Professor Max Watson, Director of Medical and Care Services, Northern Ireland Hospice, gives his impressions of his first visit to Uruguay.
For a week in the month of April I had the privilege of visiting colleagues in Montevideo, Uruguay, to see first hand palliative care services in action across a range of settings. The trip had been arranged in collaboration with the British Embassy in Montevideo to promote the use of ECHO, Extension of Community Healthcare Outcomes, in palliative care.
ECHO uses online video conferencing to develop knowledge and support networks between professionals who are often working in isolation. In situations where palliative care expertise is limited, ECHO provides an opportunity for multiplication of knowledge and support to enable teams working in more isolated areas to share the benefits of being connected with a wider support network of peers and experienced practitioners.
This was my first visit to South America and of working in a Spanish-speaking situation. Uruguay is a small country with a population of around three million, great passion for football and political pragmatism, sandwiched between its very big neighbours of Argentina and Brazil. Palliative care services in Uruguay have expanded considerably, beginning with the creation of a clinic in the Marseille Hospital under Dr. Gabriela Píriz. With residents spending time with Dr. Piriz over the course of the past seven years she has inspired many other physicians with her passion for palliative care.
The Marseille Hospital service also has expanded rapidly with a multidisciplinary team of doctors, psychologists, nurses, social workers and administrative support, providing a palliative care service. This service operates not only within the hospital but also throughout Montevideo with teams assigned to the different areas of the city. Experiencing this team in action was very encouraging. Clearly they work well together and are very supportive of each other as they deliver care to patients and families across the city, and spread the word about how important palliative care is, even amongst clinicians who struggle to understand its nature and value.
We also had the chance to visit a palliative care team in San José, a town of about 100,000 outside the capital. Once again, the commitment, ‘team togetherness’ and zeal for palliative care were clearly evident. What was unusual about San José was that the palliative care department was a private service that was delivered across the town from a base in a private hospital. The hospital had clearly seen the benefit of palliative care and had employed the lead physician in a full-time capacity and the state health system was able to integrate the private delivery of palliative care services across the region.
The development of palliative care services face many challenges in Uruguay. The specialty is neither well recognised nor understood by other clinicians. Those committed to developing services are often at an economic disadvantage to other colleagues working in different and more affluent services. Finding the time to develop and expand new services is difficult in a clinical workforce where most are holding down three distinct jobs, working from early morning to evening to make ends meet. Within Montevideo hospitals there is inconsistency of service delivery with some of the major hospitals having active palliative care departments while comparably sized hospitals have no provision.
That said, much has been achieved with the development of guidelines, training programmes and through the influence of pioneers such as Dr. Píriz and her team. Now, more and more patients with end of life care needs across the country are benefitting from a Uruguayan palliative care approach that is delivered with great skill and great compassion.
The Palliative Care Association of Sri Lanka was inaugurated on 20 April 2015 at a ceremony held at the Sri Lanka Foundation Institute. Here, the president, Dr. D. K. D. Mathew, describes the association’s priorities for developing palliative care on the island.
The Palliative Care Association of Sri Lanka (PCASL), as the national umbrella organization, will engage in the development and spread of palliative care treatment for all those who are in need of such treatment around the island and the training and education of all interested persons in the field. The formation of a national body is quintessential for the development of palliative care in a sustainable way with the participation of all relevant stakeholders in the government and non-government sectors.
The Palliative Care Association of Sri Lanka proposes to integrate palliative care into the National Health Policy in order to establish training facilities for doctors, nurses, paramedics, other caregivers and community volunteers and also with regard to the availability and control of pain management substances such as use of opiates.
PCASL aims to target the development of palliative care at the primary health care level, as it would provide greater access to those who need it most with limited economic capacity. Finally, the success and satisfaction of all we propose to do will be evaluated by the terminally ill who will receive better palliative and end of life care at the community level.