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Thread: PALLIATIVE CARE

  1. #1
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    Default PALLIATIVE CARE

    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...

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  3. #2
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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.
    Cabin Attendant,
    Augusto Pinochet Helicopter Tours

  4. #3
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    for those interested, the report is here:
    http://www.eiuperspectives.economist...ty-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.

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  6. #4
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    Quote Originally Posted by william webster View Post
    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.

  7. #5
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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

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  9. #6
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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.

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  11. #7
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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.
    Cabin Attendant,
    Augusto Pinochet Helicopter Tours

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    Finding a geriatrician on this island is like finding a gold bar on the beach.

  13. #9
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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.

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  15. #10
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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

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