There was great excitement in Belgrade at the start of the first children’s palliative care training to be held in Serbia. The training, organized by the EU funded project ‘The Development of Palliative Care Services in the Republic of Serbia’ (managed by a consortium led by Oxford Policy Management) was run in conjunction with the International Children’s Palliative Care Network and was held at the Hotel Park in Belgrade.
Forty participants attended the training from a mixture of tertiary level health institutions and social care institutions across Serbia. The course was co-ordinated by the Project Team Leader Prof. Julia Downing and facilitated by four facilitators: Associate Professor Lidija Dokmanovic, Paediatrician, Medical Faculty University of Belgrade; Tamara Klikovac, Psychologist, University of Belgrade; Dr Chantal Wood, Head of the Pain Management Unit, Consultant Paediatrician, Robert Debré Hospital, Paris/ICPCN; and Maraliza Robbertze, Social Worker, ICPCN.
The course was the first of its kind and was offered as part of a series of courses being run on palliative care and was intended to introduce participants to some of the key components of children’s palliative care. Concepts such as what is ‘a child’, vulnerability in children, the definition of children’s palliative care and the differences and similarities between adult and children’s palliative care were explored, along with the history of children’s palliative care, in the first session. The type of children needing palliative care was discussed along with different models of palliative care provision for children and how these might apply in the Serbian context.
Child developmental stages were explored alongside the role of play in childhood development, as therapy, and in improving quality of life. How to facilitate and encourage play in different settings and its importance in children’s palliative care was also discussed. Communication is essential in children’s palliative care and different techniques for communicating with children of different ages about illness and death were explored along with the barriers and challenges to communication.
Pain and symptom management are key components of any children’s palliative care service. Challenges to pain assessment and management were explored alongside best practice in pain and symptom management in children utilizing the WHO guidelines for persisting pain in children and other international guidelines. What constitutes a ‘good death’ in children was discussed along with the care of children and their families at the end of the child’s life.
The issue of grief and bereavement for children and their families was covered along with approaches to practical bereavement support that can be utilized in Serbia. Alongside this, psychosocial and spiritual issues for the child and the family will be explored and the importance of family centered care.
The training was interactive and the participants engaged with the process, participating actively in different activities, games and role plays as appropriate. It was encouraging to see the enthusiasm of the participants and to hear their comments and feedback as the training progressed. Initial feedback at the end of the course suggests that the participants really appreciated the training and that it had opened their eyes into the field of palliative care. It is hoped that further follow up and supervision of the participants will be possible.