Panel: Pandemic intensified need for palliative care in Latin America

In a virtual discussion on Tuesday, health care professionals from across the region advocated for increased resources to offer pain relief in response to the COVID-19 pandemic.

Palliative care advocates from a host of Latin American countries participating in a webinar on Tuesday co-hosted by the University of Miami Institute for Advanced Study of the Americas asserted that pain-alleviating medicines and care are more critical than ever as the pandemic continues. 

Felicia Knaul, director of the institute and an economist and public health expert, opened the “Closing the Access Gap to Palliative Care and Pain Relief: An Imperative for Universal Health Care” virtual session by sharing her experience of administrating palliative care and offering a presentation that highlighted the results and recommendations from a Lancet Commission report. Jorge Saavedra, executive director of the University’s AHF Global Public Health Institute, moderated the  conversation.

The International Association of Providers of AIDS Care, the International Association for Hospice and Palliative Care, and Tómatelo a Pecho were also co-hosts of the webinar. 

 “One of the key things we’ve learned from these conferences that explore the unfolding story of COVID-19 is that civic health organizations have to be at the forefront, speaking with one strong unified voice, sharing their evidence, and advocating on behalf of patients and their families for a radical change in access to palliative care,” Knaul said. “This is not the time to reduce spending—just the opposite. Now’s the time to invest more,’’ she added. “Denying access to these medicines that help control pain and reduce suffering does not reduce the crisis, it creates an even greater crisis for patients and for health systems,” she continued.

The Lancet Report on Global Access to Palliative Care and Pain Relief assessed the use of palliative medicines for 72 countries worldwide for the period 1990-2017, culling data from the Distributed Opioid Morphine-Equivalent and Serious Health-Related Suffering databases. An updated report charting data from the pandemic period is forthcoming.

Knaul noted that the 35 health commissioners who generated the report marked the contrasts in access to palliative care and provision of medicines between low-, middle-, and high-income countries.

“While we have seen improvement over time in nearly every region of the world, access remains very, very low compared with the need for this kind of care in all low-income and middle-income countries,” said Knaul, citing that in the latter only 4 to 5 percent of the demand for palliative care is being met.  

She noted that the price of palliative medicines varies and that the commission maintains that much could be accomplished with the cheaper or more basic medicines, yet no one is producing them because there is no incentive to do so.

“We’re hopeful that the less-developed countries can introduce innovative ways to help guarantee the demand for these because palliative care is a human right,” Knaul pointed out. 

A panel of professionals from Latin America that included Liliana De Lima, Colombia; Silvia Allende, Mexico; Nisla Camaño Reyes, Panama; and Paola Ruiz, Colombia presented the experiences of their respective countries and recommendations for expanding care and medicines in the wake of the devastating COVID-19 pandemic. 

“We’ve learned that palliative medicines are every bit as critical as the mechanical ventilators, intravenous therapies, antipyretics, and antihistamines, and we recognize the extraordinary dedication and compassionate care that palliative care workers have provided every day of this pandemic in each and every interaction with patients, their families, co-workers from other disciplines, and in the community,” Allende said.

Reyes emphasized the importance of collaboration between health care professionals. “We must not cease in our role to continue to advocate for what we believe to be our patients’ right—which is to receive palliative care,” she said.  

Ruiz echoed the need for continued collaboration that would help to raise awareness for the value of palliative care and called for better planning. “Resources are never infinite,” she said, “so the money issue in terms of this pandemic, or in medicine in general, will only be resolved by better planning and emphasizing the needs of our patients.”

“We have to reinvent ourselves and think outside the box,” urged De Lima. “Whatever national policy or response is enacted must take into consideration the people who are working with the patients—so the time of the government working apart and adopting policy is over.” 

Saavedra and Knaul both faulted governments that overly stigmatize morphine and other pain-relieving medicines that can become addictive. And because of this concern, they fail to fund training and education for doctors, nurses, and health care professionals on how to properly administer these critical medicines.  

Knaul recognized Dr. Hansel Tookes, University of Miami alumnus and assistant professor of medicine, for his novel needle exchange program and research that has served as a model for Florida and elsewhere to unravel biases relating to substance abuse.

Written by Michael R. Malone, News@TheU

Published on January 13, 2021