Natasa Milicevic, MD, National Coordinator of ‘Development of Palliative Care Services in Serbia’, explains the background to her longer article published in the February issue of the European Journal of Palliative Care.
More than 20 years ago I attended my first palliative cancer care course in Oxford, UK. At that time I was working as a medical oncologist at the Institute for Oncology and Radiology in Belgrade. We did not know much about palliative care and had very poor knowledge about chronic pain management. That course changed my attitude towards cancer treatment and death and dying and since then I have been trying to introduce palliative care in Serbia.
My first step was to complete the Diploma in Palliative Medicine in Cardiff and the next was to establish a pioneering palliative care service in Serbia, BELhospice. One team, or a service, can help some patients and their families but only a well-organised network of palliative care services can enable palliative care to become a standard approach for patients in need throughout a whole country.
For this reason the European Union (EU) funded project on the Development of Palliative Care in Serbia, with numerous international and some national experts, led by Professor Julia Downing, was a great opportunity to make my dream possible. It is difficult to say which component of the project was the most important. Was it continuing medical education for more than 1,200 professionals (doctors, nurses, social workers and psychologists) working at all three healthcare levels and social institutions, or the introduction of academic education for medical and nursing students, or social workers? Or was it the establishment of palliative care services? Equally important for our patients was the improvement to the essential list of medications for palliative care and increased availability and accessibility of some essential drugs.
Experts from the project worked with the Serbian Ministry of Health to propose a law that would include palliative care as an obligatory part of health care and enable non-governmental organisations to establish specialist palliative care centres. Probably, the most important part of the project at the time was the extensive continuing education. Serbia has a long tradition of well-developed networks of home care services as part of extended hospital care; it was therefore quite common a few years ago for professionals to say: “All of us provide palliative care but we just don’t call it that.” But for those who attended the courses developed by this project it was clear that this was not the case. Apart from better understanding of palliative care and better provision of care, this project contributed to changing cultural barriers. These words from a course participant illustrate it very well:
“Before the course, I wouldn’t even dare to address the topic of dying, neither with patients nor with their family. Now I do dare and when I open up this topic they gradually become relaxed – and then it’s up to my judgement as to how deeply I go into the topic.”
Read the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Palliative care development in Serbia, five years after the national strategy’ by Natasa Milicevic, Erna Haraldsdottir, Nina Lukic, Jo Baskott, Chris Rayment and Julia Downing, published in the January/February 2015 issue of the European Journal of Palliative Care (vol. 22.1). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
Links and resources
- BELhospice (in Serbian, English and Spanish)
- Development of Palliative Care Services in Serbia (in Serbian and English).
- Postgraduate Diploma in Palliative Medicine/Care.
- You can read more about palliative care in Serbia on the EAPC blog.
- You can download a Country Report for Serbia, including a legislation analysis, from the ATOME (Access to Opioid Medication in Europe) website.
Join us in Copenhagen for the 14th World Congress of the European Association for Palliative Care Download the programme schedule from the congress website. Register now and benefit from the Early Bird registration fees until 15 February 2015.