PALLIATIVE CARE

william webster

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Jan 16, 2009
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From today's DR1 News --

Dominican Republic: a bad place to die
According to a study by Dr. Virginia Navarro, presented at the 7th Scientific Journal of the Ney Arias Lora Hospital, the Dominican Republic is ranked after Mexico, Chile and Argentina in palliative care. Navarro presented the study “Comparative Analysis between Spain and 12 Latin American Countries Regarding Final Life Stages Care and Donation of Organs and Tissues” within the framework of the conference.

Navarro conducted a comparative study of different countries to look at the advantages and disadvantages of national health concentrating on provisions for palliative care during the final stages of life. She said the data was tabulated to create the Quality of Death Index published by the Economist Intelligence Unit that encompasses 80 countries. The DR was ranked the worst country for palliative care in the 2015 Quality of Death Index.

The study factors that directly influenced the bad local ranking were deficient policy of palliative care, deficient focus on treatment in the final stages of life, lack of legislation, insufficient resources and lack of knowledge on the subject by health professionals. She also highlighted the lack of adequate infrastructure and lack of beds in intensive care units.

Dr. Navarro observed that palliative care in the country is primarily directed to cancer patients. She said there are also no efficient policies for organ donations, which she said leads to trafficking in organs and mentioned the case of the child Carla Massiel, being investigated by the judiciary.

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I take issue with this...
I expect the study is flawed.

Where are those people be cared for at home , quietly by their family ?

I see RD differently...
a caring, look after the aged and young society...

Personally, I intend to pass my last minutes, hours, days. weeks, months, years in RD
where I expect to be cared for by people who will care for me well....

This study is about hospital care(I assume), known cases... not the uncounted masses in the country who pass peacefully and quietly into death.

Such a life doesn't exist in the other worlds - as I know them.
But I am sure - I know- it does in RD

End of sermon..

Padre WW... Dr WW... Philosopher WW...
 

cobraboy

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Jul 24, 2004
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Palliative care usually includes a lot of pain medications such as morphine drips or serious opiates.

That could be a show-stopper in the DR.

I had a Hospice/Home Care for many years. We also had several infusion pharmacies so we could control drug regimines professionally with infusion pumps, clear chain-of-possession, etc. Those procedures are a pipe dream in a country where red lights are suggestions and senior care centers are few and far between. Are Advanced Directives even a thang here?

It's a nice idea, but I'm not so sure the time is right in the DR. I suspect many die in pain.

That said, if I had $20-30 million, I'd bring correct home care/hospice/senior care to the DR properly. I wouldn't care about a profitable business model. I'd cut some deals with the state and private ARS's. Cost reimbursed, like Hospice & Medicare home care used to be.

The best suggestion I could make is to have a serious sit-down with a group of forward-thinking family and specialty physician in the DR and come to some agreement about coordinated palliative care if and when necessary.
 

dv8

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Sep 27, 2006
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for those interested, the report is here:
http://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index
scroll down to see countries' profiles.

DR:

SNAPSHOT

The country’s health system has critical shortcomings in the provision of palliative care. Many obstacles stand between patients and access to quality care.

IN DETAIL

The Dominican health model fails to ensure basic access to medical advice and facilities. There is no national strategy in place to set up palliative care units.

The scarcity of research or data makes it difficult to assess the extent of current gaps and what resources are needed. Our index ranks the Dominican Republic as having the poorest care in the Americas. The near absence of qualified practitioners constitutes the biggest hurdle. Monitoring mechanisms are non-existent.

The few specialised professionals are foreign-trained, as there are no educational opportunities in palliative care available locally. Only one of the ten medical schools offers a module as part of its oncological training; no accreditation exists. No government subsidies have been allocated to lower costs for poorer patients seeking palliative treatments. Patients can in some cases draw from their retirement funds to pay medical bills, if an illness is terminal. Medicines are not subsidised. As a result, opioids are expensive and access is also complicated by bureaucratic rules imposed on medical staff. Psycho-social support and bereavement care are very hard to come by. Doctors tend to see their role as curative and rarely share information with patients, often at the request of the family.

