Regional Reports

USA

California passes new drug prescribing legislation

A new Controlled Substance and Dangerous Drugs Act was passed in the California legislature on September 20, 2006. Like previous California legislation, I believe this act will be precedent-setting nationally and internationally.

The Act:

1) acknowledges that controlled substances can play a critical role in the treatment of pain

2) acknowledges that under treatment of pain is a continuing problem in California

3) reaffirms that excessive prescribing and dispensing of controlled substances is a crime punishable by fine or imprisonment and defines when a physician may be subject to disciplinary or legal action

4) affirms that a practitioner who has a medical basis for prescribing furnishing, dispensing or administering dangerous drugs and controlled substances shall not be subject to disciplinary action or prosecution

5) affirms that no physician or surgeon shall be subject to disciplinary action for treating intractable pain

6) defines an "addict" as a person whose actions are characterized by craving in combination with one or more of the following: a) impaired control over drug use, b) compulsive use, and c) continue use despite harm

7) clarifies that a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not an addict

8) clarifies that a physician and surgeon may use dangerous drugs or prescription controlled substances for the treatment of pain or a condition causing pain, including, but not limited to, intractable pain (this expands the indications for using controlled substances considerably from the previous intractable pain act)

9) clarifies that another physician can prescribe up to 72 hours of medications to maintain a patient until her/his physician returns and/or renew a prescription for an amount not exceeding the original prescription in strength or amount or for more than one refill

Frank D. Ferris, MD
Medical Director, Palliative Care Standards / Outcome Measures
San Diego Hospice & Palliative Care
4311 Third Avenue San Diego, CA, USA 92103-1407

Kenya

Kenya Hospices and Palliative Care Association (KEHPCA)

The Kenya Hospice and Palliative Care Association (KEHPCA) was finally registered on 29th November 2005, more than three years after the first steering committee meeting was held at the Nairobi Hospice. The steering committee was formed after a stake holder’s meeting held in August 2002.

Many were involved in setting up a steering committee. These were members who were dedicated to seeing a dream come true. And it finally did!! Many thanks to the flowing people for their dedication:

Dr. Nizar Verjee-Chairman Nairobi Hospice
Mr. Tarsem Sembhi-Chairman Nyeri Hospice
Mr. Faustin Mgendi ­Chairman, Coast Hospice
Dr. Julius Onyango-Chairman, Kisumu Hospice
Dr. Bactrin Killingo-Chief Executive, Meru Hospice
Mrs. Brigid Sirengo- Chief Executive officer, Nairobi Hospice

KEHPCA would like to give a big thank you to all of them for their never ending patience.

Currently, KEHPCA is operating on Ralph Bunch Road , Elgon Court Block B1, opposite General Accident House. Dr. Zipporah M. Ali is currently the acting National Coordinator.

Early this year, KEHPCA held a one day workshop sponsored and facilitated by African Palliative Care Association (APCA). The objectives of this workshop were: to update stake holders on the progress of KEHPCA; to share with stake holders and to agree on planned activities for the secretariat; to elect board members and to enter an MOU with APCA.

During this meeting stake holders from Nairobi, Nyeri, Nyahururu, Meru, Coast, Kisumu, Eldoret, Maua, Kijabe, Tenwek, Litein Mission Hospital and Kenyatta National Hospital were invited. New Board members were also elected. They are:

Dr. Bactrin Killingo-Chairman, ( Meru Hospice)
Mrs. Brigid Sirengo (was nominated as Vice Chair at a later date),( Nairobi Hospice)
Dr. Christine Kisia, Hon. Secretary, (Coast Hospice)
Mr. Faustin Mgendi. Hon. Treasurer, ( Coast Hospice )
Mr. Tarsem Sembhi-member, (Nyeri Hospice).
Mrs. Roselyne Opindi ­member, ( Kenyatta National Hospital, Palliative Care Unit)
Mr. Paul Asige-member, ( Eldoret Hospice)
Mr. Stephen Gitonga, ( Maua Community based PC programme)

The Executive committee is composed of the Chair, Vice-chair, Hon. Secretary and the Hon. Treasurer.

