domingo, 16 de outubro de 2016

Café Filosófico 1 - finitude e infinitude, com Ligia Py

“falar do envelhecimento, da finitude e da nossa vulnerabilidade é falar da construção da felicidade humana”, disse ligia py no café filosófico cpfl de sexta-feira, 07/10, sobre “finitude e infinitude” segundo ela, quando nos deparamos com esses temas reais, concretos, temos a oportunidade de criar um convívio entre nós muito mais proveitoso. de usufruir de felicidade de verdade. e de usufruir de solidariedade humana. “não é no consumismo vazio que vamos ter isso, nessa saciedade ilusória. vamos nos saciar se estivermos amando com profundidade e generosidade de entregar ao outro um legado.”
para ligia py, pensar na morte é pensar numa vida mais rica. “é pensar que não quero deixar uma marca de mediocridade, mas de riqueza de sentimentos para contribuir para as gerações futuras. nesse mundo que acena com esse vazio de prazeres imediatos, de gozos com fim nele mesmo, nós respondemos com uma proposta: queremos pensar que somos precários. que nós adoecemos. que ficamos dependentes do outro. que vamos morrer. que é preciso deixar um mundo melhor aos que ficam.”

do site http://www.institutocpfl.org.br

Como Uganda se tornou referência em Qualidade de Morte

morphine bottleCorante alimentar, água, conservante e um pouco de morfina em pó. Estes são os ingredientes para a receita de morfina líquida.
A dose mais leve, colorida de verde para indicar a força e garantir que as pessoas não possam confundí-la com água, custa cerca de US$ 2/garrafa. Doses mais fortes são tingidas de rosa e azul. Uma garrafa é a necessidade de uma semana para a maioria dos pacientes. Essas garrafas contendo solução de morfina mudaram a forma como as pessoas morrem em Uganda – e são uma das principais razões por que o país tem a melhor qualidade de morte entre os países de baixa renda, de acordo com o Quality of Death Index, publicado pela Economist Intelligence Unit.
FONTE: African Palliative Care Association

FONTE: African Palliative Care Association

Merriman, uma especialista em cuidados paliativos britânica que fundou o Hospice África em Uganda em 1993, ajudou a projetar a fórmula que têm usado há 22 anos. Na década de 1990, duas das maiores barreiras para a boa morte em Uganda eram: não haviam médicos em número suficiente e não havia morfina suficiente. O Hospice África Uganda desenvolveu educação profissional em cuidados paliativos que iria aprimorar a responsabilidade de enfermeiros, em vez de depender só dos médicos. Eles ajudaram a tornar obrigatório para estudantes de medicina em Uganda o estudo do manejo da dor – antes mesmo da Alemanha fazer isso. E o Hospice África Uganda fez a morfina líquida. “Eu tinha sido uma das médicas que tinha dito às pessoas: ‘Desculpe, não há mais que podemos fazer. Você tem que ir para casa”, diz Merriman. Ela adiciona: “Pacientes estavam morrendo em agonia.” Então, ela sentou-se com um par de farmacêuticos do Hospital Universitário Nacional e veio com uma fórmula para fazer um líquido de morfina em pó. Naquela época, os cuidados paliativos na África só existiam no Zimbábue e África do Sul, e os serviços, diz ela, eram “por brancos para brancos”. A medicação era proibitivamente cara para a maioria dos pacientes.
Hoje, três centros de cuidados paliativos da organização servem a cerca de 2.100 pacientes ambulatoriais. “Não é sempre que a dor é a sua maior preocupação”, diz ela. “É muitas vezes: O que vai acontecer com meus filhos quando eu morrer? Podem ser problemas espirituais, podem ser culturais. Coisas que eles têm para realizar antes de morrer. Nós tentamos ajudar com todos esses tipos de coisas. Aliviar a dor é um passo – e tem muitos benefícios. Pacientes comem melhor, dormem melhor e vivem uma vida de maior qualidade, mesmo em seus últimos dias”, diz Merriman.
O custo era um obstáculo para o manejo da dor. Outra, que persiste em muitos países, era um medo arraigado de analgésicos opióides. Embora a morfina seja considerada o padrão ouro em cuidados paliativos no tratamento da dor, em muitas partes do mundo o medo da dependência de opiáceos e do uso indevido é tão desenfreado que tem um nome: opiofobia. Merriman disse que as pessoas pensavam que ela estava fornecendo morfina para que os pacientes pudessem se matar. “E a morfina pode matar”, diz ela. Mas com os regulamentos no lugar certo, e a explicação correta para o paciente e seus familiares, ela diz, “é muito segura.”
Por mais de uma década, o governo de Uganda forneceu morfina livre para os pacientes de prescritores que são membros de um registro especial, todos treinados através Hospice África Uganda. Merriman afirma que dos 24.000 pacientes no total para os quais eles prescreveram morfina oral, “nós não tivemos nenhum vício, não houveram desvios. E os pacientes mantêm a garrafa em casa.” Em Uganda, ela teve que trabalhar duro para superar o medo de opióides. O Hospice África Uganda trabalhou com narcóticos da polícia, ensinando-lhes o que é a morfina e que é um medicamento legal. “Eles precisam entender que os pacientes podem tomar morfina e que eles não são viciados, que é entregue aos doentes após avaliação cuidadosa, e que é um medicamento seguro,” diz o Dr. Eddie Mwebesa, diretor clínico Hospice África Uganda. Sem a cooperação policial, diz ele, “haverá um monte de problemas com pacientes que tenham a sua morfina em casa” e em transportar a droga entre asilos ou casas de pacientes.


