Dr Tom Lynch, Researcher, International Observatory on End of Life Care, Lancaster University, UK
There are currently five organisations providing inpatient palliative care in five areas of Kazakhstan – Almaty, Pavlodar, Karaganda, Ust-Kamenogorsk and Kostanai; there is also one organisation providing home-based palliative care in Semei. Most palliative care for children still occurs at home, although some paediatric palliative care provision is available at Almaty Center for Palliative Care. From interviews with patients (adults and children) and their caregivers that I have undertaken at these organisations, all groups appear very satisfied with the standard of treatment and care that they receive. Although these organisations rarely run out of opioids, and most have guidelines on how to gain access to them for pain relief and use them effectively, there is a lack of choice – for example, oral morphine is not available and morphine via injection is generally available in hospital only.
As the result of a joint initiative between the Open Society Foundation International Palliative Care Initiative (IPCI), Soros Foundation Kazakhstan (SFK), the Republican Center for Development of Health and Kazakhstan School of Public Health, palliative care standards and a palliative care needs assessment were submitted to the Kazakhstan Ministry of Health on 1 October 2012. It is also hoped that a National Association of Palliative Care will be formed in Kazakhstan in the near future.
Lack of awareness about palliative care
Although there has been much progress in the development of palliative care in Kazakhstan in recent years, there has been a general lack of awareness and understanding about the discipline amongst both healthcare professionals and wider Kazakhstan society. However, things are beginning to change; a number of initiatives are helping spread the message about the excellent work being undertaken in this area – in particular, specific events developed by SFK in relation to World Hospice and Palliative Care Day which encourage NGOs, journalists, youth organisations, hospices and hospital units and Medical Universities and Colleges to work in partnership on public awareness issues about palliative care.
Palliative care on the agenda
Alongside my work with the International Observatory on End of Life Care at Lancaster University, I also work as an international palliative care consultant for IPCI. I recently attended the 7th Oncology and Radiotherapy Congress in Astana, Kazakhstan (5-7 September 2012) on their behalf where I was invited to deliver a presentation at the plenary session entitled ‘The Development of Palliative Care Standards in the Republic of Kazakhstan’, and co-chair a scientific session dedicated to palliative care where I delivered another presentation entitled ‘Theoretical Foundations of Palliative Care’. I also co-chaired a scientific meeting in conjunction with SFK relating to the availability and accessibility of opioids in the country. Approximately 1,000 people attended the congress, and this was the first time that the topic of palliative care had been included on the agenda of a leading oncology and radiotherapy congress, either in the plenary session or as a scientific session.
Palliative care in the media
During my time in Astana, I gave three television interviews about the development of palliative care in Kazakhstan; two interviews were screened on regional television networks and one is to be screened on Kazakhstan State Television to celebrate World Hospice and Palliative Care Day on 13 October 2012. The interview, which lasts for approximately one hour, is to be screened in its entirety to an anticipated audience of many millions of people, and is also to be posted on YouTube in order for it to be accessible to an even wider audience. It is hoped that this extensive coverage will significantly raise awareness about the development of palliative care in Kazakhstan. During my congress presentations and various television interviews, I also promoted the 13th World Congress of the European Association for Palliative Care in Prague in 2013.