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Regional Reports
Gaza - Sep/October 2007
By Beris Bird, RN (Australia)
Ms. Bird was an IAHPC Traveling Fellow to
Cambodia (2002) and to Kenya (2005).
We went to Ahli Arab Hospital in Gaza City last month, for six weeks. We were invited to do so, both by the hospital, and by the Anglican Diocese of Jerusalem
My husband, Geoffrey, is a plastic surgeon who was to provide specialist reconstructive surgery for patients from the refugee camps. I was asked to conduct palliative care seminars for health care professionals working in hospitals in the Gaza strip, the main focus being the nurses.
Because of the political situation, there is very little post graduate training available at present and the opportunity of learning about something new, was welcomed.
While we were in Gaza, operating rooms in Gaza’s main hospital were shut down due to the lack of medicinal gases because they were not allowed through the controlled border crossings. Today, Israel allows only 12 basic items to enter Gaza, out of over 9000 commodities. The cardiac unit at the Shifa Hospital has been closed for some weeks because of the inability to access the necessary medications and equipment. Many nurses have joined the ranks of the 65% unemployed because of bed closures.
It was difficult to get information about the knowledge and practice of palliative care as I was not able to get permission to visit the hospital although some nurses were able to attend the seminars. I was told that two doctors from the oncology unit of the government hospital had attended lectures in Israel some years ago. Appropriate medications are in short supply, and the drugs necessary for symptom control and pain management are imported very sporadically. Morphine is seldom used even though it could be accessed from Israel if this was organized and the borders were open.
Tramadol which could be useful in pain management is prohibited from import because it is a drug which is ‘ known’ to be able to delay premature ejaculation.
It was quite a challenge to organize these seminars! They were held over two weeks, each seminar was given over four days with the aim to present ‘ An Introduction to Palliative Care. ’ The language was Arabic, but good interpreters were provided and communication presented no difficulties as I have a basic knowledge of Arabic. I wish to acknowledge the help given to me by Dr Bushnaq, King Hussein Cancer Centre in Amman, Jordan, who provided me with palliative care lectures translated into Arabic. The Centre agreed that these lectures could be photocopied and given to the students - this was much appreciated.
A total of 75 nursing students attended, including lecturers from nursing colleges in the Strip. Doctors did attend at times, but for a much shorter period.
The seminars were well received; the students participated readily, with many questions and many comments.
It was clear to me that the terminally ill patients were poorly cared for within the hospital system, and the lack of adequate analgesia being a problem of concern to the nurses. Morphine and pethidine were often given concurrently and without a management plan.
Morphine, its use, and misuse, was taught very carefully according to the WHO guidelines and analgesic ladder.
This visit was only a beginning; we have been invited to return next year as interest in palliative care has been raised both in hospitals and in the nursing colleges.
Gaza today is a sad country, where the people live without any freedom, personal, professional, or economic – they describe it as living under ‘ siege’ , and in ‘ a prison’.
I think the whole situation was summed up by one of the students. As he left the workshop, he thanked me for all he had learned, and for the opportunity to participate in postgraduate education. He said, “We knew nothing of Palliative care – for us, it is very important, not only for our patients as they face a terminal illness, but for everyone here in Gaza. Gaza is dying. We are all dying. We all need palliative care…”
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Entrance to the Ahli Hospital which is in the middle of Gaza City. Palestine Square.
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The classroom with lecturer and translators. Some of the 35 students.
All Muslim and from different hospitals in the Gaza Strip.
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‘ Graduating class! ‘
Certificates were given indicating completion of the seminar ‘ An Introduction to Palliative Care’
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By Beris Bird, RN (Australia)
Asia
7th Asia Pacific Hospice Conference, 26 – 29 September 2007, Manila
The 7th conference of the Asia Pacific Hospice Palliative Care Network moved to Manila, Philippines in 2007. The theme of the conference was ‘Nurturing Partnerships in Hospice Care’ which was reflected throughout the meeting during what was a very enjoyable and friendly conference attended by 738 delegates from 18 countries.
Palliative care is still a relatively new specialty in this part of the world and many people are working in isolation in their own countries. The content of the conference touched upon issues of pain and symptom management, service delivery, spirituality, suffering, ethics, training and education, paediatric palliative care, research, advocacy and new developments in the region.
Pre-conference symposiums on ethical Issues in clinical decision making and physical suffering dealt with many of the common problems in our daily palliative care practices. Speakers from within the region as well as from the USA and the United Kingdom ably highlighted the current developments in palliative care.
For many, it is important to be able to compare developments and standards across the region, to know where we stand in our own country relative to others and to identify what we should be aiming for. While there is a need for international standards of best practice, it is also recognised that the culture in which we practice plays an important role. Palliative care naturally develops differently in each country, determined by the health care system, health care needs and the individual cultures. Exchanging experiences creates new ideas that we can adapt to our own practices, it challenges our thinking and may lead to new research to support our practice. Our regional diversity created much of the diversity in the conference’s content.
An important aspect of attending any conference is the opportunity to network, to meet people across the region who are willing to give of their time and expertise to other countries, to establish informal links by which we can support each other in our work, and to build on established relationships as we move into the future. The hospitality of our Filipino hosts made the whole conference memorable.
Palliative care in the Asia Pacific has a rich cultural texture that needs an international platform to be heard. The opportunity to share our understanding of the management of the end of life as it occurs in our region can be very rewarding for everyone who attends the conference and we look forward to the 8th conference in Perth in 2009.