The system has no official feedback channels; satisfaction surveys are not conducted and do not feature in government guidelines. Public understanding of palliative care is very low; information activities are isolated and mainly at the provincial level. Volunteers are a rare sight, with only two teams operating in the whole country.
 

dulce

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Jan 1, 2002
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From today's DR1 News --

Dominican Republic: a bad place to die
According to a study by Dr. Virginia Navarro, presented at the 7th Scientific Journal of the Ney Arias Lora Hospital, the Dominican Republic is ranked after Mexico, Chile and Argentina in palliative care. Navarro presented the study “Comparative Analysis between Spain and 12 Latin American Countries Regarding Final Life Stages Care and Donation of Organs and Tissues” within the framework of the conference.

Navarro conducted a comparative study of different countries to look at the advantages and disadvantages of national health concentrating on provisions for palliative care during the final stages of life. She said the data was tabulated to create the Quality of Death Index published by the Economist Intelligence Unit that encompasses 80 countries. The DR was ranked the worst country for palliative care in the 2015 Quality of Death Index.

The study factors that directly influenced the bad local ranking were deficient policy of palliative care, deficient focus on treatment in the final stages of life, lack of legislation, insufficient resources and lack of knowledge on the subject by health professionals. She also highlighted the lack of adequate infrastructure and lack of beds in intensive care units.

Dr. Navarro observed that palliative care in the country is primarily directed to cancer patients. She said there are also no efficient policies for organ donations, which she said leads to trafficking in organs and mentioned the case of the child Carla Massiel, being investigated by the judiciary.

---------------------------------------------------------------------------------------------------

I take issue with this...
I expect the study is flawed.

Where are those people be cared for at home , quietly by their family ?

I see RD differently...
a caring, look after the aged and young society...

Personally, I intend to pass my last minutes, hours, days. weeks, months, years in RD
where I expect to be cared for by people who will care for me well....

This study is about hospital care(I assume), known cases... not the uncounted masses in the country who pass peacefully and quietly into death.

Such a life doesn't exist in the other worlds - as I know them.
But I am sure - I know- it does in RD

End of sermon..

Padre WW... Dr WW... Philosopher WW...

I agree with you WW. I have witnesses good care of the elderly by family members.  The middle and upper middle class hire people to care for ill family members. That care is reasonably priced. They prefer to not send their relative to the hospital for care unless absolutely necessary.
 

william webster

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Jan 16, 2009
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dulce
you & I are talking more about 'old age' care....it seems

the strict definition of palliative care is another matter....more medical assistance required
 

dv8

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Sep 27, 2006
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the study is about palliative care in death. so we are talking serious diseases like cancer: long, painful and nasty death. even more so in DR where the access to strong painkillers can be a big issue.
 

cobraboy

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Jul 24, 2004
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As mentioned above, senior care and palliative care are two entirely different concepts.

Senior care does not seem to be a big issue in the DR because of the cultural emphasis on family.

Palliative care requires the constant coordination of medical professionals and the ongoing administration of powerful drugs.
 

dv8

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Sep 27, 2006
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there are geriatras although i do not know how good they are. in any case, this specialty is not particularly relevant here. palliative care is handled by a varied team: oncologists, anesthesiologists, pharmacists, nurses and so on.
 

dv8

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Sep 27, 2006
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that, and the fact that medical staff is not trained sufficiently to handle such cases and that there are little funds to take care of terminal patients and that the psychological aspect of patient's suffering is not addressed.
 

cobraboy

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Jul 24, 2004
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I may be wrong but I see the lack of "Palliative care" in the DR as a lack of drugs to combat pain
Not the case at all. The drugs are readily available.

It's the coordination and care delivery, including high tech infusion pumps for non-institutional settings.

When my mother was in HOMS not long ago she was on an infusion pump. I asked the infusion team about the pump, if others were available with lock-outs, etc. She said that was the only pump the hospital used.

A non-institution pump is diffeent than a pump in a hospital. It's designed for the home environment without the complexity of a one-pump-for-everything institutional pump. I don't know the price today, but 20 years ago they were around $1000 for the least expensive model.

I asked the nurse how common PICC or central lines were (semi-permanent venous access devices) and she said very rare, that peripheral lines is what they used even for chronic patients (think end-stage AIDS.) I asked about poor veins, and she said it was a real problem for them occasionally, especially with elders.

It's nearly impossible to do palliative care with peripheral IV lines. Peripheral lines in a typical Dominican dust and microbe-rich home environment with caregivers with little education? You're asking for massive infections that can be worse for a compromised patioent that their base disease is!
 

william webster

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Jan 16, 2009
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Clearly, there are things lacking here...

When my diagnosis in STI came back & I was sent to the oncologist, he encouraged me in no uncertain (Spanish) terms to get out of the country.
He made is clear that what I needed wasn't available in RD.

