Croatia, India, Israel
Palliative care activities in Croatia during 2007
The annual meeting and conference of the Society for Hospice/Palliative Care occurred in February 2007. There were presentations on various models of palliative care development. The University Clinical Centre Tuzla, BiH has a Palliative Care Department, a day hospice, a centre for home care hospice visits, children's palliative care, and all are incorporated into the official health protection system. The initiator was Osman Sinanovic, former Canton Health Minister, currently Director of science, research and education at the University Clinical Centre.
We actively participated at the EAPC congress in Budapest. The report on the palliative care situation in Croatia was presented during the EAPC Atlas palliative care of Europe. Also, on May 18th and 19th, an International Workshop on cancer pain management, and telling the bad news, was organized in Zagreb. The main coordinator was Christine Drummond, Director of the Lyell McEwin Palliative Care Service, Adelaide, Australia. She was invited to speak as a person of great practical experience, especially at the primary health care level. The syllabus developed for this will be essential for our didactic manuscripts and for further cooperation with Australia. On June 15th, at the Regional Hospice Centre, Emese Somogyi-Zalud, professor of geriatric medicine and Chairman of the Palliative Medicine Department at the Medical Faculty, University of Hawaii, Honolulu, gave a lecture on the organisation and teaching of palliative care.
From the 2nd to 6th of July, we participated in the organisation and realisation of the 2nd graduate course in English medical studies at the Medical Faculty in Zagreb where Croatian students were also involved. David Oliver's team (England) lead the program, with help from Croatian lecturers. The inter-university Zagreb-Kent cooperation agreement is especially appreciated. At the same time, the second postgraduate course for the Certificate of Palliative Care was held at the Regional Hospice Centre, Zagreb.
The World Hospice and Palliative Care Day and "Voices for hospices" events were marked by a press conference and a special meeting. It was stressed that, during the past 7 years, voluntary hospice home care teams have helped about 1,000 dying persons and their families. On the other hand, the great promises made by the Mayor of Zagreb, and other city officials, have not been realised. The hospice teams are experiencing the "burn-out syndrome". Central to the activities of the day was a presentation by Anica Jusic. She pointed out that, besides not having any hospice units, Croatia also has no modern hospitals for chronic illnesses, no geriatric institutions, and does not even have retirement homes that previously existed during the 1980s. There are practically no home care visits by primary/family care physicians, which were well developed during the past century.
During November in Rijeka, we co-organised the 2nd Symposium on nursing in palliative care.
The Committee on Palliative Care of the Ministry of Health and Social Welfare, still chaired by Anica Jusic, was more successful in the past year. It was charged by the Minister of Health with the task of preparing a draft of a Law on Palliative Care. The second very important task will be the elaboration of draft legislation concerning leave from work and financial support for family members caring for the dying.
Let us hope for the best ... hope dies last.
President of the Society for Hospice / Palliative Care, CMA
Quality improvement by development of National Standards – an effort in India.
Is “quality of care” something to be discussed only in the context of developing countries? Is it too much of a luxury in a developing country? This was an issue discussed at length during the XV annual conference of the Indian Association of Palliative Care at Kochi, Kerala, 8-10 February 2008. In a plenary discussion with more than 300 participants, there was unanimous opinion that it was by no means a luxury, but it is an essential requirement during the early days of palliative care development in any country.
Attempts to address this issue had started with the initiative of the NGO, “Pallium India” in 2006. NHPCO offered financial aid to the project and Dr Stephen Connor gave his expertise and time. A working group formed for this purpose met first in February 2007 at Mumbai to study the issues and develop a plan of action. Following preliminary preparations and discussion by the use of email, the group met again at Kochi on 7 February 2008 and prepared a draft document for “National Standards in Palliative Care”. This was the document that a plenary session of the conference discussed. After incorporating the suggestions from the plenary body, the final document was prepared. This has now been submitted to the Indian Association of Palliative Care (IAPC) for its consideration.
The document can now be viewed in Pallium India’s web-site: www.palliumindia.org (Please follow the link on the home page to “National Standards for Palliative Care in India”). Any one interested in quality improvement or in national standards, please visit this page and offer your comments to [email protected]. We shall compile all reactions and submit them to IAPC.