Merriman diz que os profissionais de saúde freqüentemente tem que avisar as pessoas sobre a morfina – não por causa do risco de vício, mas para explicar que isso não vai acabar com a sua doença. Ela diz que eles se sentem tão bem depois disso, que muitas vezes acham que já se curaram”, diz ela.
Mas ainda existem desafios. A organização estima que apenas 10% dos pacientes ugandenses que necessitam de cuidados paliativos podem acessá-lo. “O maior desafio que temos agora é o grande número de pacientes que necessitam de cuidados paliativos”, diz Mwebesa: 250.000 a 300.000. Ele diz que os cuidados paliativos podem custar cerca de US$ 25/semana para um paciente, e a maioria das pessoas não pode se permitir a gastar isso.” Apenas 2% dos ugandeses têm seguro de saúde, muitas famílias têm que pagar para cuidar de familiares doentes. Mesmo que Uganda esteja longe de ser perfeita, continua a ser, em muitos aspectos, um país modelo para seus vizinhos.

FONTE: BICHELL, R.E. How Uganda Came To Earn High Marks For Quality Of Death. January 3, 2016 / http://www.npr.org

do site http://www.ibes.med.br/

segunda-feira, 3 de outubro de 2016

Empathy


Bill - Palliative Care and Hospice Education and Training Act” (PCHETA). The legislation (H.R. 3119/S. 2748)

https://www.compassionandchoices.org/wp-content/uploads/2016/05/Legislative-Brief-S2748-HR3119-5.16.16-Approved-for-Public-Distribution-1.pdf


https://www.congress.gov/bill/114th-congress/house-bill/3119/text

H.R. 3119 is a bill in the United States Congress.
A bill must be passed by both the House and Senate in identical form and then be signed by the President to become law.
How to cite this information.

“H.R. 3119 — 114th Congress: Palliative Care and Hospice Education and Training Act.” www.GovTrack.us. 2015. October 3, 2016 <https://www.govtrack.us/congress/bills/114/hr3119>
show another citation format:   APA   Wikipedia Template 

The “luxury” of grieving in Zimbabwe

Author: Val Maasdorp, Island Hospice and Healthcare, Zimbabwe
02 September 2016

A Zimbabwean gentleman in his 70's whose wife had died of cancer came in reluctantly to see me at Island Hospice and Healthcare. His Pastor had insisted he come in for counselling.





While he assured me he was fine and had dealt with many bereavements in his life, I asked him about his losses and as he talked I drew up his family tree noting the deaths as he spoke.

An enormity of loss

Within minutes he was both intrigued and devastated to see the enormity of loss he had in fact encountered in his life from brothers in the Zimbabwe liberation war which ended in 1980, children in the HIV/AIDS pandemic, car accidents and other tragedies.
We ended up both sitting on the floor and he engaged thoroughly with the creation of his large multi-generational genogram giving a running commentary on relationships that had gone wrong, regrets with regard to missed opportunities with family and insufficient time spent with loved ones who had since died.
He spoke of the lack of time and emotional ability to process the seemingly non-stop attendance at funerals of family and friends during the peak of the AIDS pandemic in 2007.
He spoke of a period of a few years where it felt like whilst he were attending to a funeral in the east of the country he would receive a phone call necessitating his travelling immediately thereafter to the west of the country for yet another funeral.
As his awareness grew of the reason and justification for his chronic grief, his mood lifted and he became increasingly relieved that he was not crazy or clinically depressed.
Whilst I had follow up appointments with him thereafter, it was this first session that as he commented: "…was an "aha" moment that put his life and losses into perspective." 