That was a Wednesday afternoon---- I flew Saturday AM

I'm sorry my original post was a bit off target but this discussion is worthwhile ---IMO
 
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Drperson

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Sep 19, 2008
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there are geriatras although i do not know how good they are. in any case, this specialty is not particularly relevant here. palliative care is handled by a varied team: oncologists, anesthesiologists, pharmacists, nurses and so on.



Even in Canada I nursing homes you are stuck with the geriatric specialists they have. From our experience this care leaved A lot to be desired
I believe you would have equal or better outcomes and quality of life in the dr
 
May 5, 2007
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Not the case at all. The drugs are readily available.

It's the coordination and care delivery, including high tech infusion pumps for non-institutional settings.

When my mother was in HOMS not long ago she was on an infusion pump. I asked the infusion team about the pump, if others were available with lock-outs, etc. She said that was the only pump the hospital used.

A non-institution pump is diffeent than a pump in a hospital. It's designed for the home environment without the complexity of a one-pump-for-everything institutional pump. I don't know the price today, but 20 years ago they were around $1000 for the least expensive model.

I asked the nurse how common PICC or central lines were (semi-permanent venous access devices) and she said very rare, that peripheral lines is what they used even for chronic patients (think end-stage AIDS.) I asked about poor veins, and she said it was a real problem for them occasionally, especially with elders.

It's nearly impossible to do palliative care with peripheral IV lines. Peripheral lines in a typical Dominican dust and microbe-rich home environment with caregivers with little education? You're asking for massive infections that can be worse for a compromised patioent that their base disease is!

Guess I wasn't clear " Quote Originally Posted by IslandDreaming View Post
I may be wrong but I see the lack of "Palliative care" in the DR as a lack in the DR of drugs to combat pain
 

cobraboy

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Guess I wasn't clear " Quote Originally Posted by IslandDreaming View Post
I may be wrong but I see the lack of "Palliative care" in the DR as a lack in the DR of drugs to combat pain
Plenty of pain drugs in the DR.

But no professional infrastructure to deliver them outside the clinic environment. The vast majority of palliative care in the US is non-institutional (which was my profession back in The Day.)

And then there's money...
 
May 5, 2007
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Plenty of pain drugs in the DR.

Then why do I continually read that people can not obtain pain meds in the
DR?

Only first hand experience I had was a guy at hotel I was staying had fell and cut had, tendons on coral and best he could get was Motrin or Tramadol
 

cobraboy

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Jul 24, 2004
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Then why do I continually read that people can not obtain pain meds in the
DR?

Only first hand experience I had was a guy at hotel I was staying had fell and cut had, tendons on coral and best he could get was Motrin or Tramadol
I have no idea.

We carry morphine in the MotoCaribe first aid kit...just in case something bad happens. We had no problem obtaining it, but had to go to a large clinic with the prescribing physician and jump through several hoops.

I can't vouch for what a local pharmacy keeps. Perhaps dv8 can.

From what I can tell, the DR gubmint keeps strict control over certain medications for obvious reasons.

Additionally, the kind of meds unsed in palliative care---primarily infusion compounds---aren't routinely stocked or prepped in an IV bag in local pharmacies in the US for chain-of-custody protocols to the non-institutional environment.
 

Kipling333

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Jan 12, 2010
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I am very much a senior and have had to deal with cancer surgery and treatment.The narcotic painkillers are available here and so is good care in the east and the capital.. I have two very good servants in the house and I will be relying on them when the time comes that I can not fully look after myself. I have numerous friends in the capital and La Romana ,all widows,who rely on Dominicans who have been in service with them for many years . It really is worthwhile choosing your cook and housekeeper and maybe a gardener/driver with great care with a view to the difficult years ahead. And looking after them well.
 

dv8

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Sep 27, 2006
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I can't vouch for what a local pharmacy keeps. Perhaps dv8 can.
From what I can tell, the DR gubmint keeps strict control over certain medications for obvious reasons.

controlled medicine is.. well... controlled. only some pharmacies carry it and only some doctors can prescribe it. and i am not even talking about hard core drugs derived from morphine here but also meds to treat depression and mental illnesses.
a family fren is an anesthesiologist in santiago and she says some pain medicine is basically available in hospitals only and for terminal patients.

besides, the focus of the study is likely sad majority of dominican that have no or basic insurance only and who are patients in public hospitals. there is no comparison of their fate as opposed to those with money and good insurance plans.