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Report of the Palliative Care Fellowship to the Faculty of
Biosciences and the Teaching Hospital, Universidad
Austral, Buenos Aires, Argentina.
An IAHPC Travelling Fellowship
Dr. Bruno Gagnon

The invitation to the Faculty of Biosciences and the Teaching Hospital of the Universidad Austral had the very interesting objective to evaluate the possibilities of incorporating PC principles and knowledge to all level of patient care and academic activities.  This faculty is very young with only few years of activities.  The great advantage is that all faculty members are enthusiastic and determined to create an instrument to improve care for any patients with any medical condition.  This commitment is primordial, as the faculty desires to influence positively the whole culture of care within the country and outside the country.  For this reason, the faculty members wanted to incorporate as soon as possible PC principles and knowledge as they understand that PC is now part of good medicine and should be accessible to all patients in need of PC whatever their medical diagnosis.
 As shown in the Table 1, during my trip, I had the opportunity to influence this institution at all levels.  There were two priorities: 1) To teach the present medical and nursing (and other disciplines) staffs about PC principles and basic knowledge, with the hope of encouraging them to look for more opportunities to train and to incorporate into their practice PC; 2) To meet with the principal decision makers at the academic and clinical levels.
 I was impressed by the enthusiasm raised by the different teaching activities that I had the opportunity to be involved with.  Clearly, the physicians, nurses, pastoral agents, etc. are sensitive to the patient's distresses and were quite aware of the limitations of present medicine to meet them.  Many concerns regarding ethical decision processes regarding the opportunities of specific diagnostic tests and therapeutic interventions in end-of-life care, specific symptom management issues, communication with patients and family members, team work, etc. were voiced. There was a constructive spirit and a desire to learn more and better solutions.  The staffs were not afraid of expressing very personal difficulties and crisis in an open discussion for the benefice to all.  In a very short time, I was able to grasp relatively well the real challenges they had to face and to provide some elements of solution and orientation.  Clearly, all the staff was quite receptive.  It was a very attractive milieu.  Some medical staff had expressed the desire to look for further training opportunities, especially among the youngest ones.  As they have the responsibility to care for the sickest and the terminally ill patients-  they realised quickly how PC training may improve their ability to care for these patients.
However, the real surprise came during the different workshops with the board of directors.  All of them and specially Dr. Di Lucca understood the value of PC for a young hospital trying to create a caring milieu at the beginning of the 21st century.  While they are clearly interested in providing excellent opportunities for saving patient life like transplant program, top quality intensive care unit, etc., they realise that patients also die and best care should be provided to them.  In their short existence as an institution, they have the experience that failing to provide good end-of-life care leads to unnecessary suffering of patients and families, futile uses of diagnostic tests and therapeutic interventions, demoralizing experiences for the staff and false ethical debates through lack of understanding of the real issues at hands.  Concrete suggestions were made of the importance of a PC team, and at some later date, a complete PC service. The importance of offering home PC consultant services by the hospital was constructive and lead to many  suggestions.  Opportunities for further training and research were an important part of this fellowship and will lead to collaborative works in the future. 
The plan for the next 5 years is hopefully to return for further teaching activities and to keep close contact through collaborative research projects and exchange of opinions.
Dr. Bruno Gagnon

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