2017_05_19_ICS_rueda_prensa_atlantes

"Not even the most developed countries can make progress in complex issues such as palliative care without sharing experiences with others". Marie-Charlotte Bouesseau, Advisor for Service Delivery and Safety at the World Health Organization-WHO(Geneva), made this statement at the headquarters of the University of Navarra in Madrid. The expert spoke at press conference to present two atlases which analyze the status of palliative care in Africa and the Arab countries of the Eastern Mediterranean, which are under the scientific direction of the ATLANTES Program of the Institute for Culture and Society (ICS).

"These works represent great hope. In 2014, the World Health Assembly adopted a resolution to strengthen palliative care worldwide, a global commitment in which 194 States participated," he stressed.

With hope," he added, "comes the question of how the commitment will be implemented so that it reaches the citizens. That means having a system for monitoring practices. These atlases take the commitment seriously and help to know what is happening in countries that face many health challenges."

He also referred to the importance of the role of the media in the development of palliative care: "The social discussion is core topic, informing the public is necessary to empower communities, to make people express their opinion and be able to dialogue with politicians, health professionals and other agents involved".

Also speaking at presentation to journalists were Carlos Centeno, researcher principal of the ICS ATLANTES Program; Emmanuel Luyirika, director executive association African Palliative Care; and Hibah Osman, executive director and medical director of the Lebanese Center for Palliative Care-Balsam.

Services, medicines, professionals and health policies

Dr. Centeno recalled that these volumes are pioneers in their field: in the Arab countries of the Eastern Mediterranean there had never before been a comprehensive study on end-of-life care and in Africa one was carried out in 2007, which had not been renewed.

"With these atlases we give a tool that is a driving force for the development future of palliative care. They reach health care professionals and represent a card of presentation of the countries. They give them data about their specific status and where they are in comparison to their environment," he emphasized.  

He commented that the volumes provide indicators contrasted by the WHO and updated by the research team: availability of services, access to medicines, training of professionals and the promotion of health policies.

ICS's researcher was asked in particular about the limited access to drugs to combat pain, which in Africa is 1 milligram per capita per year and in the Eastern Mediterranean, 4.5 milligrams per capita per year compared to 120 in Europe.

"The WHO estimates 200 milligrams per capita per year. One wonders why such a cheap drug does not reach the population," he said. He considered several factors: "On the one hand, there is the fear of morphine and opioids - which many people identify with death - and they reflect the fear of dying. Another reason is that the healthcare systems do not work well, since they should guarantee that the drug reaches the population.

In that regard, he has given Hospice Africa Uganda, a care center model within the country , as an example of good practice. "It manufactures and packages morphine for the whole of Uganda."

Educating physicians on the use of morphine.

He also wanted to emphasize that the barrier of Education is also a fundamental factor. "Morphine does not kill, it relieves patients, and doctors must be taught how to use it. My students at School of Medicine at the University of Navarra learn what dose is necessary to control pain, but in many Schools it is not taught," he said.

To these two factors provided by Dr. Centeno, cultural barriers and Education, Marie-Charlotte Bouesseau has added another: legislation. "There are very different regulations on access to controlled medicines such as morphine. At WHO, we think it is important to work with countries. There must be regulation, but it should not prevent access."

"In some nations you need one prescription a week. People who live in the countryside can't go back to the city every seven days and when they need medication they can't have it," he has pointed out.

Finally, he has stated that some countries, such as the US, have problems with overdoses and require "strict control", but others "need more flexibility". "You cannot export a solution from one place to another because contexts differ."  

Support patients with advanced diseases

For her part, Hibah Osman, executive director and medical director of the Lebanese Center for Palliative Care-Balsam, said that she has been involved in this specialization program for a decade, when she realized that "there was nothing to offer" to the patients with advanced diseases she was treating as a family physician.

"One of them was a very intelligent 96-year-old woman. She asked me not to send her to the hospital because she wanted to stay at home. It was very difficult to control her pain and I couldn't treat her when she developed complications," she said.

"In Lebanon many people live with advanced disease. Cancer is detected in advanced stages and only palliative treatment can be given. The system did not support these patients and we wanted to fill that need," he said.

Among the difficulties they encounter in their daily lives, he mentioned that in Lebanon, family networks are very important and they try to protect the patients by hiding their diagnosis from them. "Many people are unaware that they have severe illnesses because their loved ones don't tell them.

Finally, he referred to the value of the 'Atlas of Palliative Care in the Eastern Mediterranean Region': "It not only gives us valuable information, but also financial aid to researchers in the regions and to promote palliative care in the regions. It empowers us to develop palliative projects in the future."

Africa: growing cancer and infectious disease problem

Emmanuel Luyirika, director executive of the African Palliative Care association , commented that the African continent faces major challenges in the field of healthcare: its inhabitants make up 10% of the global population - in addition to a million refugees from nearby countries - and face a growing problem of cancer and infectious diseases. "The aim is to reach an investment of 15% of GDP in health, but in some countries it is less than 7%," he lamented.

In this regard, he stressed that the 'Atlas of Palliative Care in Africa' "allows countries to know where they are in the field of palliative care" in terms of policies, Education and human resources, specific programs and access to medications. "With these publications we can work with governments to implement international resolutions, such as those of the WHO."

With regard to the fact that Kenya, Uganda and South Africa account for 71% of the continent's palliative services, Luyirika pointed out that this is mainly due to a historical issue: "On the one hand, they are English-speaking and many of their programs were linked to others promoted by the United Kingdom. On the other hand, there has been a strong local interest. Along with this, the role of NGOs and volunteers should be highlighted".

The specialist also said that association African Palliative Care would like to extend access to these services to other French, Portuguese and Arabic-speaking countries.

In addition, he recalled that AIDS funding has played a key role in the development of palliative care on the continent, since there have been 23 million people affected by the disease and treatment options are very limited. "It has made available a model to treat patients in advanced stages of disease. The risk is that when funding decreases many palliative programs may be affected," he has warned.