MODERN concepts of holistic healthcare seem to be far from being available in Pakistan, adding to the burden that the affected families have to carry. Recently, a resident of a Peshawar suburb died due to cancer. He was admitted to one of the public hospitals in Peshawar with some health complaints. However, after a thorough investigation, it was found that he had early-stage cancer.

The surgeons advised him of the removal of one of his kidneys due to an infection caused by cancer. Although disinclined to the idea at first, he did go ahead with the surgery.

After a few days, he again complained of discomfort and pain. Subsequent medical examinations suggested that he had stage four cancer, which led the doctors to send him back home after prescribing some painkillers. Also, the family members were told that since cancer at this stage was incurable, the patient had only a few days to live. He died within a month, leaving four children and his widow.

It was disturbing to know that there was no space for psycho-social support within our healthcare system for him. Also, unlike the medico-psycho-social treatment method, cancer treatment solely relies on the medical model, thereby ignoring the psycho-social support needed for the patient and his immediate family members.

Out of sheer helplessness and hopelessness, patient had crying fits, irritation, insomnia and depression, and was detached from reality. Similarly, his family had to go through the mental trauma of seeing their loved one dying and a sense of guilt for not being able to help the patient even in terms of pain relief. One could hardly imagine the dreadful effect of this situation on the patient’s children.

However, had there been proper psycho-social support for him, this transition would have been less distressing than what the patient and the family experienced. Also, the family could have coped better with the pre- and post-transition phases of end-of-life care had grief counselling been available.

End-of-life care, such as counselling, therapy and spiritual support, is now considered essential part of treatment plans for terminally ill patients worldwide. But, unfortunately, it has rarely been realised in Pakistan. Moreover, the need for a medico-psycho-social treatment is further established as cancer is becoming more prevalent in Pakistan, with 19 million new cases recorded in 2020.

It also includes cases of breast cancer, which is one of the leading causes of death among women, but remains seriously underreported. Also, due to cultural barriers, many women find it difficult to seek medical and psycho-social support.

Against this backdrop, the health department in Khyber Pakhtunkhwa should immediately respond to this gap in the existing healthcare system and devise a holistic approach by taking on board the various stakeholders, such as medical professionals, social workers and clinical psychologists, to ensure adequate care to anyone suffering from a terminally ill disease like cancer.

In addition, members of civil society and academia should also strive to raise awareness not just in society but in the corridors of power where decisions are made so that the critical gap in the healthcare system may be bridged.

Zia Ullah Akhunzada
Hong Kong SAR

Published in Dawn, February 27th, 2023