དཔལ་ལྡན་འབྲུག་གཞུང་། གསོ་བ་ལྷན་ཁག།
Royal Government of Bhutan
Phuentsholing Hospital Chhukha: Bhutan
Authored By: Phub Wangdi, Team leader, Palliative Care Services, Phuentsholing Hospital
THE JOURNEY BEGINS
The journey of introducing palliative care services in Phuentsholing, Chhukha, began unexpectedly for me. One day, I received an invitation from a health worker from Phuentsholing to attend the Training of Trainers (TOT) program on palliative care. I offered this opportunity to my staff, but there was no interest. Therefore, as the unit in-charge, I reluctantly decided to attend the training myself. Initially, I saw it as an additional burden on top of my regular responsibilities as the in-charge for the Maternal and Child Health unit. I also had limited knowledge about the concept of palliative care. However, on the very first day of the training, my perspective changed. I was deeply inspired by the essence and value of palliative care and the focus on improving the quality of life for patients with life-limiting illnesses.
IMPLEMENTING A MUCH-NEEDED SERVICE
After the training, motivated and committed, I took the lead to mobilize a multidisciplinary team for Chhukha district. Our team comprises a physician, nurse, pharmacist, physiotherapist, traditional medicine practitioner (Drungtsho), and me as the community health worker. We conducted comprehensive training for health workers, caretakers, and village health workers, with financial support from the Ministry of Health. On August 15, 2024, Phuentsholing hospital officially launched its home-based palliative care service. We began with 12 patients and have now registered 50, offering much-needed support to individuals and families dealing with chronic and terminal illnesses.
OUR PROGRAM
Each Thursday, our multidisciplinary team conducts scheduled visits to patients’ homes, prioritizing cases based on medical urgency and individual needs. Through our personalized, compassionate care at the patients’ home, we bring the hospital to them. Our multidisciplinary approach ensures that during each visit, the patient receives holistic care that addresses their and their caregivers’ physical, emotional, and spiritual needs.
OUR SERVICES
We offer our patients a wide range of compassionate and essential services to ensure quality care for patients with life-limiting illnesses in the comfort of their homes. These services include:
- Wound Care and Dressing: Regular assessment and dressing of pressure sores, malignant wounds, and other chronic wounds to prevent infections and improve patient comfort.
- Catheter Care: Insertion, change, and management of urinary catheters, including patient and caregiver education on hygiene and maintenance.
- Physiotherapy Services: Home-based physical therapy sessions to improve mobility, manage pain, and enhance overall well-being.
- Pain and Symptom Management: Comprehensive management of pain and other distressing symptoms such as breathlessness, nausea, and fatigue using appropriate medications and therapies.
- Medication Refill and Delivery: Regular refilling and home delivery of essential medications to ensure continuity of care.
- Issuance of Death Certificates: Timely and respectful issuance of death certificates when required, providing support to grieving families.
- Community Support and Counseling: Emotional, psychological, and spiritual support for patients and their families through regular counseling sessions.
- Traditional Medicine (TM): Integration of traditional medicine practices where appropriate, in collaboration with a qualified Drungtsho.
- Referral and Linkage Services: Connecting patients and families with relevant social welfare schemes, disability support, and financial aid when necessary.
- Caregiver Training: Empowering family members through skill-based training to care confidently for their loved ones at home.
- Awareness and Collaboration: The team conducts regular awareness programs in the community and works closely with other government agencies and NGOs such as RENEW and BBS to advocate for palliative care and provide holistic support to patients from low socio-economic backgrounds.
INNOVATIVE STRATEGIES FOR LOW-INCOME PATIENTS
Understanding the unique challenges faced by low-income palliative care patients, our team has actively introduced several innovative strategies to promote dignity, independence, and economic resilience. We believe that our services should be more than medical care and should include a holistic support system for those in need. Our initiatives include:
- Training family caregivers, empowering them with essential skills to provide safe and compassionate care at home. This reduces the burden on healthcare facilities and builds confidence and self-reliance within families.
- Independent living through motivational support and practical skills development for our younger patients living with disabilities or life-limiting conditions. We have collaborated with national media to raise public awareness and generate wider community support for palliative care.
Partnerships with non-governmental agencies like RENEW have allowed us to introduce income-generating skills training tailored for socio-economically disadvantaged patients. Training such as basket weaving, home decor crafting, basic self-cooking, and tailoring havebeen initiated. These programs not only boost self-esteem but also provide a sense of purpose and financial support, helping patients and their families lead more empowered lives despite their health challenges.
COLLABORATIVE PARTNERSHIP AND SUPPORT
The success of our palliative care services in Phuentsholing Hospital is the result of many partnerships and support. This includes visionary leadership from our Chief Medical Officer, whose consistent encouragement and commitment to community-based care has enabled us to provide comprehensive and compassionate service. The hospital leadership has been vital in providing transportation, ensuring that our team can reach patients across Phuentsholing and surrounding areas without logistical challenges.
In addition, each member of our multidisciplinary team brings together valuable expertise, insights and a genuine willingness to serve those in need. We have also been fortunate to receive guidance from the pioneering palliative care team in Thimphu. The Thimphu palliative unit began in 2018 and until now has been instrumental in providing and developing palliative care services.
ASSISTANCE FROM HEALTH VOLUNTEERS OVERSEAS (HVO)
Through close collaboration with the palliative care unit in Thimphu, we have been able to develop an initial connection with HVO. HVO has been assisting the Thimphu palliative team since 2018 with didactic education and program development. Through a recent site visit to Phuentsholing by the HVO Country Director for the Bhutan Oncology and Palliative Project, we were able to discuss ways to strengthen our services. Since that visit, our team has remained actively engaged with HVO through regular Zoom meetings every Thursday, where we interact with many palliative care experts from around the world. These HVO sessions have become an important learning platform for us, providing exposure to international best practices and innovative care approaches. We look forward to more collaborative and educational opportunities that will further enhance our capacity to deliver quality palliative care services in our community.
THE IMMEASURABLE REWARDS
Over the last few months, we have received overwhelmingly positive and deeply touching feedback from our patients and their families. Many families have expressed their satisfaction with the personalized care and support provided by our palliative care team. We have been invited into our patients’ homes and their families during their time of illness and as a support system during their time of grief. We were recently invited by a patient’s family to attend the funeral of their loved one. For us, this invitation was not just a formality, it was a sincere expression of gratitude and respect for the care we provided. Actions such as these from our patients and their families inspire us and reaffirm the value of our work. The Phuentsholing palliative care team feels deeply honored and emotionally fulfilled to know that our services are making a meaningful difference in the lives of patients and their families during their most vulnerable moments.
THE JOURNEY AHEAD
While our new palliative care journey in Phuentsholing has been filled with many successes, we have also encountered several challenges. One of our main challenges is the shortage of physicians, which sometimes affects our ability to respond promptly to all patient needs. Additionally, there is a lack of specialized training in palliative care among health care professionals, which limits the depth of care we can provide. Despite these challenges, our team remains optimistic. We are committed to continuous learning and are actively seeking opportunities for further training, mentorship, and exchange programs with other palliative care units—both within the country and abroad. We also hope for continued support from international partners and organizations to help build our capacity and strengthen the quality of palliative care services for the people of Chhukha.
As we look ahead, the Phuentsholing palliative care team continues to strive for excellence through innovation, community engagement, and multi-sector collaboration, ensuring that no patient faces their illness alone or in pain.
Right to Left: 1. The team preparing to leave for their Thursday home visits. 2. & 3.On the way to patients’ homes. 4. With a patient