Renata Marđetko, Palliative Care Coordinator in Međimurje, Croatia, describes how palliative care has progressed since the national law was changed allowing palliative care to be provided and funded within the national healthcare system.
For more than 25 years, there have been plans to develop palliative care services in Croatia. Professor Anica Jušić started the Croatian Society for Palliative Care (Jušić and Oliver), 1 but progress has been slow. However, there are now more structured developments and services are being set up in different parts of the country with an estimated total of 29 coordinators/service managers, 21 mobile palliative care teams (staffed by a doctor and nurse), ten palliative care wards in hospitals and a hospice. More than ten different charities offer different activities to support palliative care patients. In addition, several mobility aids centres, working in collaboration with palliative care services, will lend equipment, such as hospital beds and wheelchairs, free of charge to patients who are being looked after at home and who cannot get these through the national health service, or afford to obtain them privately.
In 2014, the national law was changed allowing palliative care to be provided and funded within the national healthcare system. Two national strategies for palliative care development have been published by the Ministry of Health (2014-2016, 2017-2020) encouraging local communities (counties) to carry out activities from the National Programme tailored to their resources and needs. It was suggested that coordinators/service managers be appointed within each county and city across Croatia to help start services and coordinate care.
I was fortunate to be appointed as the coordinator of services for the county of Međimurje – the northernmost part of Croatia, which is the most densely populated area outside the capital city, Zagreb. I had previously worked in a similar role in Zagreb and have an MSc in Supportive and Palliative Care from the University of Kent in the UK.
Now, steady progress is under way and palliative care teams of doctors and nurses have been established within the main hospital in the city of Čakovec, and in the community. They are working closely together and with other services to help provide palliative care for the whole population of 125,000. In Medimurje, there is a charity supporting palliative care development as well as a mobility aid centre with 400 mobility aids that can be lent free of charge to patients.
These developments were marked by a talk from Professor David Oliver from the University of Kent on 1 July 2017. David has been visiting Croatia since 2000 and is a visiting professor at the Medical Faculty of the University of Zagreb. He leads an elective module on palliative care for the English curriculum course at the medical faculty every year. More than 100 people came to the meeting in Međimurje, some driving almost four hours to come. Sonja Tošić-Grlač, who represented the hospital and the county, said:
“It was a privilege to speak to such a large group of people, all wanting to learn more and develop palliative care.”
More recently in September 2018, a two-day day course was organised in Međimurje where David Oliver and Dawn Dark were invited speakers at the workshops. Once again, 130 people who work in palliative care and other health and social services as well as volunteers from all over the country took part in the workshops, emphasizing that the best learning is based on cases from everyday practice. The course was based on the EAPC’s ten core competencies in palliative care. 2
Volunteers in palliative care from Međimurje helped to organise the event. It was amazing to see so many people interested in palliative care. There is now a real opportunity to develop services and here in Medimurje and Čakovec the teams are providing care for many people every day. We hope that this will be an example to other areas in Croatia. With the commitment from the hospital, the county and the Ministry of Health we are looking forward to the continuing developments over the coming years.
The great challenge currently facing Croatian palliative care is specialist education for the people employed in specialized palliative care services. Our future efforts will therefore be directed to this area.
References and Links
- Jušić A, Oliver D, The early days of the hospice movement in Croatia, European Journal of Palliative Care, 2016: 23 (4).
- Gamondi C, Larkin P, Payne S. Core competencies in palliative care: an EAPC White Paper on palliative care education – part 1 and part 2, European Journal of Palliative Care, 2013:20 (2); 20 (3). (EAPC members can download this paper from the EAPC website).
Lončarek K, Džakula A, Mardetko R, Sagan A. Origins and effects of the 2014–2016 national strategy for palliative care in Croatia, Health Policy, Vol.122 (8) 2018. (808-814). [Accessed online 24 October 2018].
- Contact Renata Marđetko by email.
- Croatian Association to Help the Terminally Ill.
- ‘La Verna’ charity for palliative care in Zagreb.
- Croatian Society for Palliative Medicine.
- Palijativna SKRB.
- Read more posts from Eastern and Central Europe on the EAPC blog.
Follow the EAPC blog on Friday when Professor David Oliver, Tizard Centre, University of Kent, and Tricia Wilcocks, ellenor hospice, Gravesend, Kent, UK, give their impressions of the two-day course in Međimurje.