Establishing the College of Palliative Medicine of Sri Lanka: A momentous feat 

“You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully but also to live until you die.”

– Dame Cicely Saunders 

Hospice and palliative care are now recognised disciplines globally, and focus on the quality rather than the length of life. This year, 9 October 2021 marked World Hospice and Palliative Care Day. This is an annual unified day of action to commemorate and promote palliative care in the light of achieving universal health coverage. There was a special celebration in Sri Lanka as the first-ever college dedicated to palliative medicine saw its inauguration this year as well. In this light, we spoke to College of Palliative Medicine President-Elect Dr. Samadhi Rajapaksa and Vice President Dr. Janaki Vidanapathirana.

College of Palliative Medicine of Sri Lanka

The head table at the ceremony

The founding ceremony of the College of Palliative Medicine of Sri Lanka was held on Saturday, 9 October 2021 at the Hilton Colombo. This professional body was established to promote evidence-based palliative medicine and palliative care in the country. The special nature of this college is that it consists of diverse multi-disciplinary medical professionals uniting under one umbrella to reach the single goal of improving the quality of life of palliative patients in the island. The College of Palliative Medicine of Sri Lanka was founded by Dr. Samadhi Rajapaksa, who has vast experience in palliative medicine and palliative care. This college was established with the blessings of Minister of Health Dr. Keheliya Rambukwella, with the encouragement of many eminent professionals in Sri Lanka, as well as from around the world. The Ministry of Health Additional Secretary – Public Health Dr. Lakshmi Somatunga was appointed the first President of the college. The event was graced by the presence of the Chief Guest Tareq Md Ariful Islam and the Guest of Honor World Health Organisation (WHO) Sri Lanka Public Health Administrator Dr. Olivia Niveras. Sri Lanka Medical Association (SLMA) President Dr. Padma Gunaratne also graced the occasion. Due to Covid prevention guidelines, office bearers and council members were gathered with special invitees. This College of Palliative Medicine was formed to achieve a unified forum to advocate for a collaborative partnership between key stakeholders and policymakers to advance palliative care services in the country. It aims to develop a complete multi-disciplinary team with the partnership of national and international expertise to deliver palliative care services, and additionally, to empower the community by forming patient and caretaker groups for palliative care services relevant to palliative medicine. 

The office bearers and the council

Members of the College of Palliative Medicine Sri Lanka Council

The following office bearers and council members were elected during this occasion: President – Dr. Lakshmi Somatunga, President-Elect – Dr. Samadhi Rajapaksa, Vice President – Dr. Janaki Vidanapathirana, Secretary – Dr. Dumindu Wijewardana, Treasurer – Dr. Pushpa Weerasinghe, Assistant Secretary – Dr. Thusitha Kahaduwa, Editor – Dr. Kalpanie Wijewardana, Consultant Physician – Dr. Lushanthi Kannangara, General Practitioners – Dr. D.K.D Mathew, Dr. K. Chandrasekar, and Dr. Preethi Wijegoonawardena, Consultant Anesthetist – Dr. Hemantha Kumarihamy, Consultant Oncologist – Dr. N. Jeyakumaran, Consultant onco-surgeon – Dr. Ranga Perera, Consultant Cardiologist – Dr. M. Niraj, Consultant Psychiatrist – Dr. Medhani Hewagama, Consultant Venereologist – Dr. Darshani Mallikarachchi, Consultant Neurologist – Dr. Vijayabala Jeevagan, Consultant General Surgeon – Dr. Hasantha Ranil Thambawita, Consultant Radiologist – Dr. Densil Gunasekara, and Consultant Geriatric Medicine – Dr. Kelum Pelpola. 

The council consists of different specialists who are working in the field of palliative medicine in Sri Lanka. Palliative care goes beyond one’s job description; it is seen by many as a meritorious act or a service. This service has been provided by many professionals across many disciplines, with their contribution recognised and appreciated. A Palliative Care Excellence award was given to Dr. Viswanatha Jeganathan, who has served as the Director General of Health Services. He has contributed immensely towards palliative medicine and he is a founding member of the management committee of the Sathya Sai Suwasewana Hospice Hanwella, which has the capacity of 40 beds. A  second Palliative Care Excellence award was given to the Sri Lanka Cancer Society. The Sri Lanka Cancer Society was founded in 1948 and in 1996 the first hospice in Sri Lanka, Shantha Sevana Hospice, was established with 32 beds offering free palliative care for needy patients. A third Palliative Care Excellence award was given to the Palliative Care Trust of Sri Lanka. The Palliative Care Trust of Sri Lanka was established in 2016 to deliver palliative care throughout the country, especially to establish hospice care and community palliative care services. The Institute of Palliative Medicine is the first institute dedicated to palliative medicine in Sri Lanka. The monetary contribution towards this project was approximately $ 1.2 million.

