2008; Volume 9, No 12, December



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Reports by IAHPC Traveling Scholars
from Poland and Tanzania

From Poland

17th International Congress on Palliative Care, Montréal,
September 23-26, 2008

Thanks to a grant from the International Association for Hospice and Palliative Care (IAHPC), I was able to attend the 17th International Congress on Palliative Care. I attended several plenary sessions, among them  ‘International Issues- Challenges and Opportunities’ with Dr Kathleen M. Foley who spoke about practical strategies and international perspectives in end-of-life care and the session on ‘AIDS in Children in Africa’ given by Jimmy Kolker, representative of UNICEF, plus an interactive session on ‘International Issues: Palliative Care as a Basic Human Right.’ During these sessions it was obvious how much has been done in the field worldwide, but it was also obvious that there are still many problems that we continue to encounter on our way to advancing palliative care globally.

The sessions stimulated vivid discussions. I found very interesting the sessions on European initiatives to integrate oncology and palliative care (prof. Dirk Schrijvers) and an impressive presentation by Dr Nathan Cherny on building bridges where people in Israel are admitted to hospices irrespective of their nationality. As I am unable to discuss all the very good sessions I had the opportunity to attend, I was particularly impressed with the interactive lecture given by Dr Sam Ahmedzai on the pathophysiologic basis of pain and current treatment options.

There was a general message about the importance of education, effective advocacy, national policy on opioids and integration of palliative care into the national health care systems before a real advancement in care can occur. The important role of national and regional leaders in helping to bring this about was stressed.

In many countries a great effort has been made within the last few years. However, there are still many regions of the world where the situation is catastrophic and the prospect of improvement is really poor.

It is with real pleasure that I proudly report that Poland has approximately 500 PC services. A recent international report found that Poland is in 5th  place among European countries for the development of palliative care services. This is really impressive since the health care system in our country is in a poor state and faces multiple obstacles related to the transformation after Poland gained independence from the communist block.

Professor Jacek Łuczak and other leaders have contributed substantially both at the local and national level to introduce palliative care through education, setting up PC services, building hospices, etc. In the early years many physicians and other professionals (nurses, psychologists) were given the opportunity to obtain scholarships to study in leading British hospices. Many outstanding PC pioneers visited Poland for conferences. Dr Robert Twycross visited Poland annually for years and had a great impact on the movement. With deep grief we remember Prof. Vittorio Ventafridda who visited us in 1994.

Today there are a number of centres countrywide that provide both undergraduate and postgraduate education in PC and some of them offer education for professionals from Eastern Europe countries (ECEPT in Poznań, Łódź, Gdańsk, Bydgoszcz).

The entire Montréal conference was very useful and I learned a great deal. I would like to thank again the IAHPC for giving me the opportunity to take part in this meeting.

Dr. Aleksandra Kotlińska-Lemieszek
Poznan University Palliative Care Team

From Tanzania

I am privileged to be a member of the family of IAHPC’s supported scholars. The need for palliative care in Tanzania and Africa in general is large; however there is a huge gap in the understanding of this concept among health care providers and policy makers. All human beings no matter where they live, deserve quality care provided with respect. Palliative care is an answer to this paradox but in Africa and other developing countries few people can define it in a practical way.

My first exposure to palliative care was at San Diego Hospice and Centre for Palliative care studies. This experience was instrumental in my selecting palliative care as a career. I met Dr. Frank Ferris and Sir Gail Rainer, both senior palliative care specialist at San Diego Hospice and Centre for Palliative Care Studies. They had a great influence on me during the early stages of my career. Of the many things they shared with me, was a quote of Dixon’s 6 principles of learning. In part, they describe learning as never complete unless one puts hands on and sees with one’s own eyes what is described in books.

I was privileged to receive an IAHPC Traveling Scholarship to attend a workshop on paediatric palliative care at the University of Cape Town. I learned a lot during this workshop. The workshop brought me to a higher level of understanding concerning the need for palliative care in the children we serve at PASADA (Pastoral Activities and Services for People with AIDS, Dar es Salaam Archdiocese).  We are a not for profit organization that provides services to people infected and affected with HIV. Children are among a priority group targeted as one of our beneficiaries. We have more than 5,000 children affected by HIV who access PASADA service on daily basis. The majority of these children present with multiple problems - physical, emotional, spiritual, social and psychological. PASADA has a special interdisciplinary task force (family centred care team) that provides hololistic care and includes social workers, doctors, nurses, counsellors, chaplains, house keeping staff, family members and the client. This approach invites the family to take part in the process of care and the choice of a treatment plan.  Our initial clinical offering involved five clients and it was a tremendous success. We have since scaled up to ten children who present with multiple problems linked to their illness. Our model has improved as has the quality of life of the patients during this pilot program. The families are not only impacted by the problems of the situation, but are central to the solutions, thereby ensuring their involvement. It also acknowledges the power and uniqueness of family in the African context.

The Cape Town workshop has provided us with valuable information that will improve the work done by PASADA for the people of Tanzania.

On behalf of PASADA and the community of Tanzanians we serve, I wish to thank the IAHPC for enabling me to attend this workshop.

Dr. Frank Manase

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