Global perspectives for palliative care

Categories: Education.

Dr Liz Grant, Assistant Principal and Director of the Global Health Academy, welcomed delegates on behalf of the University, reminding them of the importance of bringing old and new knowledge together; not forgetting the old but using established knowledge and innovation in creative ways.

Dr Mhoira Leng, Medical Director of Cairdeas International Palliative Care Trust, and Head of Palliative Care in Makerere University, Uganda, paid tribute to the “huge amount of expertise and experience in the room.”

Delegates introduced themselves and spoke briefly about their work in countries such as China, India, Kenya Kosovo, Nepal, Russia and Serbia among others.

The conference began with the question: “How to strengthen health systems and really integrate palliative care?” Presentations throughout the day addressed themes of: capacity building, integration, system strengthening and transformation of people and systems through palliative care.

Professor Julia Downing, Honourary Professor at Makerere University and Director of Education and Research for the International Children’s Palliative Care Network, joined Dr Leng and Dr Grant in presenting examples of how the THET Integrate and Cairdeas projects worked with national partners to help them to change their practice and systems to provide good palliative care.

It was clear that these projects put into practice ideals of partnership, not only bringing activities to a project site, but actually building up existing capacity and planning for continuity through training trainers and helping to integrate palliative care into the working cultures of individual hospitals as well as national Ministries of Health.

The speakers also noted the importance of building a strong evidence base for palliative care within the hospital setting.

Dr Grant noted that the THET Integrate project is about “cooperative working together” and not just about the work of a single organisation. She mentioned the Resolution on palliative care passed by the World Health Assembly in 2014, saying that this recognition by the World Health Organisation was “momentous,” noting that “something is happening in palliative care that has the potential to make huge changes.”

“The consequences of dying without care are huge,” argued Dr Grant, saying that, as people are living longer with more illness, we need to look at systems thinking and integrate palliative care to create strong systems to manage the whole pathway of NCDs and infectious diseases.

She reminded the audience that we need to recognise that health is “uncompromisingly complex”, and called for a structure – such as palliative care structures which routinely manage complexity – to address this.  

Dr Leng took to the stage, asking: ‘Can palliative care be a vehicle for systems change?’ before presenting ways in which the THET Integrate project has seen this happen.

Prof Downing presented a case study of Rwanda, talking about the importance of critical mass both within individual hospitals and within the whole health care system within the country.  

Throughout the day, presentations from speakers provided a snapshot of current issues in global palliative care. Rev Hamilton Inbadas tackled the challenging topic of defining spiritual care within palliative care, a distinction he compared to “defining yeast within bread.” Dr Karilyn and Dr Richard Collins shared their experiences in mentoring in palliative care.

Dr Martin Leiper of PRIME International spoke about holistic education and global partnerships, talking about “patient centred medicine and learner centred education.” Prof Downing reminded the audience of the unique palliative care needs of children, and the importance of keeping these in mind when discussing Universal Health Coverage.  

The day ended with an update by Malcolm McNeil, Senior Health Advisor at the UK’s Department for International Development (DfID) on the progress of finalising the Sustainable Development Goals. Dr McNeil noted that it would be very difficult to get palliative care included at this stage, but encouraged the audience to try.

A lively discussion followed Dr McNeil’s presentation, on the next steps for global palliative care integration and health systems strengthening, with participants very keen to get involved in influencing the SDG process. 

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