1. Perspectives of Former International Pain Policy Fellows International Pain Policy Fellowship Training Program Madison, Wisconsin, USA 6 August 2012 Bishnu D. Paudel, MD 2008 Fellow

2. Nepal

3. Mount Everest : 8,848m (29,029ft)

4. Nepalese Situation Most of the cancer patients were diagnosed in advanced stage. Pain was most commonly associated symptom in cancer patients. Pain was not treated optimally.

5. Breast cancer lady with severe pain

6. Drug availability Expensive chemotherapy & targeted therapy were available. Cheap opioid like oral morphine was difficult to get.

7. International Pain Policy Fellowship? Why opioids like oral morphine availability is problem in Nepal? Something more than routine work!

8. International Pain Policy Fellowship The Fellowship is intended for health professionals from developing countries who have an interest to improve availability of opioid analgesics.

9. International Pain Policy Fellowship Training program in June 2008 for fellow and ministry representative In country Project & Action Plan Mentorship Financial support

10. IPPF Fellow, Mentors & Ministry representative

11. Training Program 1) Policy level 2) Drug Distribution System 3) Cost of Opioid Analgesics 4) Knowledge & Attitudes Barriers of opioid availability

12. Action Plan Problems; -Irregular supply of opioids. -Dependent on foreign drug companies. -Multiple groups working -Lack of knowledge & attitude

13. Action Plan Actions: Importers to report regularly. Production in Nepal An Association of Palliative Care. Educational activities Pain Management Protocol

14. Oral morphine production in Nepal Morphine syrup in 2009

15. Morphine tab 10 mg 2011

16. Morphine Tab(10mg) PR 2012

17. Morphine Tab 30mg (PR)2012

18. Nepalese Association of Palliative Care (NAPCare) Nepalese Association of Palliative Care Officially registered 16 th December, 2009 and 11 member body was formed.

19. Dr. Eric, Mentor, visit

20. Educational Activities One month palliative care training Pain and Palliative care training in National Academy of Medical Sciences in March 2011. Dr. Eric resource person.

21. Educational activities

23. American Academy Hospice Palliative Medicine Annual Meeting 2011

24. Indian Cancer Aid Society Palliative Care Award 2012

25. INTERNATIONAL LEADERSHIP IN PALLIATIVE CARE

26. Conclusion At the end of my fellowship I am proud to say because of IPPF I could bring some changes in my country to help people who are suffering from pain. I enjoyed working as International Pain Policy Fellow and have 100% satisfaction.