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EAPC-East Newsletter
NR 19 - February 2004
By Sylvia Sauter     &      Carl Johan Fürst
Reprinted here with permission

Travelling grant to spend 2 weeks at Stockholms Sjukhem´s
palliative care unit

Money for a travelling grant to Stockholms Sjukhem was collected on the
event Voices for Hospices in October 2003. A grant to stay two weeks at
Stockholms Sjukhem was announced and there were 5 applicants.
Dr  Elena Vvedenskaya from Niznij Novgorod in Russia was the recipient
of the grant. We hope this grant will be useful to the involved parties.
There are discussions with sponsors for a project, a program with
several travelling grants to palliative care units and hospices in
Sweden, but so far nothing is decided. We will of course let you know
when decisions have been made.

International directory of palliative care

There is an international directory for all palliative care hospices and
units in the world. It is administered by Hospice Information Service.
It is very useful to have the list accurate as it gives the opportunity
for contacts from all over the world. Please check if your hospice is
listed and correctly so. If not then please let them know the needed

Moldova will have the option to prescribe opiods per os

Hospice "Angelus" has been working as a home care for incurable cancer
patients since October 2001. From the first step of our work we have understand how important to live without pain for our patients and how difficult for us to do it
(because existence only morphine in ampoules in Moldova and it
restriction in prescription). For the first time our team asked the
Ministry of Health to introduce the oral Morphine in Palliative Medicine
1 year ago. During this period of time we organized press conferences,
meetings with representatives of Ministry of Health and of oncological
Institute , National conferences , where we explained importance of
using oral morphine in Moldova (easily in dosage and cheaper). Separate
thanks to other Moldavian non-governmental Palliative Care
organizations, which support us, to Professor Jacek Luczak from Poznan,
Poland (he held conference concerning oral opioids for family doctors
from Chisinau, met Ministry of Health of Moldova) and to Soros
Foundation in Moldova (they organized the 1 satellite symposia in
palliative care in Moldova and helped us to organize trainings ,
conferences, workshops).

In December 2003 the vice-ministry of health L. Catrinici made contract
connected with supply of morphine in tablets, which after "some procedures" will appear in Moldova.

Natalia Bodiu
e-mail: [email protected]

ALS and Palliative care

The care for ALS - Amyotrophic Lateral Sclerosis is not very well
described. Now a "A Consensus Document - Completing the Continuum of ALS
Care"  presents recommendations after three years of careful study and
deliberations of the multidisciplinary Amyotrophic Lateral Sclerosis
(ALS) Peer Workgroup in the USA, chaired by Hiroshi Mitsumoto, M.D.

The recommendations address different aspects of care through the end of
life for patients with ALS and their families. You can find "Completing the Continuum of ALS Care: A Consensus Document" and supplementing appendices at:  where you can down load the 44 page document in PDF-format.

ABC on palliative medicine from BMJ

This 5th article has the theme of Anorexia, cachexia and nutrition and
is written by Eduardo Bruera. Please find the full text article to download on

The IAHPC Palliative Care Faculty Development Program

The purpose of this new program is to support the development of
palliative care faculty positions for nurses and physicians in
developing countries. The IAHPC- International Association for Hospice
and Palliative Care, Board members will identify and/or select potential
outstanding physician and nurse candidates who have completed formal
training in hospice/palliative care in a recognized institutional
program. Candidates are required to have the intention to return to
their home country (if they are abroad) and develop a hospice/palliative
care program.

IAHPC will negotiate with the potential employer (university, hospital,
or local government authorities) the terms of appointment in such a way that
IAHPC will fund the salary and benefits of the candidate for a period of two years up to a certain amount in dollars. The local employer will then commit to provide employment for at least two more years full time salary. During the 2 year period the employee will be required to comply with mastering clearly defined goals in the clinical development,administrative, educational and research areas. Funding will be contingent on the demonstration of achievement in specific goals in each of these above mentioned four domains. The first contract was signed with the Municipality of Rosario (Argentina) and we look forward to great results.

For additional information about this program and how to apply, please
contact Liliana De Lima, the Executive Director:  [email protected]

Availability of regulated pain medications in the European region: East vs. West

The World Health Organization continues to emphasize that opioid
analgesics must be adequately available for the relief of pain due to
cancer.1-3  This is particularly important in low and middle income
countries where most cancer is not diagnosed until the late stages, when
pain is prevalent.  Opioid analgesics are also needed for the relief of
pain due to HIV/AIDS.4  When opioids are not available, the tremendous
and growing burden of cancer and AIDS is increased further by unrelieved
pain and suffering.  Improvements will occur only if health system and
regulatory barriers, including excessive restriction of opioids, are
identified and overcome.

Most governments are party to the 1961 Single Convention on Narcotic
Drugs, and thus are obligated to ensure the adequate availability of
opioid analgesics for the relief of pain and suffering.  According to
the International Narcotics Control Board (INCB), many governments have
yet to examine their laws and regulations for unduly restrictive
regulatory provisions.5  Examples include burdensome licensing
requirements, punitive legal sanctions, complex prescription regulations
and limits on dose and prescription quantity.  Patients who need pain
relief seldom receive the pain treatment that was recommended by the WHO
in 1986, more than 15 years ago.

A review of INCB statistical data reported by governments and controlled
for population reveals that, in 2001, Western European countries
accounted for 88% of all medical morphine consumed in the European
region.  The corresponding data for fentanyl, hydromorphone, oxycodone,
and pethidine are 85%, 100%, 99.6%, and 57%, respectively.  In fact,
consumption of opioid analgesics in Western Europe has consistently
exceeded that of the rest of the region over the past 15 years.  This
persistent disparity, especially in light of the increasing incidence of
HIV/AIDS and cancer in Eastern Europe should be addressed if European
goals for palliative care are to be met.6

The PPSG/WHO Collaborating Center for Policy and Communications in
Cancer Care is developing a resource program to improve the medical
availability of opioid pain medication in Eastern Europe through a grant
from the Open Society Institute (see

Reference List:
        (1)     World Health Organization.  National Cancer Control
Programmes: Policies and Managerial Guidelines. Second ed. Geneva,
Switzerland: World Health Organization; 2002. (Available at
        (2)     World Health Organization Cancer and Palliative Care
Unit.  Consultation on Strategies to Improve and Strengthen Cancer
Control Programmes.  World Health Organization; Geneva, Switzerland.
Meeting held in Geneva, Switzerland; 25 - 28 November 2003. (Available
at <>).
        (3)     World Health Organization.  Achieving Balance in
National Opioids Control Policy: Guidelines for Assessment. Geneva,
Switzerland: World Health Organization; 2000. (Available at
       (4)     World Health Organization.  Progress Report: Community
Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in
Africa. Geneva, Switzerland: 2002.
       (5)     International Narcotics Control Board.  Report of the
International Narcotics Control Board for 1995: Availability of Opiates
for Medical Needs. New York, NY: United Nations; 1996. (Available at
       (6)     Council of Europe.  Recommendation (2003) 24 of the Committee of
Ministers to Member States on the Organisation of Palliative Care.
Adopted by the Committee of Ministers at the 860th meeting of the
Ministers' Deputies; 12 November 2003. (Available to down load via

All the best!

Sylvia Sauter           Carl Johan Fürst

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