This article was extracted from an article in the Newsday Magazine in Trinidad & Tobago
It was submitted by David Seemungal who was responsible for bringing this need to the attention of our club.  North Scarborough Rotary supported the program as part of International outreach.
Gateway to Heaven
By ANGELA PIDDUCK Tuesday, June 2 2015

Scores of patrons shared bowls of soup in the Hilton’s Ballroom at the Palliative Care Society of Trinidad and Tobago (PCSTT) Annual Poor Man’s Dinner on May 23. Unlike Oliver Twist, starved and mistreated, empty bowl in hand, after his allotted bowl, who mustered the courage to approach his master saying “Please, sir, I want some more”, this was rich and tasty vegetable soup, chicken soup and fish broth with dumplings, served with warm rolls, and second helpings were allowed.
This dinner is an annual fund-raiser organised by the Society to upkeep The Palliative Care Unit at Caura, now accepted as the first state-funded, specialist unit within the Caribbean, and is referred to by the Caura staff as the “Caura Hyatt” or by others as the “Gateway To Heaven.” 
The unit is a joint venture between the PCSTT and the North Central Regional Health Authority (NCRHA). It was founded in April 2011 by Satyernand “Saty” and Chan Seemungal of Maraval in memory of their daughter, Trudy-Ann Seemungal-Velauytham, who died of lung cancer at age 48, in 2009. 
Working with an extremely dedicated team at Caura Hospital, NCRHA and the PCSTT identified and renovated a formerly derelict building within the hospital to produce the Caura Hospital Palliative Care Unit, a 12-bed, in-patient unit that provides high quality, compassionate end-of-life care for patients with any terminal illness in a peaceful and serene environment. Palliative care is, in essence, about caring for patients with illnesses that cannot be cured, relieving their suffering and supporting them and their families through difficult times. The aim of Palliative Care is therefore to improve quality of life. 
One of only two physicians in Trinidad with formal palliative care training – Dr. Neil Nijhawan – who is in charge of the Caura Unit – gave diners a comprehensive talk, accompanied by slides, on the services offered since the unit opened on August 9, 2014. The other physician, Dr. Ravindra Maharaj, runs a clinic located at the National Radiotherapy Centre in St James. 
Already, said Seemungal, president of PCSTT, more interest is being generated through a Master’s programme at the University of the West Indies, Mount Hope, now in its third year, with 30 students graduating from the last programme. Some of the services offered include “a ward-based palliative care consulting service at the Eric Williams Medical Sciences Complex (EWMSC)”, explained Nijhawan. Patients remain under the care of their primary team, with the palliative care team providing specialist input; and out-patient clinics at the Caura Hospital Palliative Care Unit, on Tuesday and Thursday mornings from 8 am to 1pm, by appointment only, so that patients do not have to come to clinic hours before their appointment and wait. 
“Referrals are accepted for adult patients with a diagnosis of any advanced, progressive, life-limiting illness. This includes end stage cancer, end stage organ failure (kidney failure, heart failure, dementia) and chronic obstructive pulmonary disease (COPD). Typically, patients referred to the palliative care service have an expected prognosis of less than a year. Referrals are usually for the following reasons: 
* Complex symptom control, e.g. severe, uncontrolled pain. 
* Complex psychological or spiritual distress. 
* Respite following radiotherapy, chemotherapy, surgery or other palliative interventions. 
* Care of the actively dying patient.” 
“Effective palliative care requires a multi-disciplinary approach to patient care. We are fortunate at Caura to have a team that comprises nurses, doctors, patient care assistants, dieticians, social worker, chaplain and medical students, Nijhawan said. 
“Since the unit opened, we have had in excess of 300 referrals from all corners of TnT. Referrals come from hospital teams, GPs in the community, patients/relatives at home and ‘walk ins’. While palliative care has been traditionally affiliated with oncology/cancer services, it is not limited to patients with end stage cancer. At present, 83 percent of our referrals are for patients with end stage cancer (lung cancer being the most common – which mirrors worldwide statistics). But we are getting increasing numbers of referrals for dementia and other organ failure.”
Nijhawan also spoke of the success rate of the unit. 
“We have had just over 130 admissions to the in-patient unit since we opened. Seventy-four percent of the admissions are for end-of- life care, 22 percent for symptom control and four percent for respite. A common perception is that once someone is sent to a palliative care unit, they never go home again. However, at Caura, our discharge rate is approximately 40 percent - meaning that 40 percent of the patients who are admitted to the palliative care unit are well enough to return home. 
Unfortunately, quite a large number of patients referred to us (30 percent), pass away within 24 hours of that referral being made. This reflects (1) the fact that many patients are diagnosed with a terminal condition at a very late stage and (2) medical teams wait too long before they refer to the palliative care team – this is improving as we are now receiving referrals at the point of diagnosis. Obviously ensuring that more doctors are familiar with palliative care is a priority and this has already started with fourth- year medical students being introduced to palliative care at both the NRC in St James and at Caura. 
So many times we hear family or friends not wanting to use heavy pain killers but this doctor so well qualified in this field spoke about “Morphine for pain control as a global human right. Morphine availability varies around the world with some depressing statistics – 8 percent of the world’s morphine is consumed in North America and Europe but low and middle-income countries are home to 50 percent of all the world’s cancer patients. It is impossible to provide good quality pain control without a decent supply of morphine, and while we do have access to morphine in Trinidad and Tobago, there is room for improvement.” 
Nijhawan made the comparison, “If Uganda can compound its own liquid morphine for US $2 a bottle, then what is our excuse? Currently it costs approximately TT$ 500 for a 500ml bottle which is often beyond the means of many of our citizens.”
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