Are medicines for palliative care widely available?
Dr. Stoltenberg said that over the past decade the availability of the necessary pain relief medicines has increased in response to demands for improved access to these drugs. For example, in Jamaica and Belize, access has improved thanks to the Caribbean Association for Palliative Care. In Chile, there is reasonable access and the situation continues to improve in Colombia and Argentina.
Dr. Bonilla stressed that the need to divert medicines to COVID-19 patients has led to a shortage of palliative care drugs such as morphine for the treatment of pain and dyspnea, and benzodiazepines such as midazolam for palliative sedation.
The COVID-19 pandemic has put a spotlight on the exhaustion and stress experienced by healthcare workers. What is the situation of palliative care staff and what can be done about it?
Dr. Stoltenberg said that work-related and individual factors can cause burnout and stress. While we sometimes overstate the individual’s ability to be strong and to develop strategies for resilience, a better approach would be to focus on work-related aspects and consider how we can help palliative care providers feel more supported. There are several ways to do this, starting with expressing gratitude and appreciation. Recognizing that stress and burnout are very real helps caregivers express their feelings when they are exhausted. It is important that they have someone to talk to so that they can explore and share their feelings. It is also important to help them regain a sense of control over their schedules and learn how to adapt to their patients’ needs. It is important to help them see how they can feel in greater control of themselves, even in a pandemic.
Dr. Bonilla went on to say that there is a lot of fatigue, with multiple causes, including fear of infection, fear of dying, and the risk of staff members infecting their own families. At the start of the pandemic they were handicapped by the shortage of supplies, or felt powerless when excluded from decisions made solely by intensive care physicians. Staff also suffered from burnout because they were not able to work properly as teams. Many were negatively affected by seeing patients suffering and dying alone, separated from their loved ones. "Although we are not at the same point in the pandemic as we were a few months ago, all these factors lead to burnout, post-traumatic stress, and grief caused by everything that has occurred."
Dr. Stoltenberg highlighted an event during the first wave of the pandemic which exemplifies one positive aspect of the contribution made by palliative care: “In April last year, there was a nurse working in a special COVID-19 end-of-life unit. She witnessed the third or fourth patient die in twelve hours and telephoned the family to report that the patient had passed away. She spent twenty minutes talking, emphasizing how good the treatment had been, and the kindness and consideration shown to the patient. When she hung up, three of the nurses by the bed were crying, saying “We are exhausted, but hearing your affection and compassion for this family, on your third call tonight, you are inspiring us to carry on. So, thank you for that call and the way you spoke with the family."