady progress. Eventually, a dedicated 10-bed facility – in place of the few beds that were being used – was set up in the NCCCR in 2014.
Today, 11 years on, the one-member team has expanded to a team of seven dedicated physicians, two clinical nurse specialists, and 25 nurses, who are supported by a multi-disciplinary team of dieticians, respiratory therapists, physiotherapists, social workers, clinical pharmacists, and psychologists.
She admits that she and her team have had to deal with religious and cultural notions that influence the attitudes of people towards palliative care. These include a general hesitancy to use opioid-based medications for pain relief and breathlessness, families’ lack of trust in the patient’s decision-making abilities, and a reluctance to withdraw aggressive measures in the face of inevitable death.
Dr Hassan says all religions look to ease human suffering, and emphasises how it is necessary to convince patients and their families that all decisions are made with the comfort of the patient in mind, and by respecting their specific religion – a point which she hopes that a conference that is being held in Vatican City, will stress on.
The symposium, titled Religion and Medical Ethics: Palliative Care and the Mental Health of the Elderly, is being held from December 11-12 and is co-hosted by the World Innovation Summit for Health (WISH), an initiative of QF, and the Vatican’s Pontifical Academy for Life.
“At the conference, the medical fraternity and religious leaders will be holding frank discussions on the best way to help patients and their families facing issues associated with life-limiting conditions. This is crucial to coming up with a set of guidelines that can be used by physicians like myself, all over the world.”
Dr Hassan says that being able to set up Qatar’s first palliative care unit has been personally rewarding, but adds: “The country still has a long way to go.
“For instance, as our unit is situated in the NCCCR, we cannot admit patients who are dying of diseases other than cancer here. This means our team need to work with various clinical departments and services, to bring palliative services to the bedside of patients with non-malignant conditions.”
The physician also points out that the essence of palliative care lies in its ability to give patients with end-of-life needs the option to be among their loved ones. This means that palliative services should not be hospital-bound; they need to be extended to the homes of the patients.
“Our studies have shown that almost 60 percent of our patients prefer to die outside a hospital setting,” she says. “Yet, compared to other countries with similar healthcare facilities, patients in Qatar spend the longest time in hospitals, prior to death. In order for their wishes to be granted, we have to ensure we have the manpower and resources to provide home care.”
Qatar’s palliative care programme, though relatively young in comparison with its Western counterparts, is the first palliative care programme in the region to receive the recognition of the Joint Commission International – an international accreditation body specialising in healthcare – on three occasions. Additionally, the programme has also started a Fellowship programme in palliative care.
The 10-bed unit located on the first floor of NCCCR is a significant start. And hearing from the family of a patient who was cared for at the facility helps to provide a true understanding of the magnitude of its impact.
Zeinab Doukali, an Assistant Program Editor at Al Jazeera, lost her mother to cancer a year ago; she was taken care of in both a medical ICU at Hamad Medical Corporation, and at the palliative care unit at the NCCCR, under Dr Hassan.
“You only need to walk through the swing doors under the sign that says Supportive and Palliative Care, and you can feel the gentleness, understanding and acceptance that seems to radiate from the doctors, nurses and staff there,” says Doukali.
“It’s hard to describe the level of care that those people gave my mother – the respect they showed her until her last breath; their reassuring smiles; their quiet conversations,” she says. “I remember how, even when she was quite weak, she said she felt energised a few days into her first stay in the unit. Even the way they touched my mother, the manner in which they turned her over in bed – it was as if she was the most precious thing in their lives.
“I’m a journalist and I consider myself adept at describing emotions. But when I saw the interaction between my mother, who couldn’t speak English, and the nurses – most of who couldn’t speak Arabic – I realised that the language of compassion needs neither alphabets nor vocabulary.”
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