Cancer treatment and Hospice in the D.R.

DR Solar

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Nov 21, 2016
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Though good wishes are nice but I'm really looking for first hand experience here in the Dominican Republic.

My brother had multiple myeloma about 5 years ago and has been good until; we are waiting for the final lab results. It could be prostate rather then the mm coming back.

His wife had breast cancer about the same time and it came back. She was in Hospice for a month and passed Jan. 1 with little pain and peacefully. Hospice was such a help.

So my wife and are trying to get some good information about cancer care and if need be, Hospice just in case he needs to relocate from the U.S. to come live with us here in the D.R.

Obviously, other personal factors are involved that we don't need to discuss.

Again, please do not speculate or give opinions based on your feelings and thoughts. Real experience only.

Thank you.
 

NALs

Economist by Profession
Jan 20, 2003
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The best cancer treatments in the country are done at HOMS (Hospital Metropolitano de Santiago), its the big hospital (blue and some other color, forgot what it is) that appears as one approaches the city from the east (from the airport). They have a separate building next to the parking lot where the cancer treatments are done.

From my understanding, many people from around the Caribbean and even some from the USA visit that hospital for that purpose.

There's more info on their website (in Spanish): http://homs.com.do/

This is a private hospital, but with USA standards. Many of their doctors speak English too.
 

Hillbilly

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Jan 1, 2002
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I can second the opinion on HOMS-Centro de Cáncer.

My experience? One of my boys had his chemo done there. Colleagues also, and my wife worked there for a year.

Dr. Rafael Gutierrez and Dr.Liliana Fernandez (Hemo) and several specialists in Radio-Therapy (?) Gutierrez and most of the others know English quite well.

On Hospice care, I am sorry but I do not have any information on this.

Cordially,

HB
 

GringoRubio

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Oct 15, 2015
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Hospice in the DR would be a real blessing. I'm not aware of anything and even getting morphine injections takes a trip to the hospital.
 

DR Solar

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Nov 21, 2016
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Thanks for your replies. I thought HOMS would be the best place so I'll start talking with them.

Ty.
 

GringoRubio

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Oct 15, 2015
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Does anybody know anything hospice-like in PP? Or, a home care nurse (ish type person)?

The GF's mother is back from Haiti. There were just no pain killers at any price in Haiti and the pills that we were shipping her were not doing the job. She's much relieved after a morphine shot.
 

cobraboy

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Jul 24, 2004
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Does anybody know anything hospice-like in PP? Or, a home care nurse (ish type person)?
Doesn't exist in the DR, not at least like in the states.

You may find a nurse, but getting morphine for home use will be difficult.
 

yacht chef

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Sep 13, 2009
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This is sad that people have to suffer like this in 2018. Can meds be sent in from canada or us.
 

cobraboy

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This is sad that people have to suffer like this in 2018. Can meds be sent in from canada or us.
No way Schedule II drugs can be mailed to DR from the states.

They are available in the DR but nearly impossible for the average person to get for their personal use.
 

GringoRubio

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No way Schedule II drugs can be mailed to DR from the states.

They are available in the DR but nearly impossible for the average person to get for their personal use.

They are also financially out of reach of most people. When my girlfriend hesitated on the price, they discreetly and politely offered an alternative of euthanasia which was more economical at a fraction of the price of a single shot of morphine. I'm afraid that is the harsh reality for much of the world fighting cancer. Suffer or suicide.

This is interesting: http://www.bbc.co.uk/news/health-42871641

Although I disagree with the premise as the farmers of Afghanistan, Mexico and elsewhere seem more than willing to grow larger amounts of opium which should be able to satisfy both medical and recreational needs. However, the "drug war" once again adversely effects people outside of first world countries as these drugs are a godsend to people suffering great pain.
 

william webster

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Jan 16, 2009
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Rubio -
we have heard that before here....
sad but true

and worse, in some cases, the right choice
- just one step past the DNR clause in your will.
which I have, my mother had.....
 

AlterEgo

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They are also financially out of reach of most people. When my girlfriend hesitated on the price, they discreetly and politely offered an alternative of euthanasia which was more economical at a fraction of the price of a single shot of morphine. I'm afraid that is the harsh reality for much of the world fighting cancer. Suffer or suicide.

This is interesting: http://www.bbc.co.uk/news/health-42871641

Although I disagree with the premise as the farmers of Afghanistan, Mexico and elsewhere seem more than willing to grow larger amounts of opium which should be able to satisfy both medical and recreational needs. However, the "drug war" once again adversely effects people outside of first world countries as these drugs are a godsend to people suffering great pain.

Matilda writes about the “shot” given to terminal patients in her book. I was blissfully unaware that this happens with some regularity in DR. 
 

william webster

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Many places in the world seek to legalize it....
not that odd really.

I'm sure we all know people who have declined treatment.... I do...
 

AlterEgo

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Many places in the world seek to legalize it....
not that odd really.

I'm sure we all know people who have declined treatment.... I do...



Of course. But declining treatment and assisted suicide, assuming the patient even knows about the shot, are worlds apart. At least in my opinion 
 

william webster

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Decline treatment, and have a DNR clause....it adds up.

