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We are delighted to publish below an English translation of a letter signed by IAHPC members, Dr. Santiago Rodriguez Corrêa, representing the Group of Work of Palliative Care from the Brazilian Society of Family Medicine and Community, and Dr. Arnildo Miranda, representing the Family Medicine Association from the Rio Grande do Sul. The letter was presented to the public during the first Seminar of Palliative Care and Family Medicine on 15 July 2017. (The seminar was part of the Third Congress of Palliative Care of Mercosul in Pelotas, Brazil). The letter was later handed to Daniel Neves Forte, President of the Brazil National Academy of Palliative Care.
July 15th, 2017
Letter from Pelotas: the future role of family doctors in Brazilian palliative care
There is a current expansion of palliative care around the world. This development brings some uncertainties. When, where and how are questions raised but there is little evidence to guide such growth. The world turns its eyes to sustainable ways of promoting palliative care. A palliative care that is integrated to the three levels of care, but with emphasis on primary care and on palliative care on the community, is most likely to be accessible to all in need. This is advocated by the World Health Organization and emphasized in the recent World Congress of the European Association for Palliative Care in Madrid.
The world looks to the community to extend access to palliative care for the sick citizens. That expansion is necessary due to demographical and epidemiological modifications, and must be faced. This will necessitate deep modifications in the national policies and health services in the way that we recognize and deal with patients and their relatives that need palliative care.
The current way the systems of health are organized is not able to offer palliative care for the ones who need it. It is necessary to consider palliative care as a public health problem, due to the cost that last-year-of-life care brings to the system. That cost is not related only to the great amount of resources used in an inadequate and sometimes futile way to attend the needs of people with advanced illnesses. It is also reflected by the tangible cost of the suffering caused by the inappropriate control of the physical symptoms and psychological, social and spiritual needs that are not assuaged.
One of the solutions to expanding palliative care to all in need is primary care teams, offering a palliative care approach with the strong participation of the community. A new approach of public health and end of life care is needed. Community involvement is essential for the best results: [the] person who needs it, meeting his/her needs, as well as for the relatives. Within that approach the family doctor and the primary care professionals are a central part in relation to organization and execution of that process. It is not possible to think about an adequate system to promote palliative care without a policy in which primary care professionals take part, in the public sector as well as in the private one.
In recent years many publications affirm that the family doctor can and must offer that type of care in his/her daily practice. The lack of a supportive system does not discharge the doctor from the primary attention of his/her moral, ethical and technical responsibilities from trying to offer what is adequate for that sick person and his/her family.
The suffering of patients occurs beyond the hospital bed, and the more specialized sectors with their high technology. The suffering of those people who do not have access to palliative care and that are waiting for a correct identification of their needs and for someone that sees them beyond their diagnosis, does not belong to any professional, no matter what level he/she is. It belongs to the patient, who most of the time knows how to divide this burden with his/her family and with his/her community.
Palliative care cannot be victorious without the active participation of the professionals of primary care. That participation covers all the steps of care. Those steps cover the early identification of patients who need palliative care, the correct and continued evaluation as well as the adequate communication in all the moments of the disease, referral to other professionals when necessary and continuation with bereaved relatives in the community. In order to work, the use of existing structures helps. The use of programs like: ‘Estratégia Saúde da Família’ e ‘Melhor em Casa’ which allows the sustainability and the possibility of giving the first step of that expansion of access to palliative care in a fast way since they are well-established programs and with a huge distribution in the Brazilian territory, including in the countryside.
The goal of a national Brazilian program for palliative care has to do with the expansion of the access to and best possible care in a timely way according to the needs of the sick person and his/her relatives. In order to reach that goal, training and coordination is necessary. The discussion of the competencies of the family doctor in relation to palliative care, which will be added to the principles and tools of the primary attention and of family medicine, is the first step. For the best possible palliative care to be offered in primary care and in the community, it is necessary to learn from examples.
