Palliative Care: A Future Challenge for the Cuban Health System

By Álvarez, Karen Valdés | The International Journal of Cuban Studies, Winter 2018 | Go to article overview

Palliative Care: A Future Challenge for the Cuban Health System


Álvarez, Karen Valdés, The International Journal of Cuban Studies


Introduction

It can be said that all sicknesses are essentially social. Sicknesses are always complex phenomena that function as subsystems, at the centre of which is the ill individual in permanent interaction with the environment, the society in which he or she lives, his or her family and the health personnel who assist them. In turn, each subsystem is part of another more comprehensive system, with a greater number of elements and variables that interact and modify it. With the new horizons revealed from the technological and scientific development achieved in recent years and applied to medical practice, it is becoming increasingly necessary for medical doctors and decision-makers of health policies to assume this conception in a conscientious way. Thus, the development of disciplines such as bioethics and palliative care has gained value in their role of humanising medical practice with a holistic and therefore comprehensive approach that reminds us somewhat of the primary practice of medicine.

The terms 'hospice' and 'hospital' come from the Latin word hospes, which means 'host' and the affectionate relationship between the host and his or her guest (Saunders 2004; Lutz 2011). The first hospices appeared at the end of the fourth century as places where Christian charity was exercised upon travellers from the Crusades. In the mid-nineteenth century, a process began to transform these centres of attention to pilgrims into health care centres, mainly dedicated to the care of people at the end of their life by religious congregations such as the Association of Women of Calvary and the Sisters of the Charity.

Institutions such as Calvary Hospital in New York, Our Lady's Hospice in Dublin and St Joseph's Hospice in London (Saunders 2004; Lutz 2011) emerged, but palliative care cannot be described as being an area of knowledge within medical practice until the 1960s.

At the end of the first half of the twentieth century, the nurse and social worker Cicely Saunders, guided by the pious feeling of helping the terminally ill, carried out medical studies and later deepened her knowledge in the care of dying people, as well as in the use of morphine for pain relief, through her experiences at both St Luke's Home for the Dying Poor and at St Joseph's Hospice in London. In 1967, she opened the St Christopher's Hospice in London, where she incorporated the home care of this type of patient and coined the term 'total pain' to refer to the multiple dimensions that may be affected when a patient expresses pain. The care provided in this centre by multidisciplinary teams was total, active, continuous and extended to the family. Its purpose was to improve the quality of life of the terminally ill. It is considered the first modern hospice and served as a model for the beginning and expansion of the so-called Hospice Movement. This phenomenon allowed the appearance of numerous similar centres in the UK, Europe and the US, which progressively added new care areas that included physiotherapy and psychosocial support.

In the early 1980s, American hospices were included in their Medicare health system, and criteria were created for the inclusion of patients within these programmes (criteria of the National Hospice Organisation). This marked the exit of palliative care from private organisations to public health systems. At the same time, the first units for the control of symptoms within general hospitals appeared. Also in this period, the term palliative care was first coined in Canada as the one that best described the philosophy established in the hospices, whose acceptation - hospices - were more focused on the material conditions of care (Lutz 2011).

Progressively, the development of palliative care has surpassed the limit of medicine and nursing. The link with disciplines such as sociology, psychology, anthropology, economics, philosophy and theology has allowed adopting theories such as system, complex thought and human needs as the bases of its current conceptual framework (Morin 1998; Max-Neef 2006; Maslow 2014). …

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