Pediatric palliative care on the Pediatric palliative care on the

groundground

Examples of successful Examples of successful

programsprograms

DRA. RUT KIMANDRA. RUT KIMAN

Head CPC Team . Hospital Nacional “Prof. A. Posadas”. Head CPC Team . Hospital Nacional “Prof. A. Posadas”.

Buenos Aires- ArgentinaBuenos Aires- Argentina

Department of Pediatrícs. Faculty of Medicine. Department of Pediatrícs. Faculty of Medicine.

University of Buenos AiresUniversity of Buenos Aires

Pallium LatinoamericaPallium Latinoamerica

International Children ‘s Palliative Care NetworkInternational Children ‘s Palliative Care Network

Regional perspectiveRegional perspective

Brief report focus on some Brief report focus on some

countriescountries

Reaching out: programmes, Reaching out: programmes,

policies and partnershipspolicies and partnerships

During these ten minutes...

LATIN AMERICALATIN AMERICA

AreaArea : 21,069,501 km2

PopulationPopulation : 572,039,894

Countries Countries 19 DependenciesDependencies 1

LanguagesLanguages : - Spanish

- Portuguese

- French

- Quechua

- Mayan

- Guaraní

- Aymara

LATIN AMERICALATIN AMERICA

Poverty continues to be one of

the region's main challenges

According to the ECLAC, Latin

America is the most unequal

region in the world.

More than half of the poor

are children and adolescents

and more than half of the

children and adolescents are

poor.

Pediatric Palliative Care Provision Around the World: A Systematic Review & MappingPediatric Palliative Care Provision Around the World: A Systematic Review & Mapping Caprice Knapp, PhD, Lindsey Woodworth, BS, Rev. Michael Wright, PhD; Dr Julia Downing PhD

Models of care in LAModels of care in LALack of understanding about what children’s palliative care isLack of understanding about what children’s palliative care is

Few countries have health policies in support CPCFew countries have health policies in support CPC

Primarily on teams working in tertiary care facilities (Primarily on teams working in tertiary care facilities (Hospital based teams)Hospital based teams)

Limited experiences in home care or in primary care facilitiesLimited experiences in home care or in primary care facilities

Limited development of "Hospice” model (Limited development of "Hospice” model (Costa Rica, Guatemala, Brazil)Costa Rica, Guatemala, Brazil)

More experience in children living with cancer More experience in children living with cancer

Lack of relevant training for health care professionals Lack of relevant training for health care professionals (undergraduate, postgraduate and during (undergraduate, postgraduate and during

specialty training)specialty training)

Limited literature and materials in SpanishLimited literature and materials in Spanish

Services provided by pediatric subspecialists!!Services provided by pediatric subspecialists!!

Proactive advocacy efforts by NGOProactive advocacy efforts by NGO

Work/training without paymentWork/training without payment

Universal health coverage

CPC since 1990

Lack of National CPC policy but in 1992

legislation recognized right to die with

dignity and without pain.

Two Hospices: “Day centers”

In 1992 Fundación Pro Unidad de CP

was established

Home care

Grief support

Undergraduate training(medicine, nursing,

psychologists), postgraduate and masters

degree

Recognition of PC specialists

Since 1982 but CPC 1992 Mostly in tertiary facilities of Public health

care system Limited experience in home care or day

centers 11 Hospices for adults none for children 15 CPC teams Non- cancer models very developed Undergraduate training (medicine, nursing

schools), postgraduate and masters degree By pediatric subspecialists (more than 15.000

pediatricians) Partnership with international associations Lack of National CPC policy but in 2012

legislation recognized right to die with dignity. PC law in some provinces

National standards from 2001 2009 recognition of PC specialty in nurses NCI in 2011 In process of recognition of PC specialty for

physicians

Large public coverage Public health policy (GES 2003) Tertiary facilities mostly linked to children

with cancer but also in primary care facilities 1988 PINDA (PROGRAMA INFANTIL DE

DROGAS ANTINEOPLASICAS) started 2003 CPC in PINDA program: a multi-care PC

model continuum care Chronic diseases representing 34% of

hospital expenses 2008 Chilean Society of Pediatrics created a

multi-disciplinary committee in charge of organizing care of children with special needs (NANEAS)

Undergraduate training (medicine, nursing schools, psychologists), compulsory in postgraduate since 2000 (GAFOS-Spain)

Multi-professional CPC teams In process of recognition of PC specialty

Thank you Thank you very much very much for your for your

attention!!attention!!