This letter has a final objective of making clear to the institutions that represent family medicine and palliative care the potential of the family doctor in being part of the future of the palliative care in Brazil. A future that offers more access to that type of care and consequently less suffering and more quality of the trajectory at the end of life of each one.
Santiago Rodríguez Corrêa
Coordinator of the Group of Work of Palliative Care, Brazilian Society of Family Medicine and Community
Arnildo Miranda
Family Medicine Association, Rio Grande do Sul
This letter was written in July 2017 by Santiago Rodríguez Corrêa, with the participation of André Silva, Carla Mazuko, Erica Lara and Guilherme Gryschek. It had the approval of the Family Medicine Association from Rio Grande do Sul, represented by its president André Silva, and also of the Brazilian Society of Family Medicine and Community, represented by its scientific director, Giuliano Di Marzio.
Thanks so much Professor Scott Murray for helping us to translate the letter from Portuguese to English. Your work has inspired us to try to prove that it is possible to offer palliative care inside primary care and community centers.
Dr. Santiago Rodríguez Corrêa, July 2017.
The letter hás been edited for reasons of space.
Read the list of individuals who joined/renewed their membership with IAHPC during the past month.
| Name | Country |
|---|---|
| Irene Laska Palliative Care Center - Korca | Albania |
| Maria De Los Angeles Minatel | Argentina |
| Avetis Babakhanyan | Armenia |
| Helen-Anne Manion | Australia |
| Suharsha Kanathigoda | Australia |
| Andrew Allsop | Australia |
| Fazle Noor Biswas | Bangladesh |
| Nezamuddin Ahmad | Bangladesh |
| Sayeda Quadir | Bangladesh |
| Nazmun Naher Shanta | Bangladesh |
| Dr Wen-hao Su Hospice And Palliative Care Center, Mackay Memorial Hospital | China |
| Cecilia Elizabeth Menjivar Deras | El Salvador |
| Mayank Gupta | India |
| Vanessa Lastinowati | Indonesia |
| Jaishree Sharmini Jivanadham | Malaysia |
| Harre Haren Ramasamy | Malaysia |
| Cy Oun Teoh | Malaysia |
| Ahmad Fazlina | Malaysia |
| Shiao Yen Khoo | Malaysia |
| Diana Katiman | Malaysia |
| Socorro Cabello | Mexico |
| Wah Wah Myint Zu | Myanmar |
| Dagny Faksv Haugen | Norway |
| Mary Jocylyn Bautista | Philippines |
| Rohodora Del Rosario Ocampo | Philippines |
| Yun Hsing Lin-Go | Philippines |
| Rowena Fatima Galarpe | Philippines |
| Carol Narra | Philippines |
| John C Ely | USA |
| Judith Paice | USA |
| Nessa Coyle | USA |
| Carol Riggenbach | USA |
| Name | Country |
|---|---|
| Kathleen Grimm | USA |
| Alvaro Méndez Guerra | Uruguay |
| Mallika Rayamajhi | Nepal |
| Sunil Aggarwal | USA |
| Francis Cabatingan | Philippines |
| Samia Ahmed | Bangladesh |
| Chan, Lut Ming | Hong Kong |
| Pih Lee | Malaysia |
| Mridul Sarker | Bangladesh |
| NG Sheung Ching Jeffrey | Hong Kong |
| MKDL Meegoda | Sri Lanka |
| Lailatul Ferdous | Bangladesh |
| Chung On Chang | Hong Kong |
| Norhisham Main | Singapore |
| Mohd Yunus Khilji | India |
| Lilia Indah Irmawati | Indonesia |
| Susie Ernawati | Indonesia |
| Winnie Ling | Malaysia |
| Choo Yoke Ling | Malaysia |
| Arabele Coleen Ofina | Philippines |
| Amie Lyn D Pamplona Masecampo | Philippines |
| Palliative Care Association of Sri Lanka | Sri Lanka |
| Vanesa Rocio Orellana Caro | Bolivia |
| Finly Zachariah | USA |
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