At the First Board meeting held on the 28th April 2006 , among the first planned activity was the need to carry out a needs assessment survey of existing hospices and palliative care providers. Other activities include setting up a secretariat; planning for a two day strategic plan workshop for the Board members and stake holders. The aim of this two day workshop is to develop a mission statement, a vision, a logo and a strategic plan among others. The funds for these projects have not been received yet. However, proposals have been submitted and we are hoping to get some funding to carry out our activities soon.

Any queries or recommendation may be written to:

Dr. Zipporah Merdin Ali
Ag. National Coordinator
KEHPCA
P.O Box 20854, 00202
Nairobi

Email: [email protected]
or by calling KEPHCA Office on 254-20-2729303.

Bangladesh

The main medical university in Bangladesh has decided to launch palliative care services. This can develop into a major initiative in the country.

Within less than a year of the national seminar in Dhaka , Bangaldesh now has an active palliative care program provided by a charity in Dhaka ; it has tablet morphine available; doctors and nurses from the national cancer centre and from a few non-governmental organisations are now undergoing training in Calicut , and a community volunteers manual has been written in Bengali!

Please have a look at
http://www.thedailystar.net/2006/10/07/d6100701044.htm for details of the new University intiative

Submitted by Dr. Suresh Kumar

Serbia

In July, International Palliative Care Initiative of the Open Society Institute (OSI)

awarded its first grant to a palliative care cancer fellow, Dr. Leonida Mirilo, to develop a palliative care program in a hospital based oncology program. The two-year grant will be administered by BELhospice and the Clinical Center of Serbia.

Financed by the Serbian government, the Clinical Center of Serbia was established in 1987 and is composed of 22 existing institutions from various fields of health care. It is the largest medical center in the country, covering the entire Belgrade region (2.5 to 3 millions inhabitants, in addition to the 35-45% of inpatients from other parts of central Serbia) and with the exception of radiotherapy, has all the facilities needed for oncological services.

BELhospice was founded in 2004 and is organized as a non-governmental, non-profit organization. It is devoted to improving the care of terminally ill patients and their families in Serbia through specialist palliative care services and education. Currently, there is no other organization in Serbia devoted to palliative care.

Dr. Mirilo, who is attending her last year of training as a pulmonary specialist, will be trained by BELhospice. Hospice of Hope Romania will head the collaborative development. During this two year period, the program will conduct patients’ needs assessments, symptom management, and psychological therapy. These activities will also extend into home-based palliative care services. Dr. Mirilo will also work with patients’ general physicians and district nurses to educate them on the philosophy of palliative care and effective approaches to symptom control.

Contact Information:

Natasa Milicevic., MD
Director BELHospice
89 Jove Ilica Street 11 000
Belgrade, Serbia
Tel:381 11 309 7 209; 381 64 810 9000
Email: [email protected]

Tajikistan and Kazakhstan Country Reports

Dear colleague,

As part of our further work on palliative care updates in Eastern Europe and Central Asia , we announce that the Tajikistan and Kazakhstan Country Reports have been updated on-line. You will find these at:
http://www.eolc-observatory.net/global_analysis/tajikistan.htm and
http://www.eolc-observatory.net/global_analysis/kazakhstan.htm

A further 6 country reports from this region have been completed and will be uploaded to the web over the coming weeks.

With the generous support of the Open Society Institute’s International Palliative Care Initiative
http://www.soros.org/initiatives/pdia/focus_areas/a_international_palliative
and working closely with our colleagues in the European Association for Palliative Care Task Force on the Development of Palliative Care in Europe
http://www.eapcnet.org/Policy/DevelopmentTF.htm, it is hoped that further revised reports will become available soon.

Best wishes,
Anthony

Anthony Greenwood
Information Support Officer
International Observatory on End of Life Care
Institute for Health Research
Lancaster University
Lancaster LA1 4YG
United Kingdom
Tel: 01524 594976
http://www.eolc-observatory.net