IAHPC Traveling Scholar’s Report
Placement with the Palliative Care Program
in Extremadura, Spain
As part of a cooperative program between IAHPC and the Servicio Extremeño de Salud (SES) in Spain , six grants were awarded to Latin American Palliative Care physicians from Colombia, Argentina, Venezuela, Cuba, Chile and México. The grant provided support for travel and stay in Extremadura during the visit to a Palliative Care program implemented by the regional government. This grant was not intended to be a clinical training experience, but rather an opportunity for the participants to learn about a program which has been successfully implemented. Appropriate health policies have been developed and the program covers 100% of the population in a geographically dispersed and resource limited region.
I had the privilege of being selected as one of the grantees of this program. I visited the Palliative Care Program in Extremadura, Spain for 21 days during June, 2006. In addition, participants were also invited to attend the VI th National Congress of the Spanish Society on Palliative Care (SECPAL).
The Palliative Care program in Extremadura began in 2002 in response to the needs of patients in the region which followed changes adopted by the Spanish National Health System. The program is under the leadership of Dr. Emilio Herrera with general coordination by Dr. Javier Rocafort. The regional government designed a service model that consists of Palliative Care Support Teams in various parts of the region that take into consideration the population density in each area.
The 21 day placement was organized into two time periods: first, I made a short visit at program headquarters at the Health Extremadura Council during which I received briefings on the program’s structural organization and purpose; and the second part consisted of participating in the daily activities of the support teams in Badajoz and Don Benito.
The support team in Don Benito consists of a doctor, a nurse, and a psychologist, whereas in Badajoz, there are four physicians, four nurses, one psychologist, one social worker, and one administration officer.
During my stay with the support teams, especially when working with the Badajoz team, I found that their program was very suitable to be reproduced in Latin-American countries such as Cuba where palliative care is in the developing stages and where there is a public health infrastructure that permits the introduction of palliative care as a new service.
The main accomplishment of the Spanish program is the way in which palliative care is inserted into the healthcare system with its patient-centred care and multidisciplinary approach. A coordinating office helps determine the level of care needed among the different hospital services and between the physician in the hospital and the family doctor. It also coordinates the social services in the community. Bidirectional care, starting either from the patients’ home or from the hospital, is well integrated with the rest of the health system. The program is implemented independently of the level of care, the patient’s socioeconomic status, or the location of the patient care (regardless whether it is at home, at the hospital, in an emergency room or an outpatient clinic). In this way, the palliative care support team is the link between all levels of care.
The Palliative Care Program in Extremadura has positively impacted the quality of health services in the region. It has undoubtedly fulfilled an essential need to provide palliative care to terminally ill and dying patients in the more geographically isolated and economically stressed regions of Spain. Our challenge in Cuba will be to use the concepts learned from the Spanish experience and to apply them in our own setting and country as an effective interventional model for the care of patients and families in need of palliation.
I wish to thank the IAHPC and the SES for facilitating these stimulating interchanges between Latin America and Spain. Thanks also to SECPAL for waiving our registration fees to their Congress.
Dr. Iván Justo Roll
Director of Education
Palliative Care Team Coordinator
Policlinic Tomás Romay
Old Havana, Cuba
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