2008; Volume 9, No 5, May



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IAHPC Traveling Scholars' Reports

IAHPC Traveling Scholars’ reports after attending the
IV Congress of the Latin American Association for Palliative Care held in
Lima, Peru.  March 26-29th

From Belize City, Belize
            by Dr. Beatriz Thompson, Anesthesiologist at Karl Heusner Memorial Hospital, Belize City, Belize

It was a wonderful experience to attend the IV Congress of the Latin American Association for Palliative Care (ALCP). Two years ago Ms. Liliana De Lima sent a palliative care team from Canada to advise the Belize ministry of health and the chief pharmacist about the importance of having opioids available for the treatment of pain. On the surface, it would seem that we made very little progress in convincing them of this need.  Belize has only two oral opioids available (morphine SR and tramadol).  I was very surprised when the CEO of the ministry of health gave me a letter to deliver to Ms. De Lima, executive director of IAHPC, that stated that several additional opioids have been included in the national drug formulary and hence would be available soon in Belize. This is a milestone for us. Even though we do not have these drugs at present, it is a positive step since the CEO of the ministry of health has placed his signature to this commitment. I am confident that we will soon have access to additional major tools of palliative care.

Nonetheless, there are other major challenges to face, principally the acceptance of palliative care into the fabric of the healthcare system needs to be achieved. As was demonstrated by Liliana’s report on the use of opioids, from the WHO Collaborating Center in Policy Studies Group, Wisconsin, there is no data available for Belize. This may indicate that physicians do not prescribe opioids, or their use is not recorded which makes the justification of a need difficult. There may also be resistance from ignorant physicians who do not keep abreast of the tools available for improving the quality of life. Resistance may also occur because physicians do not want more responsibility, or that they view palliative care as just an optional task that is not reimbursed adequately. Some physicians, and politicians, may not regard palliative care as a human right.

An additional obstacle to advancing palliative care is that policy makers and politicians may determine that it is not one of their priorities since palliative care is for those people “on their way out” and therefore they do not have much to contribute to society.

Only a handful of health care workers talk about palliative care and most of them are concentrated in the cities. Patients and their families in rural areas in need of pain management must travel many miles to obtain tablets of morphine and must be taught how to adjust doses to control pain. The education of healthcare professionals is slow, but in time we will succeed.

Attending the IV Congress of the ALCP was very interesting and helped me realize that many Latin American countries have experienced problems similar to ours and some still face them. I no longer feel alone. After listening to Dr. Eduardo Bruera, MD Anderson Cancer Center, speak on strategizing and developing leadership, I knew I had come to the right place to acquire the knowledge on how to get the right people to learn the techniques and skills to develop organized palliative care both in the city and the countryside.

At the congress, I heard that the Venezuelans have incorporated palliative care into their primary health care as well as in tertiary care - this is encouraging. A Chilean surgeon discussed the palliation of patients with ascites, pruritus, and icteris which I will share with surgeons at my hospital. To hear an Argentinean oncologist talk about how to attenuate bad odors in cervico-uterine cancer patients was very useful. After reading the posters, I felt that even though palliative care is in its “morula” stage in Belize I can begin to plan research.

Even if palliative care does not receive financial support from our government, Mr. David Praill and Ms. Mary Callaway were quite enlightening on how we might raise funds for programs in Belize.

I have concluded that palliative care will come to Belize because of our relentless effort to change the attitudes towards it.

Many thanks to the IAHPC, especially to Ms. De Lima and Dr. Roberto Wenk, for giving me this opportunity to attend this prestigious congress and for being interested in the welfare of my Belizean people. May God continue to bless IAHPC with very good directors and selfless people.

Thank you
Dr. Beatriz Thompson

From Santiago, Chile

by  María Ignacia del Río Silva, Clinical Psychologist, Palliative Care Program, Universidad Catolica, Santiago, Chile

The congress was very stimulating and has motivated me to continue my personal development in the palliative care program at Universidad Católica de Chile. It was also very helpful because I now have a better understanding of the role and specific work of psychologists working in palliative care.  The congress helped me to improve my knowledge of the spiritual aspects of care. It was a unique opportunity to listen and learn from recognized leaders and other psychologists working in the field. We were able to share our various approaches, difficulties, and strategies in palliative care, as well as formulate future research prospects.

I was pleased with the high level of the pre-congress workshops and the many psychosocial conferences that occurred during the congress.

When I returned home, I realized how much of an impact the congress had on me. I noticed that I am more aware of the spiritual needs of the patients and their families and that I have developed a better method to asses this domain.  I am also surprised by my new energy and desire to improve our work here in Chile, but also to continue to study and learn more. 

Since the congress, I have been thinking of ways that we can systematize our approach to the spiritual aspects of our care. A good systematization will help us not only in clinical work with patients but also it will help define the academic goals of our program. A systematization of the spiritual needs of the patients and their families can provide our team members with a common language, which I think will enable us to have a better understanding of the team and patients. This common language will most certainly allow us to develop research in this important area, and along with our clinical work, will help us to share knowledge and sensitize students interested in this field of study.

I am very grateful for the support from the people of IAHPC for this chance to widen my understanding and vision of the greater needs of palliative care.

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