Two IAHPC Traveling Scholars’ Reports
The field of palliative care in Brazil has gained importance during the past 20 years with the development and promotion of well-organized services. Today there are about 40 palliative care services (including hospital wards, hospices, outpatient services and reference teams) located mainly in the southeast of Brazil. Considering that Brazil has a huge population, this number is inadequate. As an example, I work as a Clinical Oncologist in the Oncology and Hematology Institute of Campo Mourão, located in the city of Campo Mourão, Paraná State, South of Brazil. This Institute serves as a public referral center for the evaluation and treatment of malignant diseases for about 360 thousand inhabitants, but there is no formally organized palliative care service. Moreover, in the South of Brazil 31,238 patients died of neoplasia in 2006. Despite this, palliative care practice in Brazil has no official regulation and is not part of any government or private health policy. Because of this, the study of palliative care by health professionals is limited and far from the ideal.
With this in mind, I participated in a two-month observation/study period in the Palliative Care and Anesthesiology Departments at the Vrije Universiteit Medical Centre (VUmc). My main objective was to acquire additional knowledge in evaluation and treatment of patients requiring palliative care. This activity was supported by a Traveling Scholarship from the International Association for Hospice and Palliative Care. The clinical fellowship started in October and ended in December 2010. The program was student oriented and needs based and covered almost every field of palliative care. My mentors were Prof. Dr. Wouter, W.A. Zuurmond and Dr. Maurice van der Vorst, along with the valuable administrative support of Mr. W.J.J. Jansen and Ms. I. Jagerman.
Some of the activities undertaken in this period were:
- meetings about the organizational aspects and policies regarding palliative care in the Netherlands and in Amsterdam (netwerk paliatieve zorg – palliative care network);
- participation in ward rounds, multidisciplinary team meetings, and pain clinics;
- observations of invasive pain control procedures;
- interaction with three hospice teams in Amsterdam
- participation in palliative care day meetings;
- participation in a patient safety symposium;
- participation in the Fourth Belgian Symposium on the Integration of Molecular Biology Advances into Oncology Clinical Practice, Brussels, organized by Institut Jules Bordet and the European Society for Medical Oncology;
- learning the principles and practice of transcutaneous electrical nerve stimulation;
- interaction with the pain and palliative medicine teams in the University Medical Centre, St. Radboud in Nijmegen, the Netherlands, where I attended multidisciplinary meetings and epidural analgesia procedures.
All these activities were useful to fulfill my academic goals of learning basic and advanced skills in palliative medicine as well as understanding how an outstanding palliative care service is organized. I now feel much more comfortable as I create a palliative care ward in Brazil committed to the evaluation and treatment of public health patients. Besides the academic aspects, the fellowship I experienced was a unique opportunity to share my own views regarding the care of patients with palliative needs and to acquire life and cultural experiences.
I would like to thank the International Association for Hospice and Palliative Care, the Anesthesiology team and the Palliative Care team at the Vrije Universiteit Medical Centre for providing the support that made this clinical observation period possible.
The International Association for Hospice and Palliative Care (IAHPC) in conjunction with the African Palliative Care Association (APCA) funded my trip to attend the 18th International Palliative Care Congress in Montreal Canada during October 2010. I wish to extend my appreciation to IAHPC and my mother organisation (APCA) for their support to attend this important congress.
My attendance at this congress provided a great learning opportunity for me. The conference was a good opportunity to share experiences, make contacts, and learn a number of key lessons.
Richard beside his Poster (left) and the IAHPC booth (right) at the Montreal Convention Centre.
The purpose of my travel was to share PC information using the minimum dataset for Africa and to learn from other delegates about new developments in palliative care.
My poster presentation ‘creating a Palliative Care Minimum Dataset for Africa’ was well received. Many people visited the poster, asked questions, sought clarity and shared their experiences with the minimum dataset for PC.
Accomplishments/ Lessons Learnt:
- One of the key accomplishments was that more than 50 delegates visited my poster. They asked for APCA information, sought information on the PC minimum dataset and shared their experiences with me.
- I was able to improve my presentation and dissemination skills which will enable me to perform better in my organisation as I provide information.
- Through interaction and sharing, I learnt new ways to enhance my work. The wealth of experiences I gained will permit me to incorporate new ideas into some aspects of our work and to improve our interventions.
- The conference is organized in Canada but does not rotate in other parts of the world. Many PC stakeholders want to attend but the cost is too high and as a result many potential delegates are left out. There is a need to have the conference rotate around the world so that many more people can attend.
- Also, there was a noticeable lack of attendance of delegates from developing countries. Africa was particularly not well represented yet it is a continent with a high disease burden and great PC needs.
Attendance at the 18 th PAL Congress was an eye-opener for me. I learnt many things as highlighted above and I have started to share them with my colleagues at APCA. The lessons learnt about the evaluation of PC programmes are useful and will improve my work. I recommend this congress to other PC practitioners.
Richard Kaye Mugula, Uganda
Acting Monitoring and Evaluation Manager
African Palliative Care Association
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