Palliative care improves the quality of life of the patients and their loved ones, who are facing serious illness. Doctors working in the field of palliative care in South Africa have formed a new association.
World wide there is growing recognition for this field of medicine, where in many places it is now recognised as as a (sub)speciality. It is valuable when offered offered alongside usual treatments for patients with cancer, major organ-failure and neurodegenerative diseases.
Who is Palprac?
Palprac, the Association of Palliative Care Practitioners, was first established in May 2017 and we had our first successful AGM in June 2018. To date we are 70 member strong, all doctors from various disciplines with an additional diploma or MPhil qualification in palliative medicine.
Above all however, most have a real passion for the field. I realized that my passion might border on zealousness when I asked my middle child to heat up a hot water bottle for his younger brother who had a sore tummy. “I will take the hot water bottle and Molly (our poodle) to snuggle with him. That will be a total care package,” he said with earnest. And so for my sins, I am a founding member and current secretary of Palprac.
What does Palprac do?
Palprac was borne from a need for peer-support for doctors practising in this field, many working in isolation. Peer advice is available on the management of difficult-to-treat symptoms. It has also been very valuable to have a space to sound board complex ethical questions. Medicine is lumped under the sciences, and many hope for exact answers. Often though, it is more of an art with a whole lot of philosophy and ethics thrown into the mix. Being able to discuss these situations with colleagues, where the underlying principle of patient-centredness underpins everyone’s practice, has been a great resource.
Palprac also sees itself playing a role in improving access to quality palliative care. In South Africa palliative care has been offered by the non-governmental sector, specifically hospices since the 80’s. It has only recently, and only in small pockets, been included in the formal (state) medical sector. 2017 saw the approval of the South African National Policy Framework and Strategy for Palliative Care by the National Health Council. This will hopefully create the necessary impetus to unlocking the necessary funding, political (business) will and ethical awareness for developing these valuable services.
Palprac collaborates to improve access to palliative care
One such project has been the collaboration of Palprac with Alignd, a new managed care organization in the making, www.alignd.co.za. Currently your palliative care benefit will probably be limited to 2 weeks of hospice/nursing care at the end of life. This new benefit however, will allow for a palliative care team to walk the journey with with you from early on, while facing a cancer that is unlikely to be cured. What the journey looks and feels like is the focus of the palliative care team, while the oncologists focus on managing the disease.
Care will be available in a coordinated fashion when needed. Support will be provided in managing physical symptoms, complex (albeit normal) emotions, informational and decision-making needs and existential issues. Importantly this type of care does not need to happen in a hospital. In fact, if appropriate and this is your wish, most care will be offered as an out-patient. In other words, either in an medical office or at a patient’s home.
The benefit will also be novel in that is will be paid for through a “value-based contracting” mechanism, as opposed to the usual “fee-for-service” way. For many reasons the fee-for-service model complicates offering the kind of service that is required. One of those complications that will be avoided, is the out-of-pocket expense that people have to bear.
Finding a palliative care doctor
Palprac’s website, www.palprac.org, lists all the doctors with the appropriate qualifications offering palliative care services around South Africa that we know of. There might be more. We are still on the look-out.
In the words of Atul Gawande (yes, I know I quote him often), “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”