A Field Manual for Palliative Care in Humanitarian Crises 

Continuing our new series about palliative care in the context of humanitarian crises where we shall look at the implications of providing palliative care for migrants, refugees and people who have fled war-torn countries and places of conflict and how the hospice and palliative care community can offer appropriate support.

The first-ever book to provide guidance for clinicians not formally trained in palliative care on how to incorporate its principles into their work in crisis situations was published on 14 November. Co-editors, Dr Marcia Glass and Dr Elisha Waldman explain the background to their book.

Marcia Glass and Elisha Waldman.

I (Marcia) first got interested in palliative care doing relief work with the international, independent medical humanitarian organisation, Médecins Sans Frontières (MSF), in Liberia right after the civil war there. One third of the patients who came to our hospital died, and I started to think more and more about how to help the imminently dying even when basic medical resources were dramatically limited.  Over time, I also started to think about helping the chronically ill with symptom management and working with an interdisciplinary team to address the complex issues facing patients and families with life-limiting illnesses. I never let go of that interest, but it wasn’t until 13 years later, when I found myself at the 2018 Montreal International Congress on Palliative Care with Dr Elisha Waldman, that I started thinking we could write something to help people going through that exact scenario.

Elisha hadinitially approached me some months earlierto help design some online modules on palliative care for aid workers working abroad.  It sounded like a good idea, and a number of us batted the idea around over the course of several months through emails and phone calls. In Montreal, able to meet in person,we chatted about it more with a small group of like-minded palliative docs.  In a coffee break, I texted him, “Why don’t we just write a book?”  I got an instant reply, “Interesting.”  And then another, “I’m thinking about this a lot. Let’s meet up.”

The next thing I knew, wehad a publisher from Oxford University Press expressinginterest, and we had signed a book contract within two months.  Over the next five months, we gathered friends, former coworkers, friends of friends, and international experts, who were all immediately excited to work on this.  Several additional experts weighed in as reviewers. We were able to keepto a tight publisher timetable and managed to have the final draft ready by April 2019.   Seeing the project grow from a casual discussion of online modules, to a book contract to write the manual, and then an international collaboration with experts from all over the world was extremely gratifying for both of us.

We focused our book on palliative care in epidemics, conflict zones, and natural disasters and included chapters on public-health background and system building, symptom management, communication, pediatrics, ethics, law, and psychosocial support.  We wrote our book primarily for clinicians working in the field, but we hope it will be broadly useful in education, preparation for work abroad, and analysis of how best to integrate palliative care into humanitarian aid.

Our book was published just last week – we’re so excited to share it with the greater humanitarian aid community and beyond! And you can access our chapter, Introduction: Why Palliative Care? free of charge online until 14 February 2020. 

More about the authors

Dr Elisha Waldman is an associate professor of paediatrics at the Northwestern Feinberg School of Medicine and the chief of the Division of Palliative Care at Lurie Children’s Hospital of Chicago. His writing has appeared in the Hill, the New York Times, the Washington PostTime, and elsewhere. Email Dr Elisha Waldman. 

Dr Marcia Glass is associate professor of internal medicine at Tulane University, New Orleans, Louisiana, USA.Dr Glass provides inpatient palliative consultations at the New Orleans VA and works as a hospitalist at University Medical Center. She has worked internationally with Doctors without Borders, the Yale/Stanford Johnson and Johnson Global Health Program, Columbia University, UCSF, and Partners in Health. Most recently, she worked at Pallium India on a Fulbright Grant. Email  Dr Marcia Glass

Further reading

Follow the ‘Palliative Care in Humanitarian Crises’ series …
Read more in the ‘Palliative Care in Humanitarian Crises’ series on the EAPC blog. Next week: Joan Marston, Friedemann Nauck, Mhoira Leng and Lukas Radbruch write about current and future initiatives.

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