Yangden Paki

Putting palliative care on the map: launching a nation’s first service against the odds

Summary

Yangden has contributed enormously to the healthcare system in Bhutan and in so doing demonstrated all the qualities of a true pioneer. Having transformed the hospital’s maternity unit and spent years reducing the maternal and natal mortality rates in the country, Yangden took on the challenge of establishing its first ever palliative care service. In just two years, she’s made giant strides, has big plans for the future and is keen to take her nursing colleagues on the journey with her.

“Many people will provide for maternity needs but there is nothing yet for those at the end of life.”

Yangden Paki

LOCATION
Thimphu, Bhutan

Yangden’s story

Yangden’s professional career and journey to palliative care nursing is probably different to almost all of the other pioneering nurses. In fact, she has only worked in palliative care since 2018, after spending 20 years mostly in midwifery.

It was Yangden’s proactivity and ability to take a new service by the scruff of the neck and professionalise it that qualified and prepared her well for her recent switch.

“When I started in the maternity ward at the hospital it was an unpleasant place to be. It was understaffed and very demanding work. There were many natal and maternal deaths and the labour room needed a lot of attention and improvements.”

In 2005 Yangden was given responsibility for making that positive change, reducing the mortality rate and generally improving the service. She oversaw increased staffing and infrastructure and introduced the first computers in the unit.”

Then, having spent over a decade focused on improving services at the beginning of life, Yangden was approached out of the blue to start a new service.

“The hospital decided to start a palliative care service. To be honest I really had little idea about palliative care and I was sceptical about the role, but then I decided I should do it.”

Starting with practically no resources again, including no office, Yangden set about establishing a palliative care service in March 2018. Now she heads up a team of three nurses, an oncologist, a nurse anaesthetist and  a medical officer.

What drives you to make a difference?

“The joy I derive from palliative care is understanding that it is a privilege to reach out to people when they are at their weakest point of their life. I feel I have a gift for relating to patients and their needs and it is very special when they express their gratitude to me for helping them.”

The lack of resources means Yangden and her team are currently only able to offer home care to patients with advanced cancer. Since the launch of the service they have cared for more than 250 patients. She is well aware, though, of the need amongst patients affected by lifestyle diseases.

“There are people all over the country with diabetes, strokes and COPD who require our care and I hope we can extend the service so more people can benefit from it.”


How do we see the art and science of nursing expressed?

Yangden demonstrates the twin skills of the art and science of nursing through her organisational capabilities and her interpersonal talents.

“My fellow nurses tell me that I am an expert in establishing services, as I have now done it both in maternity and palliative care and I have been able to influence people to take up palliative care. I enjoy the work, not just as a nurse, but because as a human being I can help relieve their suffering.”

Sharing the message of palliative care across the nursing community in Bhutan is certainly on Yangden’s agenda, but she’s realistic in terms of what she can achieve in the short term.

“At the moment we have not been able to influence general nursing that widely. We are communicating with the Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, and sharing what is special about palliative care in terms of caring for the whole person and their care giver as this is ignored in other nursing. But, so far, we have not managed to influence that to a great extent. We will keep trying!

How can nurses strengthen their leadership and impact?

It’s still very early days for palliative care in Bhutan and only two years since the service Yangden runs was started, but she has big ideas.

“My vision for palliative care is to have a proper palliative care department with a multi-disciplinary team and specialist training, taking a holistic approach using social workers, and with spiritual input too. But I know it will take a long time to establish.”

The scale of the ambition is not daunting Yangden. Having attended the Institute of Palliative Medicine programme in Kerala, India, and completed training conducted by Singapore team at JDWNRH, Thimphu, she has developed a training manual which she hopes will be start of integrating palliative care into the healthcare system across Bhutan.

Yangden attended the 13th Asia Pacific Hospice and Palliative Care Conference held at Surabaya, Indonesia in August 2019, where she made her first presentation on ‘Bhutan Palliative Care’ abroad.

Yangden embodies the pioneering spirit, showing the courage, drive and innovativeness to start a palliative care service from scratch. Still in its infancy, the service has a long way to go to meet the needs of people in Bhutan approaching the end of life, but Yangden, through a new training model, as well as her organisational skills and human touch, is well on the way to spreading good palliative care.

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