Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, with her latest roundup of advocacy news.
Last month was a particularly busy one, with a workshop in Santo Domingo, Dominican Republic, on the availability and rational use of opioids, the launch of the Lancet Commission Report on Palliative Care in Miami, and the Latin American Palliative Care Association (ALCP) Congress in Santiago, Chile. All were stellar events, and demonstrate the growing interest that palliative care is attracting among new cohorts of providers, the global health community, and the general public as a whole.
The Dominican Republic has one of the lowest opioid consumption rates in Latin America, according to the Atlas of Palliative Care in Latin America. The IAHPC workshop was hosted by La Asociación Dominicana para el Estudio y Tratamiento del Dolor y Cuidados Paliativos (ADETDYCP) and cosponsored by the Latin American Palliative Care Association. Liliana De Lima, Dras. Tania Pastrana, Gloria Castillo, Bethanía Martinez, Wendy Goméz, Dr. Hernan Rodriguez, and I gave expert presentations. International Narcotics Control Board (INCB) Secretariat staff Stefano Berterame and Juliana Erthal produced a video on how the INCB oversees access to controlled medicines in UN member states. Once the didactic presentations were over, participants worked in groups to produce SMART strategies to overcome barriers to access and meet the needs of patients and families in the Dominican Republic.
Pediatric palliative care physician Dra. Wendy Gomez had the following comments about the workshop: ‘It has undoubtedly impacted the local scene concerning the control of medicines for pain management. It showed lack of access, and the complicated process of distribution and availability of medications for the patient, mainly the patient who suffers from life-threatening illness. The presence of the national authorities — Ministry of Health, National Directorate of Drug Control (DNCD), SENASA (state insurance) — Dominican palliative care providers, and representatives of the palliative care association made this event an important starting point to generate a change of mentality and strategic decision-making in our health and social systems. We had the opportunity to get to know each other and to hear everyone’s points of view. Now we can continue the work of advocacy as a specialized association in pain management and palliative care, and continue to dialogue with regulatory bodies to ensure that medicines are not unduly restricted. This will allow us to treat the country’s children and adults in need.’
On my last day, I was privileged to accompany Drs. Diane and Francisco Sabado of Corazon del Siervo on visits to a couple of their homecare patients. Neither patient needed opioids at this time, but Diane and Francisco skillfully addressed the physical symptoms and spiritual distress they and their caregivers were experiencing.
The launch of the Lancet Commission Report on palliative care was an inspiring two days of expert presentations from around the world on the global state of palliative care provision and strategies to overcome the tragic ‘abyss of access’ to controlled medicines for the relief of severe health-related suffering. It was followed by an 14 April 2018 editorial in the following week’s Lancet, and the preparation of the Miami DECLARAcTION, ‘a manifesto to turn the words of the Commission into action.’
The ALCP Congress was another exciting and inspiring moment for palliative care, which has made large strides in Latin America in recent years, thanks to the visionary work of pioneer providers and policymakers. So many people from all over Latin America registered for the Congress that latecomers had to be turned away until the waiting list could be activated and their participant badges issued! National earthquake regulations limit the number of people that can be in the hotel at any one time, a rule we were reminded to obey by the 6.0 temblor we woke up to early one morning of the Congress week!
IAHPC hosted an expert roundtable on palliative care for older persons titled ‘Que nadie se quede atrás: Los cuidados paliativos para personas mayores en la Agenda 2030’ (trans. Leaving No One Behind: Palliative Care for Older Persons in Agenda 2030). The United Nations Independent Expert on the Rights of Older Persons, Rosa Kornfeld Matte, gave the keynote address, with an overview of the demographic situation facing Latin America, and the extant state of international human rights law. Ms. Matte was followed by Dr. Mario López Saca and Dra. María Lucia Samudio Brigard from El Salvador and Colombia, respectively. Each reviewed their country’s progress and existing gaps, as well as their personal experiences of caring for older patients. We were sorry to miss the presence of panelists Iván Chanis of Panamá and IAHPC Executive Director Liliana De Lima, who can now be congratulated on the birth of her grandson Matías.
Lastly, I was privileged to go on palliative care home visits with the Hospital Sótero del Río team of Dra. María Angélica Becerra, and to visit an excellent nursing home in Santiago called Hogar Santísima Trinidad (Holy Trinity Home) one of the residences under the wing of Fundación Las Rosas de Ayuda Fraterna.
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