Five years of BELhospice       Exactly five years ago on the 20th May 2004 a group of enthusiasts from Belgrade founded a Center for palliative care and palliative medicine known as "BELhospice". It was the first charity organization in Serbia that is specifically dedicated to the care of terminal cancer. The BELhospice founders are mostly doctors of different specialties, but also nurses, psychologists, priests and economists. There were many reasons that led to establishment of BELhospice: At the time, Serbia was one of the few  countries in Europe without any specialist palliative care service (there were only two pain clinics in the country) Treatment of patients with a terminal illness in Serbia was disease-orientated rather than patient-orientated and did not follow the holistic concept of palliative care as defined by WHO There was no education about palliative care (neither undergraduate nor postgraduate) There were many misconceptions among professionals and the public regarding pain and the relief of symptoms IR oral morphine was not available in the country The suffering of the patient’s family was not taken into consideration and their additional and specific needs were not recognized The population in Serbia is aging as elsewhere (16.4 % >65 years old) with increasing morbidity in malignant diseases Our goal was to: Provide good quality palliative care for the patients and their families Organize education for health care professionals and non-professionals involved in caring for terminally ill cancer patients and the other patients and families who need palliative care Contribute to better availability of opioids and make them more easily accessible for all patients in severe pain Promote the idea and the philosophy of hospice/palliative care in the country Put pressure on the decision-makers to recognize palliative care and to develop a comprehensive and integrated program of palliative care for Serbia   The scope of our work: Palliative care for the patients and the families: Since being founded in 2004, each year has brought an increase in patient referrals to BELhospice. Presently, BELhospice is able to provide specialist palliative care for 200-300 patients per year both in their homes or hospitals. BELhospice has contracts with two hospitals in Belgrade (Clinical center of Serbia and Medical center “Bezanijska kosa”) to operate as a hospital-based palliative care team and to extend this service for their discharged patients Education for health care professionals and non-professionals: In order to be able to run palliative care education, our members had to undergo specific additional education. They attended many courses and clinical placements abroad, mostly in England but also in Poland, Romania, Hungary, Italy and France. At the moment, BELhospice is running a one-year education programme for the nurses with UK Consultant Training Palliative Nurse, Ms Terry Magee. One of our doctors has a Diploma in Palliative Medicine (Cardiff University, UK) and attended the Training for Teachers in Palliative Medicine (Palliative Care Institute, Liverpool, UK) Considering the importance of education and the fact that a service, even highly specialised, was not seen as necessary for the country, our priority was to establish the Palliative Care School from the very beginning. The first, basic course was organized soon after the founding of BELhospice in October 2004. Since then more than 120 health professionals have attended courses. Our basic course lasts for five days (40 hours) and it is suitable for a range of professions. Groups are limited up to 20—25 participants. Covered topics: Philosophy and history of hospice/palliative care Organization of services Communication skills including breaking bad news Team work Symptom control for most common symptoms Psychosocial issues Spiritual needs Ethical principles and issues  The advanced course lasts for five days (36 hours). Some topics are similar to those covered by the basic course but are addressed in more detail according to the specialists and professions of those attending. This advanced course also cover symptoms not covered by the basic course. There are several workshops regarding communication, symptom control, psychological and ethical issues. Lectures supported by power point presentations are usual, as well as role-plays and DVD presentations. Lecturers during some of our courses were palliative medicine consultants and specialist palliative care nurses from England. The BELhospice Alumni club involving participants who have undertaken our education was established from the very beginning and our meetings contribute to further education in the field. Bed-side education for the professionals who refer patients to BELhospice (Clinical Center of Serbia, Medical Centre”Bezanijska kosa”, district health care centers) contribute to the overall knowledge regarding palliative care, mostly about symptom control. TEMPUS “Pain and Palliative Medicine” is a two year (2008-2009) joint project of universities from Italy, France, Croatia and Serbia: one BELhospice doctor is involved as a teacher (14 presentations on different topics) and the one as a student. Numerous lectures and presentations were given during scientific national and international meetings for doctors, nurses and psychologists on various topics addressing palliative care in a holistic approach (mostly on symptom control but on communication skills, ethical issues, organization of services etc). BELhospice translated Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organisation of palliative care. This project was funded by Serbian Ministry of Health. The “European Conference on Palliative Care” was organized in Belgrade, October 2005. The conference was attended by 257 participants from 30 European countries. Four members of the organizing committee were from BELhospice and one from a scientific committee. One lecture was given by BELhospice's doctor and was entitled “Where we want to go?”. The subject of this presentation was the action plan produced during the year 2005 by the National Palliative Care Task Force (4 members out of 15 were from BELhospice). Palliative cancer care guidelines were issued (two BELhospice members out of four from working group which produced the guidelines). Our members have written several chapters for different books:            - Pharmacotherapy of cancer pain (three chapters)            - Palliative treatment for patient with lung cancer (one               chapter)            - Pharmacotherapy guidelines (chapter on citotoxic drugs               and on palliative cancer care)   Better opioid availability and accessibility Continuous communication with the Ministry of health, House of Health insurance and drug companies to register IR morphine, improve opioid availability and accessibility. Opioid accessibility is still a huge issue in the country.   Promotion of the idea and the philosophy of hospice/palliative care in the country There have been World Hospice Day celebrations in Serbia since 2005. Several presentations for public on hospice/palliative care philosophy and the movement in the world, morphine as a drug of choice for chronic cancer pain, ethical issues at the end of life Numerous interviews for different media groups on this topic BELhospice website has much information about hospice/palliative care, and advice for patients and their relatives BELhospice newsletter Leaflets for the patients   Pressure on decision-makers to recognize palliative care and to develop a comprehensive and integrated program of PC in Serbia: policy improvement Several BELhospice members are also members of the National Palliative Care Task Force which formulated the National Palliative Care Strategy Cooperation with WHO country office, different European and worldwide associations dealing with hospice/palliative care and European Commission with the aim of improving the National Palliative Care Strategy and to make it possible to implement it according to the action plan Good cooperation with different national institutions and associations ready to support palliative care development in Serbia  Although some of the professionals, policy makers and members of the public still do not understand the difference between general medical and nursing care on the one side and specialist palliative care for the patients on the other side, the general knowledge in this field is much better than five years ago as a result of the education courses and awareness campaigns run by BELhospice. Further improvement in this field presents a huge challenge for us as a pioneering palliative care service in the country. BELhospice probably could manage more, but, pioneering work in this field is a lonely and hard task. Having in mind our and worldwide hospice/palliative care philosophy that all services for the patients and families are free of charge we rely only on donations and project funding (national and international). For that reason, despite the fact that our work is strongly supported by the UK charity, Hospices of Hope, we are not able to employ more staff. Nevertheless, our contribution to the development of palliative care in Serbia is considerably more than the size of our organization. nbsp; Dr Natasa Milicevic, Director BELhospice, June 2009 Download this report in .pdf

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