Palliative care and government engagement in Kazakhstan

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On 4 December 2012, the fund, Together against Cancer, hosted a roundtable discussion: ‘Availability of drugs for the treatment of pain: ways to address the problem’. 

It was attended by Members of Parliament, representatives of the Committee on Narcotics and Drug Control of the Ministry of Internal Affairs, Medical and Pharmaceutical Activity Control Committee at the Ministry of Health, family members of cancer patients, international experts from France and Russia, Kazakhstan specialists in oncology and palliative care, members of the pharmaceutical community, representatives of Kazakh and international NGOs, as well as chief doctors of clinics in Almaty, the staff of the Centre of Palliative Care, oncologists and members of the media.

The roundtable participants acknowledged that Kazakhstan had problem with adequate pain treatment for patients in terminal stages of cancer and other diseases: there was an insufficient range of products for the prevention and treatment of pain in the national list of drugs; the most WHO-recommended formulations of morphine, tablets and solutions were inaccessible, the prescribed doses were insufficient, the access to opioid analgesics in communities in remote areas was limited.

After hearing the reports on the situation with opioids for terminally ill patients in the world, Russia and Kazakhstan, prepared by the invited experts, the participants recommended that the Ministries of Health and Internal Affairs of the Republic of Kazakhstan take measures to remove barriers to ensure unrestricted access to narcotic analgesic drugs for medical purposes.

A resolution came out of this round table discussion that went directly to the desk of the Minister of Health, and I think it had its effect, and a very quick effect. 

Representatives of the Ministry participated as speakers in the Together against Cancer Scientific Conference on 5 December 2012: ‘Palliative care and supportive therapy in oncology’. 

The purpose of the conference was to review the current state of supportive therapy and palliative care for the cancer patients, as well as professional community awareness about modern approaches, methods and forms of palliative care and supportive care in oncology. 

The conference was attended by oncologists, radiologists, nurses, hospice staff, representatives of public and patient organizations, social workers and psychologists. 

Leading experts from France, Russia and Kazakhstan were invited to take part. Participants covered a wide range of methodological, practical, and organizational problems of palliative care. 

The use of surgical and radiological techniques in palliative care patients was demonstrated, and psychological aspects of support for terminal patients were discussed.

We have found that our supporters have grown in the government and the Ministry of Health. So now there are people who know this problem, who understand the needs of people in the terminal stages of illness, and who understand the lacks in the system. 

From the very first days, our foundation was supported by the daughter of the president of Kazakhstan – Ms Dariga Nazarbayeva, who is currently Deputy of the Majilis (lower chamber) of the Kazakh Parliament. 

Ms Nazarbayeva is very authoritative in Parliament, and she is known to penetrate into the details of whatever problem she is dealing with. She can influence the attitudes of other deputies. 

It is thanks to her efforts that we are gaining attention of policy makers and opinion leaders. 

We are always in contact with parliamentarians to invite them to the conferences and roundtables. We are not strangers to them. They are in the picture of what is going on. 

As I mentioned before, we attracted the government’s attention to the problem of pain relief and the problem of lack of opioids for pain treatment. In Kazakhstan we have only injectable morphine. We don’t have oral morphine, and this is obviously a problem for pain management. 

Our first interaction with the Ministry of Health was around Fentanyl patches that had been registered in Kazakhstan, but de-facto were not available because of bureaucratic discrepancies. The government reaction was surprisingly quick, and the problem with access to the patches was resolved soon.

According to the Kazakhstan Cancer Care Development Program for 2012-2016, each year more than 30 thousand new cases of oncologic diseases are detected in the country, 58% of them are detected at mature stages. 

While a lot of activities are planned and significant financing will be allocated for the development of the existing oncology infrastructure, the introduction of new technologies and training of doctors, the need for palliative care, in my opinion, still is not adequately assessed and reflected in the national plan. 

However, as I said previously, we are expecting for the National Palliative Care Standards to be adopted within the next couple of months. We think it is a big achievement and we will support the introduction of these standards.

Look out for an interview with Gulnara Kunirova on ehospice tomorrow.

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