IAHPC Traveling Scholars’ reports

2014; Volume 15, No 11, November

IAHPC Traveling Scholars' reports

Nicaragua: 5th Central American Congress on Pain and Palliative Care in Managua


IAHPC traveling scholars, Managua. Left to right: Evelyn Carranza, RN, Ivania Prado, RN, Yasline Bellorin, RN, Indira Trujilo, RN,
Alberto Obando, MD, Maria Saeli, RN, Genisse Rivera Rivas, MD, Sandra Reyes, RN, Maria Elena Chavez, RN, Alice Ramirez, RN, Martha Leiva,
Sidney Antonio, MD, Ana Orozco, RN, Roberta Ortiz, MD, Nubia Olivares, MD, Megan Jordan, MD (far right).

Earlier this year, IAHPC provided Traveling Scholarships to individuals working in Nicaragua to attend the 5th Central American Congress on Pain and Palliative Care held in Managua, Nicaragua, 2-23 June 2014. Here, Dr. Megan Jordan comments briefly on the impact of the conference and shares excerpts from reports submitted by the grantees that reinforce the value of the congress in developing and improving palliative care in Nicaragua.

“On behalf of the Palliative Care Network of Nicaragua I would like to thank you for making it possible for numerous nurses and physicians to receive further education in palliative care. It was my honor to share in the experience of the Central American Congress on Pain and Palliative Care in Managua, Nicaragua, with the scholarship recipients. The passion and excitement of the medical professionals was palpable and will serve as a continued spark for the growth of palliative care in Nicaragua. I wanted to share with you the reflections of those who attended the congress so you might see just what it meant to each person.”

Sincerely, Megan Jordan, MD, 24 August 2014.

(Note: Megan Jordan is a palliative care physician from Duke University, US. A visit to Nicaragua in 2013 to conduct a palliative care needs assessment, led to Megan’s ongoing involvement. She continues to visit twice a year as an advisor to La Red de Apoyo de Cuidados Paliativos Nicaragua – a work group of dedicated Nicaraguan volunteer nurses, doctors, and social workers who do the ground work in Nicaragua).

Comments from some of the recipients of the Traveling Scholarships

For Maria Elena Chavez Ruiz, Rivas the congress was beyond her expectations giving her the strength to break the paradigms practiced by many health workers, e.g. telling a patient with end-stage cancer that “pain is normal for you”, or “telling relatives to wait outside the patient’s room when the patient is dying so that he/she dies in the hands of health care personnel and not next to his family.”

Evelyn Carranza Almendarez, a nurse epidemiologist from Managua, found the lectures interesting. She agreed with Dr. Lisbeth Quezada from Costa Rica that palliative care in Central America must be done through partnership with different medical specialties and health workers and stressed the importance of an interdisciplinary Masters at national level.

Martha Leiva works every day with female cancer patients who are in great pain. The conference has motivated her to apply the skills she learnt to her workplace so that she can “provide more integral attention to our patients and their enormous suffering”. She plans to look for possible donors in order to obtain better medication for pain and symptom control.

Sandra Reyes, a nurse in a chemotherapy clinic, appreciated the practical clinical information and the chance to hear other health professionals’ experiences of caring for terminally ill patients. A key learning point was “the importance of the primary caregiver during the terminal phase and how, when they are depleted, the support of the healthcare team is essential.”

For Dr. Mario Alberto Obando Araica the program had fulfilled many expectations: knowledge of different medications, addressing psychology and organization of services. He hoped that Nicaragua would soon have its own well-developed palliative care program with national support:

“Personally I hope to support increasing the number of participants in the program and that arrangements are made in the Parliamentary Assembly for the knowledge of officials and legalization of the program.”

Maria Saeli, a nurse from the International Christian Hospice, Leon, commented on the quantity and depth of the information shared, the excellent presentations and the opportunity to see “how hospice/palliative care had expanded throughout Latin America and to learn from others of like vision.”

Ms Alice, a nurse from Hospital Neuvo Amanecer Puerto Cabezas, comes from an area where there is “no certified entity to support patients with terminal illness”. Her key priority was to get to know other palliative care programs in Nicaragua and other countries and she found it beneficial to learn about the advanced palliative care program in Costa Rica.

“I have learned that palliative care is not only for evaluating patients with terminal cancer but also chronic diseases, and there are in Nicaragua organizations serving these patients but as non-governmental organizations.”

Indira Tujillo Orozco, is a nurse in the Departamento de Hemato-oncología Hospital Infantil de Nicaragua Manuel de Jesus Rivera. With no existing palliative care service in her hospital, she had multiple learning goals including developing a team, managing pain, and providing palliative care for children.

Thank you for letting me be part of this group of fellows, it was a great opportunity and one that I hope to develop in my service to create awareness and humanism along with the rest of my colleagues and doctors that care for our children. I hope some day the reality of Nicaragua and the children’s hospital will change and improve the care. Meanwhile staff education and awareness is what we need.”

For Dr. Sidney Antonio from Hospital Neuvo Amanecer Puerto Cabezas, the congress has motivated him to plan to open a room in his hospital for short-term care of palliative care patients.

“This conference has given me the opportunity to learn and apply the information to help those patients with terminal illnesses and [their] families. I have learned another [way] to help patients with cancers and chronic diseases.”

(We thank the traveling fellows for permission to extract and edit content from their reports, and Dr Megan Jordan for translating the comments from Spanish into English).

Read more about the IAHPC Travelling Scholarships program apply now for 2015.


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