Volume 24, Number 2: February 2023

The following reports are from IAHPC Scholars who participated in the Latin America Palliative Care Congress (ALCP), held in Costa Rica in November 2022. The theme of the congress was “Transforming the Art of Caring.” Note: All photos are used with permission.

New Knowledge Is Now Part of Daily Practice

Attending the congress gave updates to relevant topics that I put into practice every day, such as the management of delirium. By using the most current treatments, our patients will achieve greater comfort. Also, as this was my first experience presenting a scientific poster, I learned how to tailor a presentation to both the public and to a jury.

I was inspired by the variety of scientific posters on research topics that could be relevant in my country; the data is available, now we need to form a multidisciplinary team. This experience helped me to know how to start a research project that is useful in my country: one that provides necessary data on topics of medical relevance. I also learned how my team and I can create new care protocols at the hospice where we work.

The understanding I now have about the importance of palliative care in Latin America and the consumption of opioids shows me that my country still has a long way to go. As we grow, we will work toward policies that give the entire population access to freely accessible palliative care, which is what we all want.

Poster: Multiple Infusions of 2% Lidocaine without Intravenous Epinephrine as an Adjuvant for the Relief of Neuropathic Pain in Palliative Care Patients. Series of cases.

‘Two Issues That Touched Me Deeply’

Mercedes Bernadá, pediatric physician
Montevideo, Uruguay

Two issues in particular touched me deeply: a seminar on "Evaluating and managing complexity in palliative care" by Marisa Martin of Spain, and how political decisions about health care around the world are negatively influenced by the involvement of the pharmaceutical industry, a situation described by IAHPC Executive Director Liliana De Lima. Both issues will be part of my areas of study, and will help to deepen the teaching by my pediatric palliative care team throughout Uruguay, at different levels of education, especially within the pediatric palliative care interdisciplinary postgraduate diploma.

Poster: Development of Pediatric Palliative Care in Uruguay, 2008-2020 Progress Report.

New Skills Will Help Develop Country-Wide Network

The congress helped strengthen the skills and abilities needed for the development and promotion of palliative care at the community level in rural Guatemala.

One of our projects is to create a palliative care network; we have already linked six cities. Our first objective is to identify palliative care teams throughout the country, create a national directory, and, at the same time, begin interacting with each other in monthly meetings held on Zoom, WhatsApp, etc. Rural doctors can present their cases, and receive guidance.

This will be a great support for the newest teams or doctors in rural areas, giving them virtual access to large hospitals that enables them to learn palliative care firsthand. It is an ambitious project, but together it will be possible to expand palliative care in our country.

Updated Knowledge Will Flow to Doctors, Nurses

Rafael Ernesto Cerna Peña, palliative care physician
Santa Tecla, El Salvador

The event was very useful in updating knowledge and management processes that I can apply at the pain and palliative care unit of the acute-care hospital where I am head of the palliative care service.

The advocacy and educational information and strategies I learned at the congress will be used to recruit more human talent to apply to palliative medicine, encourage teamwork, promote unit growth, be part of continuous training and volunteering, and enact advance care planning appropriate to each patient and family.

Specifically, knowledge obtained will be incorporated into the training of resident physicians and nurses at the San Rafael National Hospital in El Salvador, on both general palliative care practices and, specifically, pain management for oncological and non-oncological care, as well as the humanization of health care.

New Ways to Approach Difficult Issues Passed Along

I learned new ways of approaching difficult issues in palliative care, information that will be spread to others during annual sensitization days for medical personnel, psychologists, and nurses. We visit several cities, presenting palliative care issues and possible solutions.

New information will also be used in workshops for health care personnel and family members where a difficult palliative care case is dramatized. The case is designed to create awareness and humanize our care. Cases presented include situations such as: delivering bad news, therapeutic approaches, conspiracy in silence, refusal of opioids, and therapeutic futility. We also invite patients’ relatives to activities that promote empathy and reduce the burden on the primary caregiver.

Lastly, I will update the information in continuing education for undergraduate and postgraduate students. Congresses are the best school to learn from great masters.

Ideas to Replicate: A charity shop & community music school

Marco Antonio Rodríguez, psycho-oncologist
San Salvador, El Salvador

The congress helped update my knowledge about the advances in Latin America in palliative care, but, above, all to connect again in person with friends and colleagues who do palliative care.

I believe that my work in palliative care can be strengthened by incorporating community integration strategies, using principles of compassionate communities. One strategy I learned about is to have a charity store, where selling donated used clothes and household items raises funds to support low-income patients. Another strategy is to create community music school for children. Since the social worker of Hospice La Cima and myself are musicians, we can give classes while raising awareness about palliative care among parents.

