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  • Writer's picturePre-Collegiate Global Health Review

Palliative Care in Low-and-Middle-Income Countries

By Ahmad Haroon, Bahrain Middle High School, Juffair, Manama, Bahrain


Abstract

The idea of palliative care is to provide a global solution to a global health issue—terminal illnesses. Palliative care comes in several forms, each with its own type of patient and comfortability. The care provided within palliative care can also vary from illness to illness, such as in terminal cancer patients versus non-cancer patients. Even though there are many benefits that palliative care has to offer, it has not been distributed evenly throughout the world. There is a disparity in palliative care in low-and-middle-income countries (LMIC) as opposed to high-income countries. This is primarily due to the lack of access to analgesics, their cost, and societal ignorance of palliative care in LMIC. One way to alleviate this issue is through the education of palliative care in LMIC, which will lead to better palliative care services in LMIC.

 

Palliative Care

Palliative care can best be understood through the words author Ann Robertson declared in her book, Life in Hospice: Reflections on caring for the dying, “We cannot change the outcome, but we can affect the journey” (Robertson, 2017). The World Health Organization (WHO) offers a more precise definition of palliative care as specialized medical care for those who are suffering from serious illnesses, in which the goal is not to cure the illness but to improve the quality of life as patients navigate their terminal illness, allowing them to be more comfortable towards the end of their life (WHO, 2020). Thus, care is provided based on the patient’s necessities, not diagnosis. Palliative care is not only for the patients, as the patient’s family is also taken into consideration.


Although palliative care has one ultimate goal, it can still be categorized based on the location of care. Under this umbrella, one type of palliative care is hospital care. This is often provided when short-term care is required and varies in terms of team size from case to case. However, patients who require palliative care for longer periods of time are transferred to other locations. Palliative care at a care home is offered to those already in a care home setting. This is due to the convenience for the patient to remain in a similar environment. Care homes are also viewed as being more “comfortable” compared to hospitals. Palliative care can also be received at one’s home. This yields similar advantages to care homes with the difference being the patient’s preference of receiving care at their own home. In this case, a team of specialists would move into the house (Cancer, 2022).


Palliative care is provided to those facing terminal illnesses, but care does differ for different types of terminal illnesses. The most efficient comparison would be between palliative care for cancer patients and that for patients with End-Stage Renal Disease (ESRD), cardiopulmonary failure, and frailty. According to the scientific journal articles published by Kieran Quinn and Melissa Wachterman, cancer patients had palliative care initiated at an earlier stage when they were more functional. Furthermore, cancer patients were more likely to receive palliative care in multiple care settings and through specialists. However, for terminal non-cancer patients, they were often hospitalized when referred for palliative care and thus receive hospital care. As a result of care delivered at a time of higher functioning and by specialists, patients’ families reported better care for those with cancer than those with ESRD, cardiopulmonary failure, and frailty (Quinn, 2021; Wachterman, 2022).


Although palliative care can be beneficial for those facing a terminal illness, LMICs suffer from an inadequate supply of palliative care, which leaves a high demand unsatisfied and results in health disparity. According to the WHO, 78% of those who require palliative care currently live in LMICs, highlighting the demographic of the majority of people who require palliative care (WHO, 2022). More specifically for pediatric patients, according to Hatoko Sasako’s scientific journal article, 98% of children who require palliative care currently live in LMICs (Sasako, 2017). However, the WHO reports that less than 14% actually receive necessary palliative care, leaving millions without the deserved care that should have been accessible (WHO, 2022).


The lack of palliative care in LMICs is owed to a variety of factors. Arjun Poudel, in her scientific journal article, “Access to palliative care: discrepancy among low-income and high-income countries”, highlights these factors. The most significant factor is the disproportionate distribution of narcotic analgesics, which are pain medications integral in end-of-life care. LMICs receive less than one percent of the necessary pain medications. The lack of distribution renders LMIC unable to provide palliative care. This inequality in distribution is best highlighted by the comparison between the United States and Haiti. The United States receives up to 31 times more pain medications than they require, whereas Haiti receives only one percent of needed analgesics. This issue leads to the lack of palliative care treatment in Haiti, which is dependent on pain medications. Furthermore, the cost of a palliative care facility is expensive, requiring large funds in order to be properly set up. However, LMICs often do not prioritize palliative care but focus on other issues instead. Thus, governments in LMICs do not provide sufficient funding for palliative care. Lastly, social stereotypes in LMICs strongly oppose palliative care. These stereotypes are based on belief systems that have certain views on how terminal illnesses should be treated and the appropriateness of end-of-life care. One such stereotype is illustrated through the belief that palliative care is simply “giving up on life” rather than fighting for a cure (Shen, 2019). This alienates the idea of palliative care in LMICs and limits the people in need from receiving it (Poudel, 2019).


The lack of palliative care in LMICs is an issue that needs to be addressed. Wendy Li, in her 2021 scientific journal article, “Palliative care education and its effectiveness: a systematic review”, offers an effective solution. Through her research, palliative care education (PCE) emerged as a viable option to tackle the lack of palliative care in LMICs. By educating people in LMIC on the importance of palliative care, there will be increased knowledge which can also be expanded publicly, maximizing efficiency in spreading the necessary awareness about palliative care (Li, 2021). Furthermore, it could lead to more positive attitudes towards palliative care, combating existing social stereotypes.

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