NEWS from PCPN members

Andrew Dickman's visit to Japan

Andrew is the senior clinical palliative care pharmacist at Liverpool Heart and Chest Hospital and at Marie Curie Hospice, Liverpool. The photo shows him with two of the pharmacy professors at Osaka Unversity in October 2008

 

 

Andrew was invited to speak in Tokyo at the 1st Congress of the Japanese Society for Pharmaceutical Palliative Care and Sciences in October 2007. Following on from this successful trip, four pharmacists from the Graduate School of Pharmaceutical Science, Osaka University visited the Marie Curie Hospice in Liverpool. They also spent a day at St Christopher's Hospice in London. Andrew then received an invitation to lecture as part of a palliative care study day at the Department of Pharmaceutical Science at Osaka in October 2008.  He delivered a session about palliative care, concentrating on the current situation in the UK and specifically the role of the clinical pharmacist as part of the multi-disciplinary palliative care team.

Professor Satoru Tsuneto, from the Department of Palliative Medicine, Osaka University Graduate School of Medicine completed the session by discussing the present situation in Japan and comparing it with the UK.

Andrew hopes to develop further links with Japanese healthcare professionals. Next year, he plans to visit Japan to investigate the possibility of developing a research programme between Liverpool and Osaka Universities.

Margaret Gibbs' visit to Kerala, Southern India

As we were booking a sight-seeing train trip from Mumbai to Delhi in February 2010, I suggested that we tagged on a few days of R+R in Kerala. It also seemed a great opportunity to visit on the the Hospices that are well established in this state. I corresponded with Dr M R Rajagopal, who is the Chairman of Pallium India and the founder of the hospice service at Trivandrum, the state capital. Dr Raj is a pioneer in his country, establishing Pallium India - a registered charity. Dr Raj was instumental in making morphine available in Kerala, the only state where this is so in India. He has also established a palliative care Institute on one floor of a hospital in the city which is given over free of charge to the charity and houses both an inpatient unit and the base for the comprehensive homecare service. Healthcare is not generally free in India but those who have no money are not denied treatment. At the Insititute in Kerala, those who can afford to pay for treatment do so and that money is spread around to finance the service for everyone. Local businesses are a great support to the unit and also sponsor the smart white vehicles used by the homecare nurses. The unit has eight private rooms, a six-bedded ward and a second ward used for out-patients and day care. It is airy and bright with plants and flowers amongst the basic furniture. It also acts as a training centre and I met with two doctors coming to the end of their six-week placement who are now faced with the challenge of starting up services in other parts of the country.

I sat with the doctors as they reviewed some drug charts and saw that they are using many of the same strategies and drugs that we are using. If patients come into the unit in severe pain, they titrate their pain using i.v. morphine and once pain is relieved, they convert the total dose required up to that point over to oral morphine on a 1:1 ratio. This is acheived quickly and simply. I was also impressed with their idea of using nebulised (!) metronidazole infusion for a patient with a fungating tumour in the nasopharynx - clearly the droplets stand a better chance of getting where they are needed in this way. The drugs trolley stands by the window in very warm conditions and with the ampoules and strips of tablets in individual pots. I told them this made me feel a little nervous but they pointed out that their patients can't read so would be unlikely to take anything from this trolley. They do lock up and record their morphine though.

The unit has a staff of in-patient and homecare nurses, input from anaesthetists (Dr Raj is also an anaesthetist) and a dedicated pharmacist who is clearly a valued member of the team but unfortunately, she is moving away soon. In a discussion session later in the day, it was clear that we have so much in common in the way we work and it was a great experience for me to meet these colleagues working in simple surroundings with limited resources but all speaking the same language of palliative care.



Staff at the Unit - Dr Raj had to travel to the UK so was not in the photo

Nurses' station