Ednin Hamzah, MD
CEO/Medical Director Hospis Malaysia
Council Member Asia Pacific Hospice Network (APHN)
Member of the IAHPC Board of Directors
USA
For Immediate Release from the National Hospice and Palliative Care Organization, USA:
November 8, 2007
Hospice Care Saves Money for Medicare, New Study Shows
Average Savings of $2,309 per Hospice Beneficiary
(Alexandria, Va) -- Findings of a major new study of hospice care in America show that hospice services save money for Medicare and bring quality care to patients with life-limiting illness and their families. This provides useful evidence to support the many benefits of hospice, reports the National Hospice and Palliative Care Organization.
Researchers found that hospice reduced Medicare costs by an average of $2,309 per hospice patient. The new study from Duke University appears in the October 2007 issue of the professional journal "Social Science & Medicine." ( NHPCO members may download this report.)
Additionally, Medicare costs would be reduced for seven out of 10 hospice recipients if hospice has been used for a longer period of time the study found.
"Given that hospice has been widely demonstrated to improve quality of life of patients and families...the Medicare program appears to have a rare situation whereby something that improves quality of life also appears to reduce costs," writes lead author Don H. Taylor, Jr., assistant professor of public policy at Duke's Sanford Institute of Public Policy.
For cancer patients, hospice use decreased Medicare costs up until 233 days of care. For non-cancer patients there were cost savings seen up until 154 days of care. While hospice use beyond these periods cost Medicare more than conventional care, the report's authors wrote that "More effort should be put into increasing short stays as opposed to focusing on shortening long ones."
The National Hospice and Palliative Care Organization reports that 1.3 million patients received care from one of the nation's 4,500 hospice providers in 2006. This represents a steady increase of more than 100,000 patients than the previous year. Approximately 35 percent of all deaths in the US were under the care of a hospice program.
"The trends for increased usage of hospice are expected to continue as we see an aging generation of baby-boomers face end-of-life situations for themselves and their parents," remarked J. Donald Schumacher, NHPCO president and CEO. "Hospice helps people live with dignity, comfort, and compassion during life's final journey – to know definitively that it provides a cost savings to Medicare is an additional benefit."
Hospice is not a place but a philosophy of care that provides pain management, symptom control, psychosocial support, and spiritual care to patients and their families.
This study is a landmark independent research effort, not only because it shows cost savings for hospice utilization, but because it also addresses research flaws and questionable analyses in previous hospice cost studies. The study used a methodology to match Medicare beneficiaries who used hospice and those who did not in a fashion that could be described as an "apples to apples" approach that yields sound results.
"Given that November is National Hospice Palliative Care Month, it's most fitting that this valuable study come out now," added Schumacher.
The study was funded by the Health Care Financing Organization (HCFO) of the Robert Wood Johnson Foundation.
Further information about hospice is available from NHPCO's Caring Connections at http://www.caringinfo.org/
or by calling the HelpLine at 800-658-8898; the Spanish-language HelpLine,
Cuidando con Cariño, is 877-658-8896.
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Note: NHPCO members can access a PDF of the report along with talking points via the NHPCO members-only section of Web site.
Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org
India
Read about the exciting things that are happening in India.
The Pallium India website has been updated recently. Please visit www.palliumindia.org to learn about the following:
Oral morphine enters another virgin state
National Cancer Institute Project
Beta-testing of EPEC-India curriculum
Methadone in India, and more…
Chennai, India
WORLD HOSPICE AND PALLIATIVE CARE DAY, OCTOBER – 2007
AN OUTLINE OF HOW WE OBSERVED IT
In view of World Hospice and Palliative Care Day, October 2007, Lakshmi Pain and Palliative Care Clinic (LPAPCC) and RMD Centre for Pain and Palliative Care organised a public awareness programme on the 7th of October 2007 at Vani Mahal, Chennai, India. Part of the programme was sponsored by Satyam Foundation. The theme of the programme was ‘Make Life worth Living’. About two hundred and fifty people including patients and their families, members of Satyam Foundation, the general public and well-wishers attended.
The audience was briefly enlightened about palliative care and its various aspects stressing mainly on how this care can help improve the quality of life of patients affected by cancer. The highlight of the programme was the speeches given by patients and the bereaved family members. It was felt by the organizers that the philosophy of this care and it’s details can be better understood by the audience if presented by the patients themselves.
Mr. Prakash, aged 28, has a cancer of the nasopharynx. He is on treatment with oral morphine and other medicines for pain relief. He described how he suffered in the past, but how comfortable he now is because of the pain killers he is on. He related that he almost feels that he is free of the disease. 18-year-old Michael who has a diagnosis of Hodgkins lymphoma and is currently receiving chemotherapy described a similar story. He is also on oral morphine for pain relief. The rest shared their experiences too and overall highlighted the salient aspects of modern palliative care.
The special invitees described palliative care from their perspective and stressed the importance of fundraising for various NGOs to help them continue their genuine and charitable work in this field.
The programme ended with a very good cultural programme by the members of the Satyam Foundation and was enjoyed by all.
We had a press meeting on the 4th October, 2007 at Chennai to bring about awareness among the public. Various newspapers both Tamil and English published information.
Dr. Mallika and Dr. Subathra
Lakshmi Pain and Palliative Care Clinic
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