A closer look at children’s palliative care in Latvia

A joint project between the Children’s University Hospital, St. Louis BJC Hospital and the American International Health Alliance (AIHA) in 1997 saw the beginning of children’s palliative care in Latvia. As part of the project a doctor and a social worker from the Children’s University Hospital travelled to the USA to learn more about the discipline. The Children’s Palliative Care Department, established at the Children’s University Hospital in 1998 in co-operation with the Children’s Palliative Care Society (CPCS), is and remains the only children’s palliative care service in Latvia.

The CPCS was established in 1998 with the aim to develop services and ensure access to palliative care by the families of life limited children. It also aims to provide the best quality of life for the child and the child’s family through medical and psycho-social support; joining individuals and legal entities to support children and families, to inform society about palliative care and to involve society in providing assistance to the organisation. 

Activities of the CPS over the past 10 years have included:

• Providing Home Care services to children and families
• Providing spiritual and psychosocial help in crises situations, at the moment of a child’s death and during the grieving period.
• Helping in the improvement of nationally distributed documents to improve understanding and awareness of children’s palliative care.
• Creating informative materials about children’s palliative care and how to access services
• Creating educational materials and providing educational courses for the multi-disciplinary team in order to improve knowledge of the field.
• Engaging the public by organising charity events.
• Improving international cooperation (Please could you elaborate on this point).
• Engagement in national project tenders and their implementation. 
• Conducting scientific research on children’s palliative care and participating in conferences held by Riga Stradiņš University and internationally

At present, holistic palliative care is provided to children in Latvia by a multidisciplinary team consisting of 3 physicians, 3 nurses, 2 social workers, a chaplain, a psychologist and a psychotherapist, each providing an essential element of care to the patients and their families.

At present the palliative care team provides:

• Consultations for patients and their family members in the various departments of the Children’s University Hospital
• Consultations to outpatients within the premises of the Palliative Care service
• Provision of round the clock home care  for patients living in Riga and Riga’s district   
• Consultations via a 24 hour help-line for patients in all states
• Psychological and spiritual care for families (individual support therapy and existential support group therapy for parents whose children are seriously and incurably ill and for grieving parents).

Increased demand for services
Every year the demand for services increases and the number of home care patients grows. In 2000 32 children were cared for in the hospital and 5 received home services. In comparison, in 2013, 149 patients and their families were consulted within the hospital and 157 received home care service. Finance for children’s palliative care comes from 3 different sources, these being the state budget, the municipal budget and donations raised by the CPCS. Services are provided free of charge.

The Children’s Palliative Care Society (CPCS)
In 2008 the CPCS won an award for the Best NGO and has played a significant role in the development of the palliative care system in Latvia. It has carried out 12 international and 17 national level projects for the purpose of education in children’s palliative care. The society has also provided input on national policies, improved the availability of services and helped to find resources to ensure the continuation of service provision. Eight books/brochures have been written on children’s palliative care in Latvian and Russian, four documentaries and four educational movies have been made. Specialists from within the society have also educated 3 mobile teams outside of Riga in Livani, Liepaja and Ventspils.

Members of the CPCS actively cooperate with colleagues from both western and Eastern Europe, exchanging the most up-to-date information and participating in common research programmes. The society enjoys a particularly close relationship with Dundee University in Scotland and with similar service providers in the UK, Georgia and Estonia. An exceptionally close relationship has been established with the Belarusian Children’s Hospice and the two societies have worked together on a number of projects.

New project
In 2014 a new project with the Belarusian Children’s Hospice and funded by the EEA Financial Mechanism programme was launched. The project, called “Implementation of innovation solutions in Children’s Palliative Care” (project No. 2012.EEZ/PP/1/MAC/050/032) aims to assure the availability of innovative children’s palliative care services by applying telemedicine technologies to every family with an incurably ill or disabled child thus promoting the overall improvement of the family’s welfare, while strengthening democratic values and the respect for human rights in Latvia.