Dr Serpil Özsezgin, Palliative Care Health Services, Turkey, explains the journey that has led to her setting up a mobile palliative care service.
I worked in the ‘Painless Living Centre’ in Izmir, from 2000 to 2010 on pain management of cancer patients and also Alzheimer’s disease and dementia, as an Anaesthesiology and Reanimation specialist. I did my best to comfort patients and alleviate their suffering, and to support bereaved family members. Based on my experiences of up to 1,000 end-stage cancer cases, I identified lack of empathy, barriers to opioids, opiophobia and thanatophobia.
Fortunately, I met the ATOME project (Access to opioid medication in Europe) (1) that sought to overcome the same obstacles to opioid access as I had been observing for ten years. Turkey, as one of the countries with statistical evidence of inadequate morphine consumption, was selected to participate in the project and I joined as the Turkish expert. In 2015, the final report and recommendations were sent to the Turkish Minister of Health (MoH). Thanks to ATOME, in 2014, oral rapid-release morphine production started and also the MoH included partial reimbursement of some palliative care treatment in state hospitals. By 2016, the number of palliative care units (PCU) in state hospitals had reached 1,930 beds compared with 179 beds in PCUs, in 2014.
I recently carried out a survey through doktorsitesi.com to look at palliative care in Turkey. Nine hundred and ninety-six people participated in the survey, which showed that 68 per cent of people want to die at home while 70 per cent of patients are dying in a hospital intensive care unit. Many studies indicate that the primary condition of home care is the presence of willing caregivers. In case of emergency, relatives want to know how to relieve symptoms but they need professional support to do this. As life expectancy lengthens, many of the population will be 100 years old or more in the coming years; therefore, measures need to be taken now.
In 2016, I established a private mobile palliative care service. I am now providing health counselling to support people with Alzheimer’s disease, dementia, paraplegia and cancer, both in their own homes and in care homes. I am using communication technologies in order to offer my services to patients. However, it is important to provide the right information at the right time because effective palliative care requires an accurate assessment of a patient’s physical and emotional needs. Common causes of crises at home are controlling pain, nausea and vomiting, constipation, skin problems, dyspnea, anxiety, fear of changes in levels of consciousness and time of death. Accessibility is an important component of preventing crises at home.
An approach such as this can contribute to more effective, and timely management and help patients and their relatives to feel safer and more peaceful.
Meanwhile, there is much work to do. Congresses have been held and what we have learned has started to enter into collective studies; these are being considered by the Ministry of Health and are also helping to increase public awareness. My own objective is to motivate our Ministry of Health, healthcare professionals, other key decision-making bodies and to increase public awareness of palliative care. I would also love to train young doctors.
- L Radbruch, S Jünger, S Payne, W Scholten (eds.). Access to Opioid Medication in Europe – Final report and recommendations to the Ministries of Health. Report, Pallia Med Verlag, Bonn, 2014. (Download a copy here.)
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