Lukas Radbruch, Chair of the International Association for Palliative Care, introduces our new special where we’ll be hearing more from people involved in palliative care in Latin America.
A few weeks ago I was in Medellin in Colombia, where I had been part of the 7th Congress of the Latin American Association for Palliative Care
(Asociación Latinoamericana de Cuidados Paliativos (ALCP) ).
In the opening ceremony, María del Rosario Berenguel Cook, president of ALCP, described the lack of palliative care in many places in Latin America, and that palliative care for indigenous groups in the region is particularly bad. Maria, and other opening speakers, Carlos Fernandez (president of the Colombian Association of Scientific Societies) and Claudia Agamez Insignares (president of the congress) referred to the World Health Organization (WHO) resolution draft on palliative care presented at the executive board meeting of the WHO in January this year.
I was even more impressed by a delegate from Panama, whom I met at the welcome reception after the opening. He was so proud that his country, even though small and where palliative care is still in its infancy, has initiated and led the group that has introduced and developed the WHO resolution against the inertia and, in some cases, even resistance from many bigger countries. And I have to admit: this is something he really can be proud of!
This was just one example of the enthusiasm and pioneering spirit that permeated the whole congress. The delegate from Paraguay, keen to exchange information with colleagues from other Latin American countries or abroad, as she seemed to be the only palliative care professional in her country; the team members from the first palliative care service in Colombia, who had started an inpatient unit in Cali in 1992, and who met again at the congress after 20 years in palliative care in various Latin American countries, and the palliative care paediatric specialist from Mexico who talked about the problems faced by many physicians to stop futile treatments in dying children.
Nearly 500 participants listened to the plenaries on pulmonary or cardiac diseases requiring palliative care. I was talking about palliative care for neurologic diseases such as motor neurone disease, stroke or dementia, and about new developments in pain management. The plenaries were aligned with the congress subject: “Palliative care in cancer and other chronic diseases: a joint implementation for Latin America”. There was agreement that palliative care for non-communicable diseases other than cancer will be a major challenge for the Latin American countries.
Large gaps in the development of palliative care were highlighted in the congress. Opioids are available in the formulary in all of the countries, but overregulation and lack of training impede their use, so that many patients who need them are not able to get adequate analgesia. In most countries a number of pioneers and local champions are working hard to provide palliative care at least to some patients, but a public health approach is lacking in 80% of the countries. In the rural areas, and indeed outside the few palliative care centres, no access to palliative care is possible.
This was confirmed during a visit to the hospital Pablo Tobòn Uribe in Medellin, where I met the pain and palliative care team led by Nora Saldarriaga Cartagena and Carlos Restrepo-Garces, as well as some of the patients they cared for. The patients, all with advanced metastatic cancer, had good symptom control and were feeling good and well cared for. However, it was not clear how patients would be cared for once discharged from inpatient care. There are only two home care services in all of Colombia with more than 50 million inhabitants, and none of them is in the area of Medellin.
The state of development in all countries has just been described in detail in the Atlas for Palliative Care in Latin America, which was released during the congress.
Follow the blog next Monday (12 May) when Dr Tania Pastrana will tell us more about the Atlas for Palliative Care in Latin America. And on Wednesday, Lukas will be talking to Dr Nora Saldarriaga Cartagena about her work in Colombia.
Click here to read previously published posts on palliative care in Brazil.
See you at the 8th EAPC World Research Congress in Lleida, Spain. 5-7 June 2014. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2014.
Nous aurons le plaisir de vous accueillir au 8ième Congrès Mondial de Recherche de l’EAPC en Espagne du 5 au 7 juin 2014. Suivez-nous sur Twitter @EAPCOnlus avec le hashtag officiel #eapc2014.