A struggle to cope

Living in Zimbabwe is not easy. The economic situation in the country is fragile. There are cash shortages, import bans and debt that is continuing to build up rapidly across the economy with a large government spending deficit and a balance of payments crisis taking place.  
Compounding this situation is that across Zimbabwe, more than 2.8 million families are struggling to cope with food insecurity, lack of water, disease and threats to their education and safety.
A prevalence rate of 15%[1] makes Zimbabwe one of the hardest hit countries by HIV and AIDS globally. Every 4th child in Zimbabwe is orphaned, the second highest rate in the world[2].

Bereavement overload

At follow up sessions we acknowledged how difficult it was for him to process his many bereavements due to his ‘bereavement overload’ and how overwhelming it all felt.
Several of his children had died of AIDS, and his concurrent stresses included financing his orphaned grandchildren by paying their school fees and ensuring their daily living needs were met.
With the devastating economic situation in the country, he was also responsible for feeding numerous extended family members who have lost their employment[3].
In many ways he did not have the luxury to grieve as he might wish.

The Dual Process Model

With reference to The Dual Process Model of Coping with Bereavement[4], he needed to spend most of his time getting on with what needed to be done to keep his extended family surviving, and working predominantly with the life changes that were consequences of the losses.

He had little energy or opportunity to engage in the emotional processing oriented towards the actual losses themselves.
A crucial part of the Dual Process Model is the concept of Oscillation. According to Stroebe and Schut, healthy grieving means bereaved people cope with their loss by oscillating between preoccupation with the grief itself, and engagement in a world altered by their loss.

The importance of working with loss

Given the situation in the country, the multiple losses are compounded which makes bereavement and loss work especially important.
Island provides capacity building and mentorship to institutions, partners, and community groups in order to work together to address this need in Zimbabwe. Island is currently brainstorming how this important area of work can be expanded to support more Zimbabweans.
Val Maasdorp is Head of Counselling & Support Services, Island Hospice and Healthcare, Harare, Zimbabwe.
You can find out more about Island Hospice and Healthcare on their website

References

[1]Government of Zimbabwe. National Health Strategy 2016-2020 (draft)  .
[3] IMF. 2015. Zimbabwe Second Review of the Staff Monitored Program – Press Release; and Staff Report
[4]https://www.researchgate.net/profile/HAW_Schut/publication/47716739_The_Dual_Process_Model_of_Coping_with_Bereavement_A_Decade_on/links/0c9605394b82e1ade7000000.pdf

site http://www.ehospice.com/

Palliative care legislation would help cancer patients and survivors

Everyone is touched by cancer – whether they know someone who has been diagnosed or have been diagnosed themselves. The recent post on The Hill’s Contributors Blog – “After cancer care needs improvement” – highlighted the critical need for cancer patients and survivors to have access to supportive care that treats the whole patient, not just their disease. That’s where palliative care can help. Palliative care is a team-based approach that can be given with curative care right from the point of diagnosis. It improves quality of life for both patients and their families by addressing the pain, anxiety, and other debilitating symptoms that patients often feel.
Patient comfort should not take a back seat during treatment, and it does not need to. In Illinois, Blaine Lytwyn, 59, is currently fighting stage 4 breast and ovarian cancer. In December, she underwent a complex and emotional surgery to get rid of the cancer that had invaded her stomach, pelvis and surrounding areas. The procedure led to the removal of parts of her organs, including her gallbladder, spleen, and appendix. Before her surgery, Blaine’s doctors assured her that a palliative care team would give her the support she needed to transition back home “After being cared for at the hospital 24/7, it was very reassuring to know that I would be home and still have my doctors paying attention and caring for me. That was a big help, both physically and emotionally,” Blaine said.
Once home, a nurse visited her several times a week to take her vital signs and assess her incisions. A physical therapist also came by to help her start moving and gain confidence about getting around her house. A nutritionist assisted her in finding food that wouldn’t further irritate her digestive system and help her gain weight back after surgery. Finally, a social worker was available to provide emotional support and care to Blaine and her family throughout her journey.
Today, most large hospitals have palliative care teams on staff, but often patients don’t know to ask about the services available to support them and many doctors don’t think to refer them. Patients with serious illness, like Blaine, who receive palliative care have fewer trips to emergency rooms, spend less time in the hospital, have fewer hospital readmissions, and generally experience a better quality of life during treatment. Palliative care can transform the way health care providers treat patients with cancer and other serious illnesses by improving their quality of care, while also saving health care dollars. 
“I didn’t have to worry about calling my doctors all of the time with questions because my palliative care team was able to address problems that I didn’t even know to look for,” said Blaine. “Every cancer patient should go home with palliative care after a hospital stay. The peace of mind it gives you is so valuable.”
Congress has the opportunity to expand patