Featured Story

Volume 23, Number 12: December 2022

Palliative Care Advances in the Caribbean

By Dingle Spence
IAHPC Board Member

In 2019, in this space, I wrote about developments in palliative care in the Caribbean region. At the time, I noted that we had “come a far way” with some of our new initiatives in the field of palliative care. In this article, I’ll bring you up to date on some developments in the region since then. 

Dr. Dingle Spence at the bedside at Hope Institute Hospital in Jamaica. Photo by Dr. Steven Smith. Used with permission.
Palliative care courses flourishing

Education initiatives are moving forward apace. This year, the University of the West Indies (UWI), Cave Hill Campus, Barbados, launched a MOOC (massive online open course) on the Key Principles of Palliative Care and has also launched an Introduction to Palliative Care Course at the Master’s level. In Jamaica, at the UWI Mona Campus, a Diploma in Palliative Care will be launched in 2023 with a particular focus on developing clinical skills and competencies to work in the field. This is in support of the Jamaican Ministry of Health and Wellness primary care renewal plan, which includes incorporating palliative care into community-based and primary care services. In Trinidad and Tobago, the Palliative Care Society recently hosted three, two-day Palliative Care Masterclasses, with a focus on basic symptom management and communication skills. 

One of the most exciting initiatives in the region is Palliative Care in the Caribbean - ECHO (Extension for Community Healthcare Outcomes) group, a new virtual learning network aimed at helping health care professionals develop palliative care skills. It consists of a series of monthly virtual meetings with palliative care specialists and other health professionals from across the region. The initiative is implemented by the Pan American Health Organization (PAHO), in partnership with Massachusetts General Hospital, Caribbean Palliative Care Association (CARIPALCA), and Jamaica Cancer Care and Research Institute (JACCRI). The ECHO series is now in its second year, and we have certainly built up a supportive community of practice with wide-ranging engagement across the region. Participants reported that it was an extremely valuable and supportive place to turn to during the turmoil and isolation brought about by the COVID pandemic.

Policy initiatives on
access to palliative care

Policy initiatives include new or revised National Cancer Control Plans in Jamaica, Trinidad and Tobago, and Guyana that all make reference to the need for access to quality palliative care services, including improved access to essential medicines—particularly opioids. The Beacon Foundation in Guyana, which has been providing home-based palliative care since the 1980s, recently received an offer of full support from the Minister of Health: this is the first time that the foundation has been recognized in this way. In Jamaica, the Ministry of Health and Wellness is implementing a primary care renewal program, one aspect of which is to develop and embed palliative care services at the primary care level.

With regards to improving essential medicine access, in March 2022, CARIPALCA in association with the IAHPC hosted a side event at the 65th Session of the United Nations Commission on Narcotic Drugs titled “Disparities in Access to Essential Medicines in the Caribbean Region.” The disparities here are wide and deep, and opiophobia remains a significant problem, particularly at the policy level. A call to action was made for constructive collaboration with PAHO, CARIPALCA, and other regional agencies to support advocacy and education initiatives.

Service provision expands

Palliative care and hospice services continue to develop and expand. The Cayman Islands now have a purpose-built hospice, called Jasmine, and home-based and inpatient care are available there. In Trinidad and Tobago, the Caura Hospital Palliative Care Unit is about to launch a pediatric palliative care service, and a new, private home-based palliative care service, LivHealth, was recently established. 

From March 2020 to March 2022, the Hope Institute Hospital in Kingston, Jamaica, acted as a demonstration site for the WHO Study—Evaluation of Palliative Care in Six Countries. We recruited 134 patient and caregiver dyads and followed them monthly for a year or until death. The focus of the study was measuring quality of care provided and collecting data on palliative care outcomes. The eagerly awaited results will be published soon.

So you see, I am pleased to report that “nuff tings a gwaan”: many things are happening on our sunny, sandy seashores!

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