There is still some light at the end of the tunnel

PANAMA. Sometimes I receive in my office very sad patients who complain that a close relative was found to have cancer and that it has spread to other organs. His doctor told him that he had just a few months of life. The majority of doctors usually feel sympathy with the patient, but they also feel uncomfortable in this situation, because they feel that there is nothing else that they can offer.

They have been trained to heal, and when they cannot do it, sometimes, they avoid that patient. To some physicians, death is seen as defeat.

But there is still something that we can do for them.? Under this situation, patients and families get scared, and they want to stay at the hospital because they do not know what to do to control pain and suffering.

Dying patients experience a range of symptoms that are best managed within a comprehensive care model that includes the family and close friends of the patient. Interestingly, before our society became so modernized, communities often rallied around their sick and dying and cared for them with love and commitment even when death was on the horizon. The medical profession is returning to that concept.

Palliative care, also called hospice care, is care provided near the end of life. It is based on a philosophy of providing comfort, dignity, and personal growth, not only for patients, but also for their families.

Pain management is essential to this situation, but so is spiritual care and support. It is usually provided by health care professionals and volunteers. It can be provided in the hospital, nursing homes, or at the patient’s home. The emphasis is providing quality of life and healing or strengthening interpersonal relations.

Modern hospice care is a team effort, in which the typical hospice interdisciplinary team consists of medical providers (physician, nurse, and nursing assistant), psychosocial care providers (social worker, psychologist), spiritual care providers (chaplain), and other supportive care professionals, as needed (nutritionist, physical therapist, pharmacist, speech therapist, and other specialists).

The palliative care concept has broadened to patients who have a significant burden of illness, not necessarily cancer, like end stage renal disease, multiple sclerosis, advanced Alzheimer’s disease, or advanced congestive heart failure among others.

Traditionally hospice care is advised for patients who have a prognosis of less than six months of life, while palliative care is given to patients who could live longer, even a few years.

Today, modern palliative care is provided mostly in the patient’s home, with the aid of primary caregivers that are trained to control pain, or other symptoms, and usually supervised by a team of health care providers that perform routine visits to the patients and family, and are also easily available by phone 24 hours a day, seven days a week.

One of these groups in Panama, is HOSPES, which is a non government association of health professionals and the Catholic church, that offer palliative care to cancer patients. (Tel. 6618-2810, Francis Palma).

Another advantage of Palliative Care is that it diminishes the costs of the hospitalization, brings patient and relatives to their home and environment, thus, making it easier to strengthen interpersonal relations and give support at the end of life.

One of the goals of the new Ministry of Health is to strengthen the Primary Care in the community, and the concept of Palliative Care will be transferred to the Health Centers and the community.

Ironic, isn’t it. Some of the best ideas the medical profession embraces, are rooted in the common sense of the communities they serve.