Thanks to a grant from the All Ireland Institute for Hospice and Palliative Care (AIIHPC) in Dublin, the IAHPC was able to award 18 Traveling Scholarships to palliative care professionals from Africa, Asia, the Caribbean and Latin America, enabling them to take part in the Global Colloquium, held in Dublin, Ireland on 14-15 October 2015. This prestigious meeting, sponsored by the World Health Organization and the All Ireland Institute for Hospice and Palliative Care, brought together national policy and clinical experts from around the world to explore relevant issues in palliative care in the context of the recent World Health Assembly Resolution (WHA67.19), which called for the strengthening of palliative care as a component of comprehensive care throughout the life course.
Following the first part of our special report published in January, more of our traveling scholars describe some of the challenges and barriers to palliative care in their country and how their attendance at the colloquium might influence further developments in their countries.
“Attendance at the colloquium was an honor. It helped remind us all that there is a need to build bridges of understanding and relationship at all levels (a little like we do with our patients and families). At this meeting, international bridges were built between nations. Top-down strategies, such as those led by the WHO, feed down to WHO country offices, which in turn assist us in country to ignite and sustain interest and awareness of palliative care at a national level. Patient and carer-centered research provides a platform to present the importance of a patient-centered approach early in the course of illness.
“It was enjoyable and informative to network with colleagues from Ireland, to hear about the innovative services they deliver and are developing as well as to share resources from training courses which are offered to different cadres. More integration through increasing opportunities for a palliative care presence at traditionally ‘non palliative care’ national and international events is needed to continue to make our voices heard in order to assist others to understand that palliative care is not only for those at the end of life.”
“The meeting was very positive, promoting the discussion of the implementation of the World Health Assembly Resolution. Before the meeting the WHO Technical Advisory Group on Palliative and Long-term Care held a meeting with the same objective, so that it was a really productive week.
Now we will try to implement the objectives of the resolution in the countries of the region, and for this, meetings like this are essential.”
“Some 20 years ago I ‘discovered’ palliative care during an Observer program in Canada. I realized that palliative care practices were perfect for the patients I saw: very old, with chronic and progressively degenerative conditions (Alzheimer’s disease, for me, is the perfect palliative care disease model since, from the diagnosis and throughout the long progression of the disease, palliative care is used comprehensively). Palliative care was little known in Brazil at the time, and in general focused on cancer patients. I am part of a small group of people who shared the same interest in palliative care, and we started to disseminate its concepts in Geriatric meetings and congresses in Brazil. In 2004, we established a Palliative Care Standing Committee in the Brazilian Society of Geriatrics and Gerontology. In 2005, we founded the National Academy of Palliative Care (ANCP), with interdisciplinary membership.
“It was very gratifying to see WHO’s concern with life-threatening diseases, and their advocating for palliative care to be integrated into different settings, from primary care to emergency care. WHO recommendations carry a lot of weight and should further promote palliative care worldwide.
“In Brazil, as in many other countries, access to opioid drugs and lack of knowledge by practitioners on how to properly prescribe them are major problems. At the colloquium, I realized that many countries share these problems. Medical education is vital as well as putting pressure on governments to make opioid drugs available.”
“Colombia is located on the northern tip of South America. Palliative care is still in development and has great challenges ahead. Morphine consumption is seven milligrams per capita. We have a new law that promotes the development of palliative care – interestingly very few specialties in our country have their own laws. Although education started a few years ago we do not have enough doctors trained in palliative care, and there is a lack of training for general practitioners. But now we are working really hard in pre- and post-graduate education. Colombia has been a country stigmatized by drug trafficking for which opioid consumption is also a cultural component that has become an even more difficult development.
“The colloquium demonstrated how different countries solve problems in palliative care. Many of these innovative solutions might be applicable to Colombia – especially at this historic moment for our country where palliative care has become a priority in public policy.”
“We also work closely with the Palliative Care Association of Uganda (PCAU) and the African Palliative Care Association (APCA) both of which began at HAU. Through PCAU and those we train (up to degree levels for Africa), there is a palliative care service in 90 of 112 Districts in Uganda. However, there is still gross suffering from cancer and other diseases in Africa and very little pain control and so much more needs to be done to bring the comfort and peace of holistic care through compassionate carers.
“Most of the challenges are from the resistance of doctors and health professionals to the use of oral morphine because of outdated fears from myths regarding addiction, which they were taught, (and are still taught) in medical schools and other training institutions. These professionals are now advisors to governments and this is a major barrier to getting affordable oral morphine available in the homes, where most Africans wish to die, close to their ancestors.”
Reflecting on how the learning at the colloquium might help to overcome these barriers, Dr. Merriman mentioned the value of sharing and adapting knowledge and experiences to the culture and economies of the different countries. She praised the venue of the Global Colloquium, the kindness and helpfulness of everyone, and the Irish hospitality that shone throughout. But she did have an important reminder for the future of palliative care.
“But I did feel that the spirit and ethos of palliative care was not stressed enough. This, to me, is the main need with the values required to carry palliative care forward in all countries. This includes empathy, compassion, hospitality and our ethos and ethical values.”
Our congratulations to the All Ireland Institute for Hospice and Palliative Care and the World Health Organization for hosting the Global Colloquium and our thanks to all the Traveling Scholars who contributed to this article. For reasons of space, comments have been edited.
Read more contributions from traveling Scholars who attended the Global Colloquium in the January edition of the IAHPC Newsletter.
To find out more about IAHPC’s Traveling Scholarships and other opportunities, please visit our website.