At present there is limited access to palliative care services and to medicines essential to pain treatment in México. A recent report from Human Rights Watch (HRW), Care When There Is No Cure, found that currently only a few dozen public healthcare institutions in the country offer palliative care and even fewer provide it in patients’ homes. Most healthcare personnel have received no training in the discipline, and few doctors are licensed to prescribe strong pain medicines that are essential for palliative care.
Seven of México’s thirty-two states have no known palliative care services and another seventeen states have just one palliative care service, in the capital city in each case. The report states: “For many Mexican residents, at the moment when they are most desperately ill, frail, and in intense pain, care is not available at all or only hours away by public transport. Opioid analgesics for chronic pain such as morphine are also almost completely unavailable outside state capitals.”
A recent ehospice article reports that although legally patients and their families in México had a right to palliative care, these rights were not claimed. Structural barriers such as inadequate coverage by health insurance schemes, obstructive drug control regulations and insufficient training of palliative care workers made it too difficult to do so. The government has announced efforts to draft a national palliative care strategy, as well as work on a government health insurance scheme for the poor and drug control regulations are being reviewed to make access to essential medicines easier for those who need them.
At the invitation of Diederik Lohman from HRW, Dr Rut Kiman, ICPCN´s representative for Latin America on the network’s Board of Trustees, accompanied him on a visit to México to talk to key stakeholders on the importance of palliative care for both adults and children. Their visit began in the city of Toluca, in the state of Mexico and included a visit to four more states, these being Guanajuato, Queretaro, Hidalgo and Morelos.
Dr Rut Kiman writes this about her visit to México:
In December 2014, a ruling was made in México regarding “Criteria for the care of the terminal patients through palliative care”. Included in this ruling was the development of palliative care for children with life limiting conditions.
In our first visit, we meet Dulce Gallardo, the coordinator of the children’s palliative care team at Toluca´s Children Hospital. As a nurse, she has been working in this field during the last two years with very good results and resulting in fewer visits to the hospital from children with life limiting conditons.
After our visit to Toluca we went to the city of Leon, Guanajuato state. Our activities consisted of presentations by HRW on the status of palliative care in Mexico and when it would be a suitable time to develop palliative care services for children with the assistance of the ICPCN. An interesting discussion ensued on the implementation of the palliative care approach within their present services.
Through a call from Dr. Celina Castañeda, programme coordinator for Palliative Care in the National Social Security of Mexico, a meeting with professionals who refer patients to paediatric hospitals, universities and health managers was held in Mexico DF, to discuss the scope and implementation of the children’s palliative care project that the recent law proposed.
We also went to Pachuca (Hidalgo) and Cuernavaca (Morelos), meeting professionals who showed a great interest in developing skills and children’s palliative care programmes.
In conclusion, it is hoped that access to paediatric palliative care will be soon a reality in México thanks to the efforts of professionals, non-governmental organizations and health policy makers.
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