History of Palliative Care.pptx

About palliative care for terminal illnesses

1. History of Palliative/hospice care

2. Ancient history To understand palliative care, it begins with the story of hospice. ‘ Hospice’ comes from a Latin word  hospitium ,  meaning hospitality, and was used in the Middle Ages (500AD-1500AD) in Europe and Mediterranean regions to describe a place of rest for travellers and pilgrims. Hospices were run by religious orders, they were places that offered special hospitality and care to travellers who were far from home and to people who were ill or dying.

3. History of hospice and palliative care . For some time there were no hospices, but then they re-emerged in the 19 th  century in the UK and France particularly, again, run by religious orders to care for people who were terminally ill, but also provide accommodation for the incurable and destitute. These centers were for the most part run by community volunteers and civic organizations, and hardly interfaced with the health care structure.

4. Ethiopian history Ethiopians have a long history of caring for strangers and travellers. The sense of communal responsibility for the sick and dying is also deeply ingrained in the culture and tradition. Historians have documented how Ethiopians accepted and cared for both Christians and Muslims who were displaced during the various holy wars.

5. Modern palliative care movement The modern use of the term ‘hospice’ dates from 1967 with the opening of St Christopher’s Hospice, London, established by Dr Cicely Saunders (1918 – 2005 ). At that time there was a growing awareness that 20 th  century medical advances, while offering a cure for many illnesses, also resulted in the health system ignoring those people who could not be cured.

6. Cicely Saunders, originally a nurse, then a social worker (almoner), finally studied medicine to meet this challenge, the neglect of the suffering of those with life-threatening illnesses. Dr. Cicely Saunders first articulated her ideas about modern hospice care in the late 1950s based on the careful observation of dying patients .

7. Her work in building  St Christopher’s Hospice and her approach to pain and symptom management, recognizing the multi-dimensional nature of suffering and the need for emotional, psychological and spiritual support for both the terminally ill patient and their family was the foundation for modern hospice and palliative care practice.

8. Dame cicely saunders ‘You matter because you are you, and you matter to the last moment of your life.'- Cicely Saunders She said: "I once asked a man who knew he was dying what he needed above all in those who were caring for him. He said, 'For someone to look as if they are trying to understand me'. It is impossible to understand fully another person, but I never forgot that he did not ask for success but only that someone should care enough to try." 

9. Palliative care The term ‘palliative care’ was first used in 1975 by a Canadian surgeon, Balfour Mount . He had learned about hospice care from Cecily Saunders. Returning to French speaking Quebec, he needed to avoid the word ‘hospice’ because of the connotation it had with the destitute institutions in France. Mount developed a comprehensive hospital-based service at the Royal Victoria Hospital, Montreal that included an in-patient ward, consultation service, home care programme, and bereavement support service under the name Palliative Care service by which he meant non-curative therapy aimed at improving the quality of life.

10. What does ‘palliative’ mean? Palliative comes from the Latin word ‘to cloak or cover’

11. Ethiopian history T he modern hospice movement in Ethiopia started more as a response to the health system’s inadequacy to respond to the HIV/AIDS epidemic, than a desire to provide an alternative care setting. The first HIV positive sera were recognized in 1984 and the first two AIDS cases were reported in 1986. The disease spread rapidly with hospitals and clinics quickly filling up and overflowing.

12. The National and International response to HIV/AIDS in Ethiopia has helped strengthen the health care delivery system in general . Palliative care was incorporated into the care and support element of the response to the epidemic . However, the amount of resources dedicated to PC in HIV/AIDS care is erroneously inflated, as unrelated services such as opportunistic infection prophylaxis and pre and post-test counseling are reported as PC.

13. The training of personnel in PC is an integral part of the effort to expand services in Ethiopia. Two nurses were trained in PC at Hospice Africa, Uganda in 2006 . One of the trainees opened “Hospice Ethiopia”, a community based PC service providing valuable assistance for patients with advanced disease.