Some people may think that I, and other ‘pioneers’ of hospice/palliative care, were alive with the dinosaurs.
Those far-off days brought much pleasure as well as challenge, though no-one could call them easy. Since we started planning in 1968 there have been many successes, and more to be proud of than we ever thought possible.
The comparative success of our ‘movement’ owes much to the national, international and professional organisations that have worked over the years to promote palliative care. In particular The International Association for Hospice and Palliative Care (IAHPC), has played a huge role, through its dedication to encouraging the development of palliative care worldwide.
The IAHPC has had its work cut out – so many people see palliative care as luxury care, and therefore very far down their priority list. This has meant endless negotiations with national and international leaders at political and professional levels, often with few results after 20 to 30 years.
Other major obstacles have been dose ceilings set for opioids and, persisting to this day in nearly half the countries of the world, the belief that opioids inevitably cause dependency addiction.
Now (I am tempted to say ‘at long last’) the WHO is throwing its authority and political influence behind us. The WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020 includes palliative care as one of the areas proposed to Member States. The WHO will soon publish a Global atlas of palliative care in collaboration with the Worldwide Palliative Care Alliance. And this week a report was submitted to the WHO Executive Board on the growing need for palliative care services. The report broadens the scope of past efforts, to address the need for palliative care for people with conditions other than cancer.
But with this backing comes the reminder that 21 million people need palliative care each year and 42% of the world’s countries have no palliative care provision whatsoever.
We also know that only so called ’developed‘ countries teach palliative care in medical and nursing schools, that close on 50% of countries do not make opioids available, and that palliative care is a recognised specialty in only 10 countries.
Can we in Scotland do anything to help? The answer is a resounding YES!
- We can make provision for a doctor or nurse from a developing country to spend at least two weeks in a Scottish palliative care service. They should see everything we do, with 30 minutes each day spent with individual key members of our team in a Q&A session.
I know from experience this is an exhausting task for all concerned – it is not an excuse for a holiday for the visitor, and it brings no income to the unit. But the experience can be so valuable. If sufficient units were willing to do this it might attract funding from an interested charity.
- Secondly, palliative care doctors, funded by IAHPC, can go to a struggling unit / service abroad for a minimum of two weeks. There, they can demonstrate, teach and explain every aspect of palliation care provision to those working in that service.
Once again this is no holiday – flights are at budget rate, accommodation basic, the hours are long – in fact this scheme almost came to a stop because so few doctors were prepared to make such sacrifices!
- My third suggestion is that we develop twinning schemes whereby units in a developing country are twinned with units of roughly similar size and staffing in a Scotland. Both parties would agree to be in regular and frequent contact with their ‘twin’, by email & Skype, as well as sharing with each other clinical problems, teaching material, specimen examinations papers, management problems, staff morale tips, and information about negotiations with government.
It is important to appreciate this is of most value when services are at roughly the same stage of development. It is a sharing exercise, both services being ready and eager to befriend and help each other.
A final challenging question:
Palliative care has always been an exercise in compassion, in caring for those in desperate need. Should that compassion not extend to our unseen friends abroad who are currently finding it even more difficult to get recognition than we did back in 1968?
I believe so.