Lynna Chandra

Ashoka Fellow
Jakarta, Indonesia
Fellow Since 2012

Citation

This profile was prepared when Lynna Chandra was elected to the Ashoka Fellowship in 2012.
The New Idea
Lynna developed a pediatric palliative care service to provide dying children with high quality integrated care—pain and symptom relief management as well as spiritual and psychosocial support. Initially set up in hospitals, it was soon discovered that the best place for this care is in the home.

Reversing the current top-down, doctor to patient structure, Lynna focuses the pediatric palliative care delivery on parents and nurses. She believes in the power of nurses to serve as the eyes for the doctors and the voices for the patients, and has thus created a new professional role for nurses as home-based pediatric palliative care providers. Lynna equips nurses with the skills to work with parents on how to manage and administer medications, change dressings, manage pain, and detect symptoms. Lynna aims to reframe palliative care as providing continuous care rather than “giving up,” which is how it is currently perceived. Working with Health Sciences Higher Education and other nursing schools, Lynna is integrating pediatric palliative home care training into the curriculum. With the system in place, Lynna also enables parents to understand and provide support and treatment for their critically ill children and to receive grief counseling after their child’s death.

To run a home-based pediatric palliative care service, Lynna set up satellite centers to which families are referred from public hospitals, Puskesmas (Public Health Centers), traditional public health volunteers and individual health professionals. In each of these referring institutions, in-house nurses are trained to identify patients for whom chemotherapy is no longer effective and then refer these patients to Rachel House—Lynna’s organization. Breaking the existing practice where hospitals keep control of all medical records, the new referral system mandates that copies of patients’ medical records be shared with Rachel House. The home care nurses, together with parents, provide the palliative care.

With four home-based palliative care satellites spread across the greater Jakarta area and two participating national public general hospitals (Cipto general hospital and Dhamais cancer hospital), Lynna is developing the Centre of Excellence, an educational training institution as the base for spreading the philosophy and skills for home-based palliative care. The new professional role for nurses in this field is supported by the recent issuance of the Health Ministry regulation on SIPP (license to open nurse practitioner practices). National spread is further boosted by newly passed government regulation for general hospitals to qualify for ISO (International Standardization for Organization) certification. This new regulation makes it compulsory for hospitals to include palliative care programs if they want to receive ISO certification.

Lynna has built and refined her model of care in partnership with many organizations including private and public hospitals and clinics, citizen organizations (COs), individual partners including health professionals, social workers, parents and families of the children, universities, professional associations, private businesses and corporations.
The Problem
The Strategy
The Person

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