Rosa Buitrago is Professor of Pharmacology and Pharmaceutical Care in Cancer Pain Management in the School of Pharmacy, University of Panama, Republic of Panama. She is currently Vice Dean elected for the period 2011- 2016 and a member of the Board of Directors of the International Association for Hospice and Palliative Care.
Fifteen years back, when I enrolled as a student on the Master’s Degree Program in Clinical Pharmacy at the School of Pharmacy, I became interested in the topic of cancer pain management. At the time, I thought that with my knowledge of pharmacology I was in good shape to successfully work in this field ... yet nothing was further from the truth. The pharmacist who cares for cancer pain patients needs to integrate a range of complex skills including pharmacotherapy, pathophysiology, laws and regulations on controlled substances, pain assessment, and should also get involved in promoting the necessary changes in policy and education. I also thought, “… if this is what it’s like for me, what about my own students?”
Motivated by this, I immediately set out to change things. After nearly two decades, we have achieved the following major changes in the teaching offered by the School of Pharmacy:
Today, Panama has about 300 pharmacists who have received 50 hours’ specialist training and six specialists with a Master's Degree in Pain Management and Palliative Care. We have initiated a research and teaching group that has driven changes in national regulations on access and availability of opioids and palliative care. We have also participated in different advocacy activities. These include the development of the National Palliative Care Program of the Republic of Panama, a side event at the United Nations in 2010 to support the approval of the US resolution to reach a balance between measures of access and control of substances for medical use, and workshops held in Panama, Ecuador and Peru to promote access and availability of opioids. This would not have been possible without the support of the Pain and Policy Studies Group, the International Association for Hospice and Palliative Care, the Livestrong Foundation, the Open Society Foundations and Human Rights Watch, among others.
But life is full of surprises. Less than a year ago, almost at the moment I was elected as a member of the IAHPC Board of Directors, a close and much loved member of my own family was affected by serious illness. Even with all my accumulated experiences I knew that it would be very difficult for me to face up to the sequence of events. My ‘patient’ was given a pacemaker but also suffered three ischemic strokes that led to a diagnosis of vascular cognitive impairment. In addition to that, a diagnosis of chronic obstructive pulmonary disease (COPD) and sleep apnea aggravated the overall condition. Suddenly I became the caregiver of a previously strong, smart and independent person. I was in no way prepared for this.
Palliative care goes beyond cancer pain management – people affected by other conditions such as those mentioned above might also benefit from it. I have been wondering about my students and other caregivers who might be in the same situation. What changes should I promote? What should I do for patients and caregivers who are, or will be, affected by these conditions in order for them to have a better quality of life? The first thing I did was to read and study information about every illness of my ´patient´ using the internet and books. I checked global statistics and I found that millions of people worldwide suffer strokes, COPD and apnea. I also talked with other caregivers of patients with these conditions. In all cases, strokes had taken them by surprise and – in some cases – the situation was aggravated by mixed diagnoses such as vascular dementia and Alzheimer's.
My conclusion remains the same as it was 15 years ago: education is essential, with an emphasis on prevention of these diseases and, if the disease is already established, to provide patients with the best options of palliative care, without forgetting their caregivers.