By Dr. Katherine Pettus, IAHPC Advocacy Officer
Brno, Czech Republic — I have been in Brno since New Year’s Day, when I arrived at the Czech Medical Center for a scheduled hip replacement surgery on January 3. By the time you are reading this, I hope to be home in Spain preparing for the regular meeting of the Commission on Narcotic Drugs (CND) in Vienna, scheduled for the first week of March. When my health insurance company refused at the last minute to cover my scheduled U.S. surgery in December, I had to hustle for a quality venue at an “affordable” (private pay) price. I was caught between the increasingly unbearable pain of what orthopedists winningly call “terminal arthritis” and my annual duty travel, beginning with the 146th session of the World Health Organization Executive Board at the end of January.
The Czech Republic advertises itself as an affordable, world-class medical treatment venue for non-residents, including for orthopedic procedures such as hip replacements. I had made a short trip following the December meeting of the CND to meet my surgeon and reassure myself that there would be adequate post-operative pain relief and rehabilitation. My contract stipulated a “private room with English-speaking staff” and a vegetarian diet. I also chose the Czech Republic because I have two palliative care colleagues there who promised to keep an eye on me and ensure I received appropriate pain relief. I had met Drs. Ondřej Sláma and Ladislav Kabelka at the Leadership Development Initiative (LDI) at San Diego Hospice in 2013. This extraordinary program, overseen by Drs. Frank Ferris and Shannon Moore as well as many other colleagues known to most readers, gave birth to a community of practice that continues to this day.
Both Ladislav and Ondřej attribute the rapid advancement of palliative care in the Czech Republic — including the growth of vibrant, multidisciplinary Domácí hospice in Třebíč overseen by Ladislav — to their participation in the LDI program seven years ago. I was astonished to learn that all palliative care and essential palliative care medicines are fully reimbursed for Czech taxpayers by the national and private health insurance programs. The problem is a lack of trained personnel to meet the need as palliative care becomes better known and integrated into public health care. Moreover, thanks to tireless advocacy by the Czech Palliative Medicine Association, family caregivers can now take three months of paid leave (at 70% of their salary). The government pays caregivers’ (compulsory) health insurance for them while they are on leave, and their jobs are held open for them. This sort of coverage is a dream for people who live in countries like the U.S., where millions forego essential medical care because it is either too expensive or not covered at all, and where millions of family caregivers (mostly women) lose their jobs when they take time to care for seriously ill family members.
My recovery from hip surgery took longer than I had hoped, but then again, I was told! Four to six weeks minimum! I just thought (wrongly) that I could beat the odds and attend the WHO Executive Board meeting in Geneva. Happily, Dr. Natalia Arias Casias — a Spanish physician, researcher, and a coauthor of the EAPC Atlas released last year in Berlin — offered to lead the IAHPC delegation, which also includes Dr. Rumana Dowla, a palliative care physician from Bangladesh and another alum of the LDI program.
I am honored to know such a global cohort of talented and compassionate palliative care professionals – including those reading this column – who are doing the important work of reducing serious health-related suffering through both advocacy and clinical practice. One takeaway of my Czech Republic surgical adventure, which I expect to write about elsewhere, is that being a patient, especially a patient in severe unrelieved pain, creates an experience of extreme vulnerability and fear. I was able to experience that in person, in my own body, and then feel how palliative care met and matched that vulnerability with both technical skill and compassion.
I fully understood how fortunate I was to have access to strong pain-relieving medicines when so many in the world must do without, largely owing to fears of misuse and diversion in the context of unbalanced “drug” policies, and I recommitted myself to IAHPC’s work of advocating for equitable universal access to palliative care and essential palliative care medicines for all who need them.
Until next month!
See more about Dr. Kabelka, "Building specialized palliative care for the Czech Republic: A 15-year leadership journey in a developing country".