“A deeply respectful” programme: Presentation of ATOME outcomes side event 67th World Health Assembly in Geneva

Katherine Irene Pettus, International Association for Hospice and Palliative Care Advocacy Officer

Dr Katherine Pettus

A side event at the lovely Domaine de Penthes conference room, sponsored by the International Association for Hospice and Palliative Care (IAHPC) and ATOME  (Access to Opioid Medication in Europe), kicked off an unofficial ‘palliative care week’ at this year’s WHA. The week culminated in the passage of the first ever resolution on palliative care, sponsored by Panama, co-sponsored by more than a dozen member states, and endorsed by more than 50 others.

Side event speakers presented the findings of the ATOME Project and discussed how other (non-ATOME) countries might approach the problem of opioid availability in their specific contexts. Begun in December 2009, ATOME was funded by the European Community’s Seventh Framework Programme and conducted by a consortium of 10 member organisations from seven European countries. The project convened palliative care physicians, harm reduction specialists, government regulators, and NGOs in each of the 12 participating countries for structured conversations about how to improve access to controlled medicines in their jurisdictions. (See ATOME website for detailed information on the project.)

Outside the United Nations offices in Geneva – in the background is the iconic ‘Broken Chair’ representing disability rights

Professor Lukas Radbruch opened the meeting by welcoming the more than 40 attendees from many Geneva missions, and delegation reps from all WHO regions. Dr Hanna Páva, head of the Hungarian WHA delegation, led the list of distinguished speakers, citing the cutting edge nature of the project, which has created a safe space for often previously unacquainted providers to have crucial conversations about problems relating to pain relief and dependency treatment in their countries.

Professor Marie-Hélène Schutjens, specialist in pharmaceutical law at the University of Utrecht, presented some of the outcomes of these conversations, listing both small gains and system-wide improvements in specific countries. My colleague in Hungary, Dr Agnes Csikos, who founded the Department of Hospice and Palliative Medicine in Pécs, and manages home care, as well as other services, is already crediting ATOME’s Hungary workshop with the Ministry of Health’s decision to reintroduce Sevedrol, a quick-acting opioid used for breakthrough pain. The presence of regulators and Ministry of Health staff at the country meeting educated them about the barriers and challenges providers face every day in treating severe pain and opiate dependence. Dr Csikos is proposing to hold a follow up workshop in Hungary, two years after the 2013 Budapest meeting, to assess progress, bring new colleagues into the conversation, and take the practice to another level.

Professor Radbruch presented the new Opioid Price Watch project of the International Association for Hospice and Palliative Care, which documents the dramatic fluctuations in opioid prices in different parts of the world, and Dr Willem Scholten spoke about problematic access to those same medications and steps that are being taken to reduce barriers.

The final speaker, Dr Joan Marston, CEO of the International Children’s Palliative Care Network, praised the ATOME project for its “deeply respectful” approach to clinicians and practitioners in participating countries. Marston’s description of the project’s interdisciplinary virtues and ethic of mutual respect and cross-national collegiality revealed how the project mirrors the palliative care approach itself.  Best practice palliative care relies on a commitment to deep listening, honest communication about goals of care, collegiality, and hospitality, all of which were characteristics of ATOME. In other words, ATOME was palliative care “writ large”.

Urging the integration of paediatric palliative care into national health systems, she suggested that the next iteration of the project could involve transnational mentoring between ATOME alumnae and providers and regulators in other countries needing to improve access to essential opioid medications. Such a ‘multiplier effect’ in an era of tight budgets could be part of the overall implementation strategy of the palliative care resolution passed at the WHA.

Other speakers at the side event included Dr Carlos Galvez (Panama); Dr Bogdan Gheorghe (Romanian National Anti-drug Agency); Kees de Joncheere and Gilles Forte (WHO); Dr Raymond Jansons (Latvia); Rick Lines (Harm Reduction International); Dr Stephen Connor (Help the Hospices and the Worldwide Palliative Care Alliance).

Links to presentations and speakers’ resources

• MH Schutjens’ PowerPoint presentation
• W Scholten’s PowerPoint presentation
• International Association for Hospice and Palliative Care
• Opioid Price Watch project
• International Children’s Palliative Care Network
• Worldwide Palliative Care Association
• Harm Reduction International

Read more about the palliative care side event at the World Health Assembly on the EAPC blog.