Knowledge and Practice in Generating Paediatric Palliative Care in Low-income Countries

Categories: Care, Education, and Featured.

Today, there continues to be a significant shortage of services or units offering palliative care (PC) in the paediatric area, so the burden of severe illness and health-related suffering in this age group, and the corresponding need for palliative care, is immense. However, PCs are still not accessible to the majority of people in need, especially in low- and middle-income countries (LMICs).

Worldwide, it is estimated that about 56.8 million people require PC each year. 67.1 % are adults around the age of 50 and 7 % are children requiring specialist children’s palliative care. The number of neonates, infants, school children and adolescents with PC needs per year may be as high as 21 million.

Children with HIV/AIDS and congenital malformations account for almost 46% of patients requiring PC, followed by neonates with extreme prematurity. In one study, it was reported that nearly 2.5 million children die each year with health-related suffering and that more than 98% of these children are in LMICs.

At the paediatric stage, Africa accounts for more than half of the regions requiring PC, followed by South-East Asia (20 %), the Eastern Mediterranean (12 %) and the Western Pacific (8 %). Europe and the Americas account for 9% with paediatric PC needs. There is an inverse relationship between the rates of children requiring PC and the income level of each country. Countries with the lowest incomes have the highest proportions. One proposal to address this is to develop policies, programmes, resources and training on palliative care for health professionals to improve access to palliative care. There may be various circumstances that impede access to PC, but if we make known the benefits of this care, they will realise that timely attention to its application will prolong the patient’s life with quality and not just with days of suffering. It may be that, over the years, we continue to struggle with selfishness generated by a blindfold that prevents us from doing good for others. However, one thing that no one will take away from us will be the essence of mutual support for the well-being of patients with complex chronic diseases.

How can we achieve this, through a variety of pathways that, no matter how narrow or complex, will help us to recognise and treat patients in need of palliative care?

One example is the proposal set up by “Palliatives Without Borders”, where a distance learning course has resulted in the training of approximately 400 paediatricians and other health care professionals. However, its representative, Dr. Wilson Astudillo, concerned about the application of the knowledge acquired, has generated links and a network of teaching hospitals in solidarity with PC services in other countries that host professionals interested in acquiring skills in the practical area. In view of the above, I, María de los Ángeles González Ronquillo, in charge of the Palliative Care Service at the Hospital for the Children of El Poblano, can confirm through images that the chains of support generated between countries will lead to the training of various professionals interested in acquiring theoretical and practical training to develop paediatric palliative care in their place of origin.

This type of training will undoubtedly lead to palliative care being applied in various countries or communities that lack this type of care, reflecting the interest in reducing the suffering of patients, without the need to wait for the necessary infrastructure to be in place to begin the steps that will help us to build areas, services or units in the future, thereby reflecting humanism and empathy towards patients with life-threatening or life-limiting illnesses. Thus, in October 2021, Dr. Gerardo Ismael Castro Martínez, from Honduras, carried out a rotation at the Hospital para el Niño Poblano, in the city of Puebla, Mexico, in order to apply the theoretical knowledge acquired in the online course “Palliative Medicine in Children and Adolescents”, organised by Paliativos sin Fronteras.

Courtesy of Paliativos Sin Fronteras/Palliative Notes Magazine 2021.

Leave a Reply

Your email address will not be published. Required fields are marked *