Source: La Jornada
By: Rosa Elvira Vargas
Source: La Jornada
By: Rosa Elvira Vargas
Tuesday, January 14, 2020. Mexico has many years of delay in palliative care, both in the training of specialists and in the construction of infrastructure and adequate budgetary support.
Mexico is many years behind in palliative care, both in training of specialists and in the creation of an adequate infrastructure and budgetary support.
However, reaching death from the acceptance of the lived, the connection with the loved and the surrender to the belonged, as defined by the Iberian palliativist Enric Benito, is much more than just good will acts.
It is the right of any Mexican to receive palliative care at any age, whether or not he’s about to die within an imminent term). It is part of the medical care recognized by the World Health Organization since 2015 as a fundamental human right, stated Dr. Monica Osio, specialist in this subject.
In 2012, the so-called Prague Charter became the starting point from which the obligation to offer palliative care to people with chronic and terminal illnesses was established, and compelled countries to assume them as a care obligation on behalf of their inhabitants until the end of their life.
Currently, and given its acceptance as a universal guarantee, if a government doesn’t offer palliative assistance, such omission can be considered cruel and inhuman treatment and, therefore, typified as torture, the specialist points out.
And she documents: in Mexico, palliative care has been a component of medical care since 2009, and the General Health Act (or LGS) recognizes them as an integral part of the service that implies prevention, cure, rehabilitation and palliation. In addition, between 2013 and 2014 the regulations for the related legislation were drafted and the corresponding official Mexican standard (NOM) was issued.
Later, palliative care was instituted by the General Health Council as mandatory for all national, public and private health institutions, and in 2016 it was decided to extend it to the whole pediatric milieu.
In fact, a special rule was deemed as necessary on a pediatric scale, because it constitutes a particular and differentiated niche among palliative care for children and adults.
That way, we do have an established and perfectly clear legal framework. But from my point of view, there has been a lack of political will to finance palliative care related projects. This specialization has not been given or allocated the required budget, and therefore, like many other things in our legislation, is only a set of good intentions, Osio laments.
The School of Medicine of the UNAM will open a specialty
Several academic and health institutions offer face-to-face and online courses on palliative care.
The School of Medicine of the UNAM imparts a highly specialized seminar on this subject and is getting ready to create a specialization to train palliativists.
Dr. Nayeli Salazar Trujillo, specialist in anesthesiology, algology and palliative care, coordinator of the Working Groups of the Seminar on Global Studies of the School of Medicine of the UNAM, states: ‘The idea is that any health professional has at least a general basic preparation in palliative care, and where aspects of communication with the patient and family are addressed, mainly to know how to share bad news information and to address the symptoms.
Afterwards, subjects such as psychology, nutrition, physical rehabilitation, thanatology, mourning support would be imparted during the intermediate preparation; and in the most advanced one there would be a specialty focused on complex case situations.
Currently, only the Jalisco Institute of Pain Relief and Palliative Care (Palia)—endorsed by the University of Guadalajara—imparts that specialty, although it only admits anesthesiologists.
Palia is a pioneer institution (established in 2001) which carries out a multidisciplinary integral work that includes algologists, palliativists, nurses, psychologists and social workers.
The central idea is to make all those persons understand that the existence of a terminal disease does not imply the neglect of the patient. Moreover, palliative care is not at odds with the prescription of curative treatments, says Salazar Trujillo.
Today, palliative care focuses on the set of chronic progressive diseases, but also on other aspects, such as how to address pain, as well as on those related to the social, spiritual and emotional context, and the way to handle and share grief.
There are studies revealing that the cost of not having a palliative care unit is higher than the cost of having one. And although the most difficult thing might be to guarantee availability of medicines, Salazar suggests to work at the institutional level to guarantee the availability of medicines and, in the subject of palliative care, to optimize the human resources available among other measures.
In hospitals there are psychologists, nutritionists, and other specialists, so, why not train them in palliative care and integrate them? It’s not something expensive, and they are essential for this kind of care, says the specialist.