IAHPC Traveling Scholars' Report
Prepared by
Harmala Gupta
President, CanSupport
New Delhi, India
Thanks to a Traveling Scholarship awarded by the International Association of Hospice and Palliative Care (IAHPC) I was able to attend the 10th Congress of the European Association of Palliative Care (EAPC) held in Budapest from the 7th to the 9th of June, 2007.
It was an event to remember for a number of reasons. It was large. There were 2000 registered delegates and almost 1000 posters on display. It was diverse, in keeping with its theme. Besides Western and Eastern Europe, who were well represented, there were delegates from the USA, Africa
and Asia. It was exciting and challenging. It provided an opportunity to listen and learn from the best in the field, to reflect on what lessons and techniques could be taken home, to meet old friends and make new ones and to feel part of an energetic and growing movement. It was in
Budapest! Surely, one of the most beautiful cities of Europe renowned for the numerous contributions of its inhabitants to the arts and sciences as well as for the famous river that runs through it.
If I were to select the highlights of the first day, I would have to begin with the wonderful opening ceremony. A gratifying speech by the President of Hungary which dwelt on the need for palliative care was followed by a breathtaking depiction
of the passage of time using sand. A moveable feast for the senses. The plenary talk by Faith Mwangi-Powell from the African Palliative Care Association that followed was spirited and hard hitting. I was particularly struck by her emphasis on the phrase “impeccable assessment and treatment...”, part of the
WHO definition of palliative care. It reminded me of the balancing act that many of us who deliver palliative care in countries where resources are scarce have to perform between offering care of quality and at the same time ensuring wide coverage.
Of the subsequent sessions I attended on that day, the one titled ‘A Change of Perspective – from Risk to Resilience’ stands out. It was a follow up to the masterly plenary talk given by Barbara Monroe from St. Christopher’s
Hospice, UK on resilience in palliative care. What was helpful was the practical means that were suggested for assisting people cope with bad times such as cognitive behavioral therapy, creative activities and holding on to good memories. It was also useful to hear Nathan Cherny from
Israel share his professional and personal experiences and learn how palliative care can help build bridges of understanding between communities divided by hostile stereotyping. Since I had a poster on display on this first day and the organisers had scheduled frequent breaks for
poster viewing, including a very welcome and valuable guided tour, by the end of the day I was tired, hungry and in need of succor. The reception cruise down the Danube with fellow delegates with plenty of wine, food, live music and sightseeing was a perfect end to a busy day.
Day two dawned nice and early for me. I was eager to meet the fundraising experts from Resource Alliance and Help the Hospices, UK. CanSupport has just set itself an ambitious five year plan and raising funds is of the essence. Useful tips were gained on how to make an effective case
for support, for developing a fundraising strategy and for targeting a diverse range of sources. One was understandably envious of the Hospice Association of Ireland who seem to be wizards at everything including fundraising!
Of the plenary talks that day there were two that I thought were outstanding. One was by Lars Bjorklund, a priest from Sweden, ‘The Courage to Be’. It spoke to the sense of helplessness many of us experience in our work with patients who are seriously ill and dying. It
was reassuring to know that even though we may not have any ready answers or fix-it solutions, just being alongside the person in distress is often enough. The second by Finella Craig from the Great Ormond Street Hospital, UK on Paediatric Palliative Care with a special focus on adolescents
was extremely educational. It drew our attention to the pressures on adolescents as well as their sexual needs, which are often lost sight of once they are diagnosed with a grave illness. She advocated for the right of children to receive the information they need, for their involvement
in “safe” decision making, for the inclusion of parents and for facilitating peer group interactions.
The workshop with David Kissane on ‘Family Focused Grief Therapy’ was packed to capacity. All of us struggle with families, no more so than in India where the family is omnipresent and the main decision maker. Our job as counselors is often to help the family realize that
the interests of the patient may be best served if they are also included in decision making and to identify families that may be at higher risk of psychosocial morbidity. The family relationship index is a useful way of doing this. The role plays that were used to illustrate how to
conduct these family focused sessions revealed how difficult it is to ask circular questions that invite reflection and draw the entire family’s attention as opposed to linear questions that are directed at an individual.
The highlights of day three were a joint EAPC/IPOS session on Communication. Eva Banyai from Hungary spoke of her personal trauma as a survivor of breast cancer. She drew attention to the change that occurs in the person’s usual frame of reference and to the increased susceptibility
to negative suggestions after a diagnosis is made. This has implications for doctor-patient communication, verbal and non-verbal, which though unintended can impact the patient in a negative way. She argued for special training in suggestive techniques for people with cancer so that
they could find personal meaning and free themselves from “the law of unfavourable interpretation”.
