IAHPC Hospice and Palliative Care Newsletter

“Solaris – Hospice: Palliative Care in Kazakhstan”

by Valeriy Smola, Director

The Republic of Kazakhstan is a one of the emergent nations in Central Asia with the population of 15 million.

In the city of Pavlodar, the cancer morbidity rate is approximately 273.7 out of 100 000 people. The presence of metallurgical, chemical and other insalubrious manufactures round the city results in such a high level of cancer. The South of Pavlodar region is a part of the Semipalatinsk nuclear polygon.

The Public Health and Social Protection reforms in the Republic of Kazakhstan still have not touched the sphere of aid to people with fatal diagnoses. The patients in the last stage of cancer are discharged to their homes from medical establishments, under the supervision of district doctors. But these doctors are not qualified for rendering special aid to the incurable patients. Their relatives become responsible for further care of the patients. However, they are usually not prepared for such demanding care. The existing medical establishments are not orientated to rendering specialized medical and psychological aid to dying patients. Palliative aid for incurable patients in Kazakhstan is only starting to grow. Currently there are only 4 hospices in the Kazakhstan Republic.

Our hospice was created on the basis of NGO “Solaris” in October 1^st, 1999. For the first year and a half all the organizing work with the patients was accomplished by volunteer's initiative of the "Solaris" staff. At first we only worked through outreach (home) service. Visiting the patients, the outreach services could give only nurse’s aid and doctor's consulting while the equipment and technical support system was acquired. We gained our first experience of working with the patients. During this time, we worked without financing and we were able to help 70 patients.

With this effort we formed logistical support for the hospice. We worked with international charity organizations, state and business organizations, and the mass media. Through this process we were able to obtain and make the necessary repairs to a building for the hospice. We obtained financing from donor agencies and charity organizations. The hospice received a state license, and resources for medication, transportation, and salaries. At the end of 2002, we established a permanent department for 15 patients.

Currently, the organizational and functional structure of the hospice allows for serving all patients, who apply for the hospice help, and live in the city of Pavlodar (about 400 per year). Hospice offers the whole range of palliative services: medical, psychological, social and legal aid. Approximately 75.5% of all patients demand different kinds of social and legal services: lawyer‘s consultations, executing documentation for receiving a handicapped status, and social benefits. 9% of the hospice patients live alone, without close relatives. About 70.2% of the patients and their families apply for the help of psychologists, and attend meetings with representatives of different religious affiliations in the hospice. 94% to 96% of patients suffer from pain syndrome, about 28% to 30% of these patients get narcotic analgesics. We follow WHO recommendations in treating the pain of our patients.

NGO “Solaris” hospice is the first and the only hospice now created on the basis of an NGO. It causes some peculiarities of our activity. Currently, there is no legislative basis providing a guaranteed state support to NGOs in the Republic of Kazakhstan. Therefore, one of the main operative sources of financing is grant help from international charity foundations. The competitive principal of financing of the international organizations does not provide guaranteed financial independence and stable work. Commercial organizations render mainly spontaneous and non-recurrent help. Commercial business donations are not stimulated with tax privileges and other incentives from the state. The search for sustainable funding for current hospice needs takes the largest amount of time and negatively influence the main activity of the hospice services.

We plan to improve the quality of the services for the patients, by increasing the medical indications for taking patients into the hospice. That is the reason why we are so interested in a permanent and stable source of financing that would support the hospice’s stable development. Our long-term goals involve participation in starting the hospice movement in Kazakhstan and creating and carrying out the standards of palliative aid in the Republic. Currently we are promoting the creation a hospice on the NGO basis in the city of Semey. The myriad of people in the Republic of Kazakhstan desperately need hospice help. Our duty is to offer our experience, care and compassion to the people who demand our support.

We are also looking forward to the information exchange in the spheres of palliative aid with foreign colleagues.

Contact Information:

NGO “Solaris”

4, Jayau Musy St.

Pavlodar, 637023б,

Republic of Kazakhstan

Tel/Fax: + 7 (3182) 57-18-72

[email protected]

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