Dr Robert Twycross honoured
The Palliative Care Community of India honoured Dr Robert G Twycross with a citation for his exceptional contributions to the palliative care scene in India. It was presented to him by Dr Sukdev Nayak, president of the Indian Association of Palliative Care (IAPC) during the inaugural function of the XV Annual Conference of IAPC at Kochi, Kerala on 8 February 2008.
Dr Robert Twycross’ contributions to the Indian palliative care scene span over the last decade and a half. During most of this period, he visited the country twice a year, traveling through the length and breadth of the country, lecturing and mentoring. Often he would lecture in other countries to raise the money for his work in India. The majority of palliative care physicians in India are either his students or his students’ students. He gave the copyright of his book Introducing Palliative Care free so that a low cost edition of his book could be produced in India at the negligible cost of about $ 2.5. At the ceremony, in the true Indian way of honoring a guru, Dr Sukdev Nayak touched his feet. Many of us in India do the same, in spirit.
Refresher course in palliative care
A refresher course in palliative care was organized by “Pallium India” in Trivandrum, Kerala, India from 15 -17 February 2008. It was an educational program with a difference. 18 faculty members including many who love India and have taught in India over several years, participated as faculty members. With Dr Mhoira Leng acting as course chairman and with Ms Raelee Jensen and Dr Baburaj Chakrapani acting as coordinators, the faculty included Ms Gilly Burn, Dr David Brumley, Dr Bill Gretch, Ms Liese Groot-Albert, Dr Jeremy Johnson, Ms Penny Johnson, Mr Gary Kirlew, Dr MM Sunil Kumar, Dr Sue Marsden, Ms Shakila Murali, DrLalitha Kanny, Dr Biju Raghavan, Dr MR Rajagopal, Dr Robert Twycross and Dr Odette Spruyt.
The participants included 29 doctors and nurses, all of them trained, and practising palliative care. The whole teaching program was interactive, including video demonstrations and role plays, and as it progressed, the difference between faculty and participants gradually evaporated resulting in a three-day long learning experience together.
In a developing country with limited opportunities for palliative care training and for updating knowledge, a participant opined, the need for such refresher courses cannot be overemphasized.
Dr. M R Rajagopal
Al-Taj Hospice, Arab Sector, Israel
We are pleased to share with you our activities and achievements in addressing our community’s health and quality of life. Al-Taj’s mission is to promote good health by raising awareness of prevention, early detection and improved management and outcome of cancer and diabetes for those living in the Arab sector of Israel.
Cancer Facts: there has been a 100% increase in the prevalence of cancer in the Arab sector since the 1970’s, compared to a 25% increase in the Jewish sector. The most common types of cancer in our community are lung cancer in men and breast cancer in women. Researchers found that during the last 40 years there has been an increase of 388% in the occurrence of breast cancer among Arab women, compared to a 24% increase of Jewish women. The major causes mentioned were lifestyle changes, which includes nutrition, obesity, lack of physical activity, hormonal replacement and contraceptives use, delaying marriage and motherhood, and a decrease in length of the breastfeeding period.
Diabetes: We published the first comprehensive book in Arabic Diabetes Mellitus – the Era Plague. We conducted the first regional diabetes study day for patients and families from Galilee. We provided lectures to the lay public and school children on diabetes prevention and early detection in various Arab cities. Al-Taj was elected to become the first branch in the Arab sector of the Israeli Diabetes Association.
Cancer: We provided lectures by leading specialists on breast cancer and other topics. We edited the materials to publish the first book in the Arab world on Cancer and Palliative Care. Our health promotion activities included dealing with life style modification, physical activity, smoking prevention and the importance of screening tests for early detection and improved survival and quality of life. We also presented lectures in national and international conferences about “Islamic Views on Death and Dying”. We also provided voluntary home hospice to terminally-ill cancer patients with psychological, spiritual and social support. We plan to establish the first home hospice in order to care for Arab cancer patients.
Acknowledgements: we are grateful to those who have supported our projects. We wish to express our sincere appreciation for the generous support and true commitment of the following: MAP – UK; The Sobell Foundation – UK; Pfizer Community Fund – Israel; New Israel Fund – Israel; Wolfson Foundation – UK; Help the Hospices – UK; Children of Peace – UK; The American Academy of Hospice and Palliative Medicine (AAHPM) – USA.
We hope you will be part of our efforts and join forces with us to help improve our community’s health and well being.
Kassim Baddarni - Founder and Director
Al-Taj for Health and Heritage
P.O. Box 85, Arraba 30812, Israel
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