How do expatriate health workers cope with needs to provide palliative care in humanitarian emergency assistance? 

THIS MONTH’S EDITOR’S CHOICE FROM PALLIATIVE MEDICINE. . .

Martin Schneider, physician and humanitarian worker, Geneva, Switzerland, explains the background to his longer article selected as ‘Editor’s Choice’ in the December 2018 issue of Palliative Medicine.

When I worked as a general practitioner with humanitarian emergency organisations, the bulk of consultations were acute infectious diseases such as malaria for which treatment was easily available. But from time to time, patients with advanced chronic conditions came seeking our help. Unfortunately, I did not have much to offer to those patients that would have required advanced pain control or palliative care.

Hospital in Eastern Africa receiving support from humanitarian emergency organisation.

This confrontation with patients in need of palliative care happens to many medical workers involved with humanitarian organisations. Often, they are not able to take care of such patients. This can be because the organisation concentrates on life-saving care; because opioid medication is rarely available and because some medical workers lack the required training to provide palliative care.

This is why I wanted to know how medical workers on assignment coped with the impossibility of providing palliative care. I wondered about their emotions in such a dilemma. I was interested in how they thought they could have been better prepared to carry out their task. Given the manifold challenges that can make a humanitarian engagement a tough experience, I hope that the findings of my study, published in this month’s Palliative Medicine, will enable humanitarian organisations to prepare their staff more appropriately.

In-depth interviews with 15 medical workers showed a wide range of clinical challenges related to pain control/palliative care. Frustration and helplessness were among the resulting emotions, sometimes mixed with some anger:

“Frustrated! Frustrated, because maybe we would have had… maybe we would have been able to make him [the patient] more comfortable, […] like back home.”

The medical workers suggested better availability of opioid medication and they would also have appreciated training about advanced pain control before their assignment. They also noted cultural differences in how to communicate bad news to the patients.

'Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide'. World Health Organization 2018.

‘Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide’.

In a world where non-communicable diseases account for the majority of deaths, humanitarian organisations have become aware of the need for pain control and palliative care. They have started setting up projects that specifically aim to provide palliative care. The World Health Organization has now published guidelines on how to include palliative care in humanitarian emergency assistance.

Much remains to be done, as palliative care is still missing in most areas of the world. 2Ultimately, the human and humane presence remains core to humanitarian assistance – in the spirit of Henry Dunant who founded the humanitarian movement after caring for injured soldiers after the battle of Solferino in 1859. 3

References

  1. Smith J and Aloudat T. Palliative care in humanitarian medicine. Palliat Med. 2017; 31: 99-101.
  2. Knaul FM, Farmer PE, Krakauer EL, et al. Alleviating the access abyss in palliative care and pain relief – an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018; 391: 1391-454.
  3. Dunant H. Un souvenir de Solferino. 13 ed. Bern: Croix-Rouge Suisse, 1962.

Links and resources

READ THE FULL ARTICLE IN PALLIATIVE MEDICINE
This post relates to the longer article, ‘How do expatriate health workers cope with needs to provide palliative care in humanitarian emergency assistance? A qualitative study with in-depth interviews’ by Martin Schneider, François Chappuis and Sophie Pautex published in Palliative Medicine2018 Volume: 32 issue: 10, page(s): 1567-1574. Article first published online: August 16, 2018. Issue published: December 1, 2018. https://doi.org/10.1177/0269216318794091.

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