Coming from India, one rarely has an opportunity to meet people delivering palliative care in parts of Europe other than the UK. The session on “My Own Palliative Service” which had speakers from Georgia, Italy, Extramudera in Spain
and Hungary talking about the palliative care services in their countries was very interesting. Among other things it highlighted the unevenness of services and the divide that exists between Eastern and Western Europe not only in terms of coverage and quality but also with regard
to attitudes. People in Eastern Europe present with more advanced cancers, have a more reverential attitude towards doctors and are struggling with truth telling. What was revealing was that across the board there was an emphasis on home based palliative care where possible and on
integration with basic health services within the existing medical structure so as to make palliative care more widely accessible and services more sustainable in the long run. The importance of advocacy, especially targeting those at the highest level of decision making in the government,
was also a common theme that ran through all the presentations.
To sum up, I have returned from the 10th EAPC Congress with a wider understanding of palliative care in the international context and with the knowledge that we are all searching for answers that suit our particular circumstances. I believe
the challenge before us will be to gain a deeper understanding of diversities that exist between and within countries and different population groups. Surely research, both quantitative and qualitative, will assist this effort. From the poster presentations it appeared that this was
being undertaken mainly by the more developed countries. National and international palliative care organizations need to encourage collaborations. Perhaps the Budapest Declaration will be a step in this direction.
Harmala Gupta
Prepared by
Ms. Carolina Monti, BA
Administrative Manager
Latin American Association for Palliative Care
Thanks to a Traveling Scholarship grant from IAHPC, I was able to attend the 10th Congress of the European Association for Palliative Care from June 7th to 9th in Budapest, Hungary. The main topic of this congress was “Connecting Diversity”.
On June 6th there was the “The Budapest Commitment” meeting. This meeting was an initiative of the European Association for Palliative Care (EAPC), in collaboration with the International Association for Hospice and Palliative Care (IAHPC)
and The Worldwide Palliative Care Alliance (WPCA), to motivate the representatives of national associations and professional groups to assume specific tasks to help develop palliative care in the world. The main objective was to highlight the priorities and necessary steps for successful
implementation of palliative care. The meeting welcomed representatives of all national associations with various levels of palliative care development.
During the meeting leaders spoke about the important areas of work to consolidate palliative care in countries, medications, education, policy and service provision. After the discussions with the representatives of the national and regional associations, a list of priorities and commitments
was created to improve palliative care in our countries. The national associations will present at the next EAPC congress in Vienna (2009) the projects and advances in the development for palliative care in their countries, and they will receive advice on implementation.
During the congress I attended conferences about palliative care policy, resources, education, certification and quality. All these important topics provided me with ideas on how we can improve the delivery of palliative care for patients and their
families in Latin America.
I am very grateful to IAHPC, and especially with Liliana De Lima, for the personal and professional support and for the opportunity to meet and establish contacts with the world leaders in palliative care. I was very proud to be able to represent the Latin American Association for Palliative
Care in this important event.
Ms. Carolina Monti, BA
Prepared by
Dr. Maria Fidelis Manalo, MS
IAHPC 2007 Traveling Scholar
Department of Community & Family Medicine, Far Eastern University-NRMF Medical Center, Quezon City, Philippines
I am most grateful to the IAHPC for the 2007 Traveling Scholarship grant to attend the 1Oth Congress on the European Association of Palliative Care (EAPC) in Budapest, Hungary on June 6-9, 2007. The Congress was a marvelous venue
for gathering up-to-date information about a number of key issues related to pain and symptom control and comprehensive palliative care, as well as, important existential issues such as life’s meaning, hope, faith, and guilt. I was impressed by the multiplicity and heterogeneity
of the scientific papers presented in posters and in the free paper sessions. I feel privileged to have had the opportunity to discuss the results of two of my studies with colleagues from other parts of the globe and to exchange experiences with them. The workshop sessions on wound
care and family focused grief therapy were excellent.
Consistent with the theme "Connecting diversity”, 2,000 palliative care practitioners from 50 countries participated. The Congress was indeed a showcase of the creativity and diversity that exists not only across the whole of Western, Central and Eastern Europe, but in the
other continents, such as the Asia-Pacific region, as well. I hope that the pre-congress activity (“The Budapest Commitment”) which I attended, will indeed raise awareness among policy makers, physicians, other health care professionals and within the wider society,
both on a national, regional and international level so that we can truly build a bridge for better palliative care around the world.
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