To some - there comes a time....

I can tell you that my mother died quickly with a DNR and in a socialized medicine environment.

I suspect there may have been 'help' and see nothing wrong in it.

You're right... personal choices
 

dv8

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Sep 27, 2006
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about a week ago i read in la zeta about a new agency of home care in DR. they employ nurses to take care of the elderly, sick and post-op patients.
http://www.angelesamigosrd.com/
they are likely to have professional contacts to assure adequate pain management, as much as it can be done in DR.
 

cobraboy

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Jul 24, 2004
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Decline treatment, and have a DNR clause....it adds up.

To some - there comes a time....

I can tell you that my mother died quickly with a DNR and in a socialized medicine environment.

I suspect there may have been 'help' and see nothing wrong in it.

You're right... personal choices
Having been involved in the HIV/AIDS community in FL in a major capacity, I can assure you that suicide---with a little help from your friends---was a major "therapy" back when HIV diagnosis was a death sentence. Our mixing pharmacies were allowed a minimal amount of morphine and opioid derivatives to be purchased, and each of those purchases was closely monitored, inventoried and audited by the pharmacy boards. The paper trail and chain-of-possession were intense, and if you screwed up even one vial your purchase of *any* pharmaceutical could be shut off immediately, and your pharmacy red tagged.

I went through that process well over a thousand times.

But to the OP's question: home care and hospice in the US sense does not exist in the DR because of cost constraints. And there is not enough wealthy population to support private efforts on any scale of efficiencies.

Morphine is available but difficult to come by for the average person. You have to work through a sympathetic doctor with connections. And then the quantities would be small, not enough for long-term pain management.

DV8 was in the pharmacy bidniz. Perhaps she could offer her opinions.

When we first started MotoCaribe and needed an extensive first aid kit, it was like pulling teeth to get any analgesics for bad road accidents. We ultimately prevailed, but it took lobbying by connected docs to the Minister of Health to get it done, and my personal medical background indeed helped. That was in 2008. That said, renewals have been a little easier. A little.

I like the "one-shot" solution. Frankly, if you've ever seen pain management for terminal illnesses, the patient is pretty much out of it anyway. A nudge over the line would go unnoticed and unfelt. I can't tell you how relieved relatives, friends and significant others are when the "out of it" stage was reached because all the good-byes had already been made.

It sounds crazy, but back then AIDS patients would have suicide parties. Well, they weren't called that. They were called "celebrations." When a patient was ready to give up the fight and the inevitable was in sight, friends and families would gather---sometimes nurses would be "unofficially" present---a warm evening would ensue, life's celebration reviewed, and the patient would retreat to his bedroom with experienced friends for leaving the earth. It wasn't until the residence was cleared of ALL drugs and people (except the s.o.) that the nurse would report for "Hospice duty*" and 911 was called without blaring sirens.

*I say "Hospice duty" because at the time in FL the only people who could pronounce death were physicians, certain EMT's and Hospice nurses. So we had nurses that worked for both our home health agency/infusion pharmacy and our hospice. The same nurse could do both infusion and hospice. If she was acting as a home health nurse a call to 911 requires blaring sirens and "heroic efforts" even if she knew the patient was dead. If she was a hospice nurse, the ambulance would arrive without sirens wailing. That's what the patients wanted.
 

AlterEgo

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I talked about to my husband about this. He hemmed and hawed a bit about putting someone out of misery. I asked could he do it to his mother and he thought maybe. Then I reminded him that when we had to put our beloved dog down, he couldn’t even come to the vet. The kids came with me and then they bailed at the last moment and stayed outside crying. I went in alone. He remembered, and realized he couldn’t ever do it to a human being.  He laughed when I told him not to give me the shot....unless I ask for it. :)
 

william webster

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My story went this way....

My mother fell down the cellar stairs and banged her head pretty well...
The ambulance boys at the time warned me on the phone ( I was in PHL) the situation was 'dire'.

Then the hospital came and you need to define what you mean by the DNR clause --
Food? -- only if eaten by herself, not fed
Water -- certainly
Pain ?? -- no pain
The list got long.
And you need to be appointed to make those decisions - a bit of forward planning needed

Anyway I came from PHL - in the middle of a move - lease over and a relocation...

She had become alert before my arrival so I had hope.
Doctors said they bounce up like a cork first before taking one last dive...

I sat with her daily for days - not responsive at all.
Trust me - that wears on you.

Finally, I said to the nurses...
Look , this is tough enough watching her but I have a moving van pulling up in 3 days... I have to go.

Yes, you do Mr Webster...
leave it to us - this is what wedo , why we're here.

I went to PHL- about 1 1/2 to 2 days later they called....
Gone

Seemed convenient to me - for all concerned -
Her , me , the system...

Logistically, I had it all done...
Cremation, funeral parlor, body pickup.... all prearranged.

That too is a big relief - not having to do all that 'at the time'

My mother was big on that stuff-
No newspaper, announcements, nothing....

Gone is gone she said...

It was her request... I just followed it