Delivering community home-based palliative care in Bangladesh during the COVID-19 pandemic

Aim: The aim was to understand how community home-based palliative care could be adapted in a pandemic and still address palliative care needs in poor areas of Narayanganj, Bangladesh. Design, methods and approach: Using a case study approach, we gathered data through a survey and interviews with 20 people. Qualitative data were collected to understand lessons from adapting PC services during Covid-19 lockdown. Adaptations to services included training in Covid-19 precautions and communications skills. Home visits were replaced with weekly phone calls to patients by Palliative Care Assistants with doctor/nurse follow-up calls. Medicines were made available locally. Food parcel size was increased and was made available at local shops for patients/carers to collect. Community sensitisations moved online. Results: In the first 3 months of lockdown, more than 1500 calls were made by PCAs to patients and more than 150 nurse/doctor follow-up calls made. One-hundred thirty food parcels and 100 prescriptions were dispensed. Six thousand people were reached with sensitisations. Patient feedback included: 'Your service is not just a phone call;it is a beacon of hope. I have no one here . . . receiving phone call from you gives me a lot of courage. I believe, you will stand by us in this crisis period like before'. 'In this lockdown, we had nothing to eat. But you have distributed food. I am able to eat today only thanks to you'. The team relied on online groups to communicate, exchange information and to cope. Conclusion/lessons: Providing PC support via telephone proved to be a good way to continue services during lockdown. Lessons learned: How to be flexible, adaptable and take on new challenges;Increased understanding of using technology effectively;Increased empathy - realising the difficulty faced by housebound patients;Partnerships with local businesses made access to food and medicine easier;Frequent virtual team meetings were key for the team to overcome their own fears.