What does the action plan encompass?

Palliative medicine will improve the quality of life of patients with life-threatening illnesses and their families by offering them holistic support for prevention and relief of suffering, through evidence-based, multi-disciplinary, and cost-effective approaches. In Sri Lanka, the need for palliative care is increasing, owing to the ageing population and the rising prevalence of non-communicable diseases (NCDs). According to data, it shows that almost 83% of all deaths in Sri Lanka are due to NCDs. Since a significant number of cancer patients present are at a late stage, it is estimated that more than 15,000 cancer patients need palliative care at a given time. However, only a handful of them have access to palliative care services in the country. To overcome these deficiencies, the College of Palliative Medicine of Sri Lanka was formed to bring multidisciplinary expertise under one umbrella. It aims to promote, develop, and harness active partnerships of relevant expertise related to palliative medicine.

Palliative Care Excellence award being presented to a representative of the Palliative Care Trust of Sri Lanka

The national health policy in Sri Lanka, and many national strategies as well as guidelines, have also identified the need for palliative care for all patients who need such care, for them to live and die in dignity. With the demographic and epidemiological transition, demand for palliative care services increased over the years. Considering this situation, at the 67th World Health Assembly in 2014, the first-ever global resolution on palliative care was released by requesting member states to strengthen palliative care as a component of comprehensive care throughout the life course with special emphasis on primary healthcare. At the 69th World Health Assembly in 2016, high-quality palliative care was identified as an explicit element of the WHO framework on integrated, people-centred health services. Sri Lanka started palliative medicine as well as palliative care by collaborating with both government and non-government organisations, stated Dr. Vidanapathirana.

Sri Lanka’s public health approach to integrating palliative care into the mainstream healthcare system is rather recent. Though the first modern hospice in Sri Lanka was established as early as 1962 in Colombo, palliative care in the country was limited to a few home-based care initiatives and a couple of hospices till recently. Major government and non-governmental initiatives in this area started materialising after 2010. Palliative care services are also evolving gradually at all levels of care over the years due to the initiatives of government, non-government, and civil society institutions. The College of Palliative Medicine of Sri Lanka will complement all these activities and the college can be advocated at many policy levels. “It is my pleasure to congratulate all these professionals who are committed to starting this initiative,” emphasised Dr. Rajapaksa.

The strategic direction of work for the next five years

  1. Advocate for policy level authorities to ensure the recognition of palliative care as an integral component of the health system and strengthen the legislative framework for delivery of palliative medicine
  2. Facilitate and link the effective partnership between different stakeholders at the national and international levels to improve palliative medicine in Sri Lanka
  3. Ensure the partnership for developing a skillful multi-disciplinary team for the delivery of palliative care services by conducting evidence-based training programmes 
  4. Contribute to the development of relevant national protocols and guidelines for the provision of palliative medicine and palliative care for national needs
  5. Advocate at a national level and local level on essential drugs and assistive devices for the provision of palliative services at all levels
  6. Conduct and enhance partnerships for delivery of evidence-based knowledge-sharing, use of facilities, and conducting research on palliative medicine
  7. Empower the community and form patient and caretaker groups for palliative care services in the country. Furthermore, facilitate and promote the use of these facilities
  8. Contribute and partner for special programmes to improve the mental wellbeing of palliative patients and their families

Palliative Care Excellence award presented to a representative of the Sri Lanka Cancer Society 

Different subcommittees will be formed to work towards achieving the above-mentioned strategic directions and to identify the different activities with time targets. Monitoring and evaluations of these activities will be done by the College of Palliative Medicine Council. These activities have been linked with both local and international involvement to achieve the targets. Each year, the college has a theme, which will reflect the theme of World Hospice and Palliative Care Day. Based on this theme, activities will be developed under each strategic objective. 

Establishing the College of Palliative Medicine is a great initiative, and it can open many avenues internationally, for our undergraduate medical students, junior doctors, postgraduate doctors, and specialists alike in the field of palliative medicine while providing and uplifting the standard of care for our palliative patients.