BUILDING CAPACITY TO FIGHT HIV/AIDS IN EURASIA

Slovakia/Scranton partnership. “She was one social worker, a priest, and 11 lay TRNAVA PARTNERS BRING dying amidst very poor conditions, alone, volunteers—visited hospice programs in afraid, and in considerable pain. Touched the Czech Republic and began building HOSPICE CARE TO by this woman’s situation, I promised her a fledgling network of care-providers that I would do everything I could to make dedicated to expanding hospice care in WESTERN SLOVAKIA sure that other terminally ill patients would both countries. They also took part in By Kathryn Utan not have to suffer through their last days targeted training seminars to learn in the cold, clinical setting of a hospital more about pain management, end-of- For a compassionate healthcare ward. And, from that day, it became my life care, the multidisciplinary approach provider, being forced to watch a pa- mission—and the mission of several dedi- to care, and patient and family counsel- tient suffer a long, lonely, and agonizing cated colleagues—to make good on that ing. Because nurses play such a key death from an incurable disease is a bit- promise.” role on the palliative care team, particu- ter pill to swallow. This is especially true lar attention was paid to their training among those who know that there is a At that time, Slovakia had no compre- and hands-on preparation. kinder, gentler way for people to make hensive palliative care policy for termi- it through their final days, but find their nally ill patients and no actual hospice “We faced many obstacles as we hands tied by legislative policies, insuffi- programs in place, although there were worked to get this project off the ground, cient funding, or lack of political will to a number of home-based services that not the least of which were obtaining the implement change. provided end-of-life care and support, necessary financing and raising aware- notes Patricia Dobrikova-Porubcanova, ness among the medical community and In many parts of the world, those facing a clinical psychologist, social worker, the public at large about what the hos- the end of their lives have little choice and assistant professor at Trnava Univer- pice concept actually entails,” Doczeova, but to suffer through their final days sity who collaborated with Krcmery and who is an associate professor at Trnava alone in a hospital bed rather than in a internist Andrea Doczeova on the hos- University where she also serves as assis- comfortable environment surrounded by pice project. tant dean of international affairs, ac- loved ones. In many countries, the con- knowledges. Both remain ongoing chal- cepts of palliative care and hospice are Eleven months from the day of that lenges for the team as does continuing virtually in their infancy. Such is the case promise made to the dying woman, the education and training. in Slovakia, where the term “hospice” three colleagues presided over the first appeared in legislative documents in opening of a 10-bed hospice unit at “Soon after the hospice unit opened its April 2000 and standards for the provi- Trnava University Hospital. During those doors, we arranged for our nurses to sion of palliative care followed suit more months, a team of Slovakian care- undergo additional practical training at than two years later in August 2002. providers that included specialists in on- several Czech hospices and conducted cology, geriatrics, and other fields trav- information sessions for hospital depart- In the historic Slovakian city of Trnava, eled to Scranton, Pennsylvania, where ment heads to explain the palliative care not far from the nation’s capital of their partners at the University of Scran- philosophy, teach them how to determine Bratislava, a handful of practitioners at ton helped procure start-up financing which patients are suitable for placement Trnava University Hospital refused to sit for the venture through by and quietly accept the suffering of the Edward R. Leahy, Jr. their fellow man. Instead of waiting for Center for Faculty Re- a far-off future when things might get search and also ar- better, they decided to make “some ranged a day” now by opening one of the coun- series of exchanges try’s first hospices in December 2003. designed to introduce participants to various “It was a personal experience with a pa- palliative care models tient in January 2003 that inspired me to being employed at local implement a hospice program at our Hos- hospitals, long-term care pital,” explains infectious disease special- centers, and hospices. ist Vladimir Krcmery, dean of Trnava Back in Trnava, the University School of Nursing and Social team—which includes Care’s Public Health Department, and three physicians, eight member of AIHA’s now-graduated nurses, one psychologist, Photo: Andrea Doczeova. Members of Trnava University Hospital’s hospice team meet before their shift.

C OMMONH EALTH • WINTER 2004 in the hospice unit, and introduce them creditation as a teaching facility, Doczeo- ations they will ever face is very fulfilling to our procedures for admitting patients,” va explains. “Our hospice is perhaps the and, at the same time, very tragic,” ex- Dobrikova-Porubcanova says. “Since the best working model of a multidisciplinary plains Dobrikova-Porubcanova. facility opened, we’ve had more than team approach to palliative care that ex- 100 patients and the feedback we’ve re- ists in Slovakia today and we are using Her colleagues both nod in agreement ceived from clients and family members our strengths to teach a new generation before Krcmery concludes, “We’ve made alike has been very positive,” she contin- of care providers,” she points out. considerable progress with the hospice ues, noting that the occupancy rate con- movement in Trnava, but we still have a sistently exceeds 80 percent. “We gener- Doczeova, Dobrikova-Porubcanova, and lot of work to do to ensure this philoso- ally have a waiting list most of the time Krcmery all admit that working with ter- phy spreads to Bratislava and other cities and plan to start home care services in minally ill patients is demanding and throughout Slovakia. Some religious the near future to better meet the needs emotionally draining, but they remain groups have been involved in smaller of the community.” dedicated to the promise of helping projects, but doing everything we can to these patients and their families find make dying with as much dignity and To that end, the hospice unit also serves peace. “It may sound strange, but, for comfort as possible is not solely the re- as a practical training site for social me, the most rewarding aspect of this sponsibility of the church or a small work, psychology, and public health stu- work is also the most challenging. Help- group of clinicians. Making this a basic dents at Trnava University and the team is ing people work through what has to be human right is the responsibility of all in the process of applying for national ac- one of the most difficult and painful situ- civilized societies.”

C OMMONH EALTH • WINTER 2004