NEW SERIES: HOSPICE AND PALLIATIVE CARE IN EASTERN AND CENTRAL EUROPE
Alexander Wolf, Head of the All-Ukrainian Association of Palliative and Hospice Care, and a clinical social worker at the National Children’s Hospital in Kyiv (Kiev), Ukraine, explains how palliative and hospice care is organised in his country and how change may come about.
As mentioned in my previous post, palliative and hospice care for adults and children in Ukraine started to develop in 2006. With at least 0.5 million seriously ill citizens in our country, the need to increase and develop palliative care is great. In this post, I shall try to analyse which provider organisations will be the main catalysts for future developments in Ukraine.
Organisations fall into two types: governmental and non-governmental providers. The latter include social enterprises and, of course, churches. Governmental organisations in Ukraine that develop palliative and hospice care include those within healthcare settings controlled by the Ministries of Health and Social Policy. The Ministry of Health initiated many local so-called “hospices” or “palliative care units”, but sadly these are mostly unworthy of the name.
For example, the Kyiv “hospice” unit in a state hospital has 80 beds, serving impoverished and homeless people but the “hospice” is not dealing with pain syndrome and cancer. There is no social worker, and only very little psychological and spiritual support is available. Another “hospice” based in a cancer hospital is closer to the international standard: there are25 beds, pain management, a psychologist and chaplain. However, patients must make a financial contribution for their care; relatives have no access to bereavement care, and the “hospice”, in official documentation, is called an “institution for treatment and prevention of diseases”.
The Ministry has now decreed that only institutions that are accredited by the Ministry of Health may provide hospice and palliative care. Meanwhile, the Ministry of Social Policy has issued another Order that approves the standard of “home palliative care”. Unlike the Ministry of Health’s Order, this official document allows different organisations (for example, businesses) to develop this type of care.
Some institutions controlled by the Ministry have established “palliative care units” (in nursing homes, for instance) but multidisciplinary teamwork and pain management remain a novelty here as well.
It was the non-governmental organisations (NGOs) that initiated the development of hospice and palliative care in 2006. Mostly, this development was supported by international grants from donors affiliated to Soros’s Open Society Foundations. Based on modern international experience, and being more flexible than governmental organisations, NGOs have encouraged the development of new documentation and standards on palliative and hospice care. The All-Ukrainian Association of Palliative and Hospice Care was the pioneer. Since 2013, after the release of pain management procedures, NGOs have provided advocacy and capacity building for healthcare workers on this issue. They have also initiated some positive changes in formal education.
Thanks to grants from the International Renaissance Foundation (a Ukrainian NGO founded by George Soros), some home-based palliative care services have been established. The All-Ukrainian Association of Palliative and Hospice Care cooperates with different medical facilities, influencing better standards of palliative and hospice care, and organises international study visits, clinical placements and other events.
Although war and armed conflict have been present in Ukraine since 2014, it is difficult to define how these have impacted the development of palliative care in different regions, as there is currently no valid information. Perhaps this is something that our Association, in cooperation with sociological studies groups that are our partners, could research in the future.
We believe that NGOs will be the driving force of changes in how we care for incurably ill people in Ukraine.
Links and resources
· All-Ukrainian Association of Palliative and Hospice Care.
· 2016 report on the All-Ukrainian Association of Palliative and Hospice Care.
· Contact Alexander Wolf by email.
· Follow the All-Ukrainian Association of Palliative and Hospice Care on Facebook.
Next week on the EAPC Blog, Dr Vladimir Poroch from Romania will be contributing. Read more posts in this series on Palliative Care in East and Central Europe.