Meet Our Team
Q&A with Dr. Peter Louie
Dr. Peter Louie has volunteered with TWCC and our Sunflower Children’s Network since 2019. Dr. Louie is a pediatric palliative care specialist with Canuck Place Children’s Hospice and BC Children’s Hospital in Vancouver, Canada.
Photo: Chuck Russell/Two Worlds Cancer
How did you choose a career in health care? And then pediatrics and palliative care?
I really enjoy working with people and I really enjoy teaching. And so originally it was a toss-up between becoming a teacher going into medicine and I thought that medicine gave me more opportunity to be able to work with more people. And why pediatrics is because I think there's lots of opportunity to teach in pediatrics because we get to spend more time with families, more than a lot of adult specialties do.
I kind of stumbled into pediatric palliative care because I had an experience there and thought these are all the things that I really enjoy doing. One of which is you get to know families really well. It's either intensive for a short period of time when time is short or over many, many years. I really enjoy the continuity – being able to follow them over time and really enjoy working with the teams.
We see a lot of seriously ill children that we support over many years and this work is done within a multidisciplinary team. I know what my strengths and weaknesses are and I work in my area where I think I can help while I defer to others – my nursing colleagues, my counselling colleagues. I defer to them for their expertise and at the same time learn from them.
What are the things that you find you consistently teach?
I have two different roles. So my time is spent doing general pediatrics, and then and a lot of that is newborn care and doing the traditional kind of curative medicine type role. And then half of the time is with palliative care.
In both settings a lot of the time I teach and talk with families – about looking at what's good, focusing on the better aspects of their quality of life. And so in my pediatric practice, a lot of what I provide is reassurance. A of lot of families have worries. Are there developmental or learning concerns?
Often it's nothing really big and serious. And then you're re-focusing and educating them, spending the time with them saying, “ This is okay. We will watch it over time.”
And then in my palliative care role, a lot of the conditions that we see are not curative. Sometimes [medicine] focuses on the curative aspects which can sometimes cause suffering and not enough time is focused on the good things of day-to-day life. So then we focus on the good – going to school, spending time with family.
What are your roles at Canuck Place Children's Hospice and at BC Children's Hospital?
At Canuck Place, I work as one of the pediatric palliative care physicians and in addition to my clinical work, I'm also the program director. I look after all the aspects of pediatric palliative care education for the trainees in BC. So we educate medical students, residents and fellows. So various fellows who
either are interested in palliative care or would benefit from having that knowledge in the work that they do. For example, someone training to be an intensive care doctor or in pediatric and neonatal care. Also adult palliative care physicians. We train them as well because they may have young adolescents that they look after.
And my other role is general pediatric care [including] newborn resuscitation and care in the nursery at BC Children's Hospital. And I have a general pediatric practice with the group of physician colleagues that I work with.
How did you become involved with TWCC and what is your role?
I overheard one of my colleagues talking about Two Worlds Cancer Collaboration. She was already involved. We got talking about it and then a few months later I'm in India.
My first time going to India was 2019 and then the second time was right before the pandemic in February 2020. My role is primarily helping to support the education for the Sunflower Children's Network. We do a lot of education for trainees and healthcare providers in South and Southeast Asia.
It has involved in the past going to the site and doing presentations, workshops, and then working directly with the physicians – training and then administering exams. Since the pandemic, it's been a lot of core ECHO sessions on Zoom – so virtual education.
And also our hybrid fellowship, which is training physicians in various countries in South and Southeast Asia for one year to have some expertise in pediatric palliative care where they do clinical work locally and a lot of ECHO sessions with an international faculty.
The fellows have a clinical session in Hyderabad, but they also have clinical experiences in their own country. So if they're from the Philippines or Nepal something is set up so that they have adult palliative care experience because that's available or other pediatric experience where they look after kids with more complex needs where that's available. In most of these countries there is little or no pediatric palliative care yet. That's what we're helping to support and to build.
What do you see as Two Worlds Cancer Collaboration’s biggest successes?
It’s unique in the sense that it has pediatric palliative care, working with children with serious illness that can live short or long periods of time and potentially living that time with a lot of suffering. There aren’t, as far as I know, many organizations that do that.
And then also the fact that the goal is to go in to help establish and support local faculty and healthcare providers creating and building programs making them sustainable so that they integrate into their healthcare systems rather than going in [ourselves] to do the work.
So when I first went to India in 2019, TWCC was helping train the first [pediatric] fellow and I remember administering the final exam. The training program in India – in Hyderabad – was a more established adult palliative care program at that time.
Across the street is Niloufer Children’s Hospital, which is a children's hospital for the entire region that has a huge population. At that time palliative care was not very welcomed there. Now there are many consults coming from the hospital.
The [Hyderabad pediatric] team is bigger and more robust now. Many, many children are seen through their mobile program where they go to the home. There's been education to satellite sites that don't necessarily do pediatric care, but they do palliative care. There's going to be children there and so now they have some capacity to work collaboratively.
Hyderabad has become a center of excellence for South Asia in pediatric palliative care. They're asked to teach throughout India and they're also training other doctors to have expertise in pediatric care in other countries.
In the last years, it was the Philippines which had no [pediatric] program and when they showed interest we started training some physicians [through our fellowship program] who are now palliative care specialists starting to create a program there. Now the focus is on Nepal and Bangladesh.
So in those years, it's amazing that with the limited resources that TWCC has money-wise, they've been able to help make so much change.
What do you see as the biggest challenges?
It's similar to what we experienced here in Canada but it's going to be much harder in Asia. Pediatric palliative care is not initially welcomed by the health care system or by families, We are one of the few specialties that nobody wants to see.
If I say as a pediatrician that I'm going consult a cardiologist there's no question that they want to be seen. We're not a specialty that people want to be referred to or healthcare providers want to refer to.
The reason is that we're all trained in a system which is rightfully curative focused. But unfortunately we can't cure everything and in our training when it's not curable we feel defeated. We don't know what to do in the sense that we don't know how to talk to families about it. That communication is not easy. It's difficult. We're not taught this part.
There is the misconception of what we do. So the word palliative immediately makes all of us think end-of-life which isn't necessarily the case. Trying to overcome these misconceptions and a system that doesn't want us is an uphill battle. And so you can educate how to do [palliative] medicine, but then the harder part is how do you integrate it into the health systems and become accepted and welcomed.
Part of the problem is finances. I can understand where in a resource-limited country if you don't have the money to even provide the curative care then someone might look at it and say, “Why are we shifting some of this money to palliative care when we could use it to try to cure?”
The difficulty of that is you can keep trying to cure which uses more resources. You might have done a surgery that shouldn't have been done because the outcome isn’t going to change. You can almost argue that our involvement can probably save money. You don't do more radiotherapy or more chemotherapy when it's going to make the child sicker and not help.
If we can help to manage the pain in a setting that's not causing suffering and be able to continue to follow them in the home then they get out of the hospital. I don't know how much it costs in other countries to be in hospital for a night but here [in Canada] it's very expensive.
So overall, we're not an expensive specialty, but we can offer a lot to the children and families. And in some cases the children live longer when we're involved which people don't necessarily understand.
And I think that's even more true in lesser-resourced countries where the mortality rate for cancer is 80 percent. So the chance of cure is only 20 percent and there's going to be a big population from diagnosis that are going to need that extra support.
There is going to be a workshop* in February in India to teach leadership skills and program building skills to the participants: How do you do that? How do you administer it? In a health care system this often is the harder work really.
* The workshop is an initiative of the Children’s Palliative Care Leadership Institute – a joint venture with our Sunflower Children’s Network, Hyderabad Centre for Palliative Care and St. Jude Global Palliative Care (Memphis, USA)
Is there an experience with a patient and family that sticks with you from your travels?
I wouldn't say that it's a particular family, but how I feel about many families that I've seen go through this experience in the India.
Because they have a public and private system mostly without palliative care, without the right communication, and without the right advice families continue to seek treatment. If one hospital says no, they go to another.
So what happens is families are paying, taking out loans and bankrupting themselves to support ongoing care of a child. In a way they're often supporting prolonged suffering and then at the end-of-the-day not getting the right support for what's going to inevitably happen.
If the outcome is that the child is going to pass away in a month, they could have spent that month at home rather than recovering from a [needless] surgery. Time and again in India, I hear of families going through this and at the end-of-the-day they don't have their child. They have the trauma that is left behind.
What have you learned from your experiences in India that you've brought back to your own practice?
I've learnt a lot because I didn't really go through a formal training because none existed. I’ve learned a lot from the ECHO training sessions – a lot about communication, talking to families, a lot about systems, and challenges, and leadership. And that's been very, very valuable.
A good way of learning communication really is watching your colleagues do it, and do it well. They're modeling that and that's been very helpful for me. The difficulty in our training is that these opportunities don't come up that often and often we, as trainees, are the ones that are sent in to talk to the family. So you're not usually seeing staff do it.
I do see the Canuck Place nurses, nurse practitioners and counsellors do it. I I've learned a lot from them, but I think there are more intensive and a higher amount of difficult communication situations in India and other countries.
Who inspires you?
When I think of TWCC, I've been able to meet so many amazing people who have so much expertise and with the such strong drive to be able to make change. They've been really inspirational.
How do you cope with the emotional intensity of your work?
First, I'm surrounded by really amazing people at Canuck Place. There's lots of team members – nurses, nurse practitioners, physicians, councillors, unit clerks – and we are all very supportive of each other. When you have many, many people trying to work at the same goal then that in a way already shares the burden.
So it's not all coming to me per se in terms of the emotional heaviness, because we all feel it together and in a way it’s shared. We support each other.
When I'm on palliative care, then my goal isn't necessarily to cure. The goal is to improve quality of life and manage symptoms, and support family spending good quality time together, and if I can achieve that then I that makes the work easier for me.
I'm also able to shift gears. So I have the ability to move to my other work at
BC Children’s Hospital which is a different pace. It has its own stresses, but it's different. I also work with an amazing group of colleagues in our practice that are highly supportive.
So I've been lucky to be able to be surrounded by a lot of amazing colleagues that I enjoy working with and we work well together.
What do you like to do when you switch your health care brain off?
I like to travel so I've travelled a lot. Also, I just stay active. So a lot of physical activities to balance the mental working.