Modern palliative care in Iran – practice, education and barriers

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The story of modern palliative care in Iran began in the early 2000’s. Professor Zahra Eftekhar, Gynaecological oncology surgeon of Tehran, spent one year (2001) with Professor Neville Hacker at Royal Hospital for women in Sydney, Australia, and observed the value of palliative medicine consultancy in influencing the care of the patients. On her return, she decided to introduce these ideas to Iran.

Prof Eftekhar arranged the first National Palliative Care workshop in 2004, involving Professor Norelle Lickiss – still my main mentor and leader – of Sydney, a pioneer of palliative medicine.

Senior Ministry of Health staff as well as clinicians and academic staff attended this three day event. One of the gynaecologists at this workshop decided to train in specialist palliative medicine at the Sydney Institute of Palliative Medicine.

Palliative care practice and education in Iran

The first palliative care consultant service in Iran was established in 2006, but this was only based on one palliative medicine consultant.

Palliative care clinics now form part of cancer clinics in the Tehran Cancer Institute, providing services three days per week since 2009.

A palliative care curriculum for the training of one palliative medicine fellow per year was authorized in 2009, and an inpatient hospice with eight beds was opened close to the cancer institute in 2010.

Palliative care is part of most national and international cancer congresses in Iran and it has been the subject of an ever increasing number of published articles.

Barriers to providing palliative care

There are still many barriers to improving palliative care in our country: Iran is a highway for transferring drugs from Afghanistan and opiophobia is part of our culture.

There are rules limiting prescribing, which impacts the availability and accessibility of opioid medications. Also, only oncologists and some specific physicians have license to prescribe opioid medications.

Unfortunately we don’t have any form of oral morphine. Morphine 10mg Ampoules, methadone Tablets, ampoules and syrup, Fentanyl patches – which are expensive – and buprenorphine – which are limited – are our main choices.

A day in the life of an Iranian palliative care doctor

I work six days per week. On even days I visit outpatients in the clinic (8:00 am-3:00 pm), accompanied by a nurse and a fellow.

On odd days we have a ‘learning palliative medicine’ class of about one and a half hours in the early morning, then I visit inpatients and also consult with patients from other departments such as emergency, internal medicine, oncology and surgery.

I am responsible for patients in the hospice, and I am on call through the nurse 24 hours a day, seven days a week. All palliative care patients can call me every evening between 6:00pm-8:00pm if they or their relatives need to.

Drawing on ehospice

As I work alone, I often feel very isolated. Until recently, participating in international palliative care congresses was the only way for updating myself and it is an expensive way.

ehospice is a window to the palliative care world. It is a great source of information and stories that inspire me. 

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