Back to School: Day1 of Palliative Medicine PGDiploma

Back to School: Day1 of Palliative Medicine PGDiploma

150 150 Kat Evans

I have made the decision to put my student hat back on and start a 1 year Postgraduate Diploma in Palliative Medicine through UCT this year. Day 1 discussions were facilitated by Dr Rene Kraus. Our class are a fascinating group of largely very senior/experienced palliative medicine doctors/nursing staff/allied health colleagues. I am excited to collaborate and learn from the group

History of Palliative Care & Hospice

Hospice traced back to medieval times:
“The first hospice or monastery was built in the 9th century at Bourg-Saint-Pierre, which was mentioned for the first time around 812-820. This was destroyed by Saracen incursions in the mid-10th century, probably in 940, the date at which they also occupied Saint-Maurice. Around 1050, Saint Bernard of Menthon, archdeacon of Aosta, regularly saw travellers arriving terrorised and distressed, so he decided to put an end to mountain brigandage in the area. With this in mind, he founded the hospice at the pass which later bore his name. The church’s first textual mention is in a document of 1125. The hospice was placed under the jurisdiction of the bishop of Sion, prefect and count of Valais, thus explaining why the whole pass is now in Swiss territory.” – Wikipedia

The Modern Hospice Movement

Dame Cicely Saunders introduced modern hospice movement (click here to read more about her, she was a phenomenal lady who was a nurse, social worker and a medical doctor). She started St Christophers Hospice and the Cicely Saunders Institute 

Where did the concept of ‘Palliative Care’ come from? Dr Balfour Mount from Canada proposed the word palliate, which comes from latin word Pallium which means cloak, because symptoms are “cloaked” or “disguised” with treatments whose primary aim is to provide comfort even if cure is not possible.

Palliative Care Principles – WHO Definition:

Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual…. [click here for further part of WHO definition] 

Dr Kraus unpacked the above definition for us into its components:
  • What is QOL? Depends on individual values, presence and absence of certain symptoms. QOL is fundamentally unique to each individual! Don’t apply your version of what good quality of life is to your patients.
  • What is a family? Legal family vs the people the patient perceives to be family.
  • What is a life-threatening illness? Difficult to define and very important to base on your context. Interesting in the international oncology discussion on this topic they spoke about ‘progressive metastatic cancer’, an African oncologist asked that instead we change this to ‘metastatic cancer’ due to different management strategies/interventions available. The SPICT Tool is useful in this regards BUT remember doesn’t mention TB/HIV which is key in our setting.
  • What is suffering? Suffering (patient, family & community) is multi-factorial. Important that suffering & discomfort are not the same thing. Discomfort may be normal or actually necessary.
  • What is spirituality? We will discuss this at a later stage.. as we are doing an entire week theme on it.. Important to understand that Spirituality does not equal Religion. 

Some thoughts/discussion points brought up regarding the definition: Important that not only TREAT suffering, but PREVENT suffering in the first place. Dr Kraus alluded to when her interest in PC began, which was working in rural SA in the height of the AIDS pandemic when ARVs were not yet available. At that stage there was no treatment option available. Something that is discussed a lot in EM circles.. regarding dying as a normal process. Using the “natural death” terminology. We discussed that dying and death is a process/journey not an event. 

Will try and post regular “African” context Palliative Care pearls as the Diploma proceeds

Kat Evans

Emergency Medicine Physician in Cape Town, South Africa. Looking for solutions to our unique EM challenges with a quadruple burden of disease.

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