Our Center to Extend Services by Adding Home Visits

I work at a social health center that offers inpatient services, and our plan is to extend our services to home visits. In order to do that, we will require advocacy inside the center, good planning, and the help of palliative care students currently on rotation.

Attending this event was useful for updating my knowledge, for getting new ideas for my practice, for making contacts with whom we can work together in the future.

It Was a Richly Varied Experience

Alicia Krikorian Daveloza, psychologist
Medellín, Colombia

My experience at the congress was richly varied.

• I presented the workshop "Promoting compassionate care through community participation in palliative care" with a colleague from Spain; we hope it will help develop new compassionate communities in Latin America.
• I participated in the session "Innovations in undergraduate education in palliative care" with colleagues from Chile and El Salvador, presenting an experience integrating arts and humanities in palliative care education.
• I also presented two posters that resulted from the work of our Group of Pain and Palliative at Pontifical Bolivarian University. Finally, I participated in two ALCP meetings, the commission on psychology and the general assembly.

The plenaries and sessions were helpful to further develop palliative care in Latin America, and the congress was a wonderful opportunity to network and strengthen relationships for future collaborations. Also, I learned about many new issues essential to continue promoting the development of palliative care in my context.

Posters: Delirium in Patients with Cancer Hospitalized in a Palliative Care Oncology Unit and Its Association with Venous Opioids, and Integration of Art and Humanities in the Teaching of Palliative Care in Undergraduate Medicine at a University in Medellín, Colombia.

‘We Shared Treatments for Emergencies in Palliative Care’

Ancu Tatiana Feng Escobar, palliative care physician
San Salvador, El Salvador

We developed a workshop for the congress with colleagues from Mexico titled “Emergencies in Palliative Care” based on experiences with patients who required emergency interventions and how to manage different stages of the oncological and non-oncological diseases in different scenarios. Examples used included the case of a young patient with polytrauma and sudden, irreversible neurological damage and an advanced oncology patients with uncontrolled symptoms.

At the congress I gained new knowledge for daily practice involving patients and their families that will help improve our care, such as recommendations for homemade diets and how to prepare some medications for use via feeding tubes.

The reunion with Latin American colleagues and friends after the pandemic was a great joy, as was seeing the interest of new professionals joining the journey of palliative care.

Poster: Use of Subcutaneous Ertpenem for Patients Diagnosed with Urinary Tract Infection in Palliative Care

‘Tools Given to Raise Public Awareness’

I learned tools to implement strategies to raise awareness among our population. The knowledge acquired allowed me to identify topics for continuing education. I also learned practical things for patient management, both in direct care and assisting other providers. I also gained tools and scales that can be implemented to improve teamwork.

Since many times we have the desire, the availability, or good papers to present at a congress, but the financial issue stops us from participating. I am grateful for having had the opportunity and privilege to be an IAHPC Scholar.

The Congress Expanded My Perspective

Dany Alexander Coca Zapata, psychologist
Tegucigalpa, Honduras

This experience helped me view palliative care from different points of view, as an integrated whole, rather than just the psychological aspect. I was able to see in what ways other countries are more advanced than ours in terms of palliative care, and, spurred by this knowledge, I hope to create a real impact in my community and, more so, in my country.

I will use the knowledge acquired to strengthen the design of our palliative care program, based on short- and long-term objectives, and focusing on the overall well-being of our patients. One of our goals is to create better intervention policies to reach—and help—more pediatric cancer patients in Honduras.

Congress Inspired Proposals for Improved Practices

New knowledge and resources acquired will have a positive impact on the quality of my care and educational activities. For instance, I learned new developments in the pharmacological management of demoralization syndrome and the desire to anticipate death, and a comprehensive approach to chemical coping.

New information allows me to make proposals for improvement both in my work team and in the scientific work commissions in which I participate. This includes the use of clinical simulation as a didactic strategy, and various ways to include the psychologist in palliative care teams.

Furthermore, the congress allowed me to share experiences with colleagues and promote networking and the exchange of resources between different professionals in Latin America.

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To find out more about IAHPC’s Program Support Grants, including IAHPC Scholarships and Fellowships, please visit our website. Through these programs we support projects and individuals around the world, especially in developing countries in Africa, Eastern Europe, Asia, and Latin America.

You can help palliative care workers attend and participate in congresses and courses by donating to the IAHPC Scholarships Campaign.

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