Ukraine needs public hospices and home palliative care

Every year more than 700,000 people die in Ukraine, including 500,000 in need of professional palliative care. According to the Ukrainian League for Palliative and Hospice Care Development, cancer alone claims some 260 lives every day. The state is unable to provide citizens with adequate painkillers, just as there is no social protection and public support. The League’s CEO, former Minister of Health, Vasyl Kniazevych, is convinced that a system of effective palliative care can be built in Ukraine within the next decade, but this will require joint effort on the part of the bureaucracy and the public: “Being part of the European palliative care system, we are studying the experience of various countries. Actually, this system isn’t that sophisticated; we must develop a network of hospices and palliative care wards at our hospitals and healthcare social centers, with special wards for WW II veterans, with an emphasis on home care.”

By WHO’s standards, Ukraine should provide patients who need palliative care with at least 4,600 hospital beds. Andrii Serdiuk, president of the National Academy of Medical Sciences of Ukraine, says there are some 800 hospital beds available: “That is a woefully small number, considering that 150,000 patients are hospitalized every year, and that considerably more are in need of this type of care.”

HOME CARE

A system of home palliative care could help solve this problem. This system cannot be built in Ukraine today for a number of reasons, including the unavailability of orally administered morphine, which is a narcotic drug and prohibited by law. In other words, Ukraine’s terminal patients can have injections of painkillers, but their numbers are strictly limited by law.

Says Vasyl Kniazevych: “The struggle against narcotic drugs in Ukraine is on a scale unmatched in the world. There are only two countries, Ukraine and Kyrgyzstan, which have no domestic morphine tablets. Opioid analgesics should be considered as drugs that must be available to everyone who really needs them. As it is, each such patient (or his/her relatives) can have three to five vials that last for one to three days; then they have to find ways to get more. What about patients in rural areas, where it is necessary to travel to a regional center to buy such painkillers?”

Experts explain that the struggle against narcotic drugs should be balanced by making such drugs available to terminal patients who need such painkillers.

Kniazevych believes that “it is necessary to establish this balance, to determine where and when people must be denied access to narcotic drugs [as addicts] and allowed access when they really need them [as painkillers, when afflicted by terminal diseases]. The Cabinet of Ministers is considering a draft resolution and, hopefully, will adopt it before the end of the month.”

Mary Callaway, Project Director, International Palliative Care Initiative, explains that the maintenance of a hospice as a separate institution is very expensive, so palliative care at home is actively developing in the world: “To make this a reality, the law should be changed. And when these drugs [tableted morphine. – Ed.] become available, patronage forms of assistance to such patients should be developed in Ukraine for the patients to receive all necessary medications, all necessary assistance at home. And to make it all work, we need to educate health professionals.” She stressed that public support is essential in making such painkillers available to the terminal patients. Ukrainian society should demand their availability as part of an effective palliative home care system; that this system is being implemented from “upstairs” to “downstairs,” and that to make this system work, one needs pressure from “downstairs.”

Mary Callaway says the Ukrainian government is prepared to collaborate with NGOs, that they really want to learn, but to do so, they need support from private foundations to help train government officials or Ukrainian physicians abroad. Foreign experts must visit Ukraine and share their experience. Palliative care must be made effective in every tuberculosis hospital, every AIDS center, every hospital of infectious diseases.

GOVERNMENT’S ROLE

The Ukrainian government promises to increase the number of hospices, but warns that this process will be gradual and time-consuming. Svitlana Ostashko, head of the Ministry of Health’s Department for Maternity, Childcare, and Resort Treatment, says the National Program to Combat Oncological Diseases has a separate clause concerning the expanding of the hospice network: “Thanks to the assistance on the part of the World Health Organization and the Ukrainian League for Palliative and Hospice Care Development, we have been able to work out an agenda of medical assistance for such patients. Of course, we would like to have everything done overnight. As it is, we will go step by step to develop the required system that will provide some 3,500 hospital beds and qualified personnel. This will also require an adequate legal framework that will provide for quality health care. Regrettably, we are short of funds today.” Ostashko adds that palliative care is a matter that relates not only to the Ministry of Health, but also to local authorities, NGOs, and volunteers.

P.S. The First National Congress of Palliative Care took place in Ukraine, not so long ago, attended by more than 350 Ukrainian and foreign experts in the field, and supported by the government.

Vasyl Kniazevych: “We adopted a resolution requesting that the president of Ukraine take special care of the matter. Hopefully, next October the Verkhovna Rada will pass the Ten-Year National Palliative Care Development Program bill.”