Palliative care in developing countries

I have a dog called Nino back in the Dominican Republic. He just turned 10 years old, which means that in my most defining moments and moving back and forth from the DR, Nino was always there. For a chihuahua’s life span, he’s reaching his last stage of life. Sadly, we recently learned that he has a chronic heart failure and the Vet said that there is nothing he can do. Nino can no longer opt for a curative care option. Now we can only try to improve his quality of life and ease his pain. Here’s a picture of Nino while he was at the clinic:


My goal is not to compare dogs and humans; however, this unfortunate situation got me thinking even more about one of my preferred areas of study in healthcare: end-of-life care.

The population is going through a demographic transition. People are living longer in most countries. At the same time, fertility rates are generally falling. This is especially important in low and middle income countries where health systems lack the infrastructure to cope with the population shift. Also, these countries are going through an epidemiological transition as mortality rates are declining for communicable diseases, and increasing for chronic conditions. The WHO estimates that by 2020, noncommunicable diseases are expected to account for 70% of deaths in the developing regions.

Palliative care offers pain and symptom management during an advanced illness. The WHO defines it as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

It is urgent that developing countries find the right model for the management of aging populations and the growing burden of cancer and other noncommunicable diseases. What strikes me the most is that palliative care is not recognized in many government plans, therefore it is not part of the essential services offered by many public health systems. For example, many countries in Latin America including the Dominican Republic lack a national program/plan for palliative care; although, some countries like Costa Rica and Panama have made important advances.

In particular, there is a substantial opportunity for improvement for palliative care in the Dominican Republic. The Economist Intelligence Unit recently categorized the country as the fifth worst place to die (#75 out of 80 countries) and the worst to die in the Americas region, as reported by their “Quality of Death Index,” a measure of the quality of palliative care.

Palliative care is a crucial part of a comprehensive health care system, and governments need to allocate resources, develop national policies, train public health workers, and raise awareness to improve access to these services. Developing countries, in particular, need to act fast to meet future needs given the demographic and epidemiological transition.

Also, Nino seems to be getting better, but the reality is that he has a few days left. However, he’s receiving the best attention at home. Both humans and pets deserve to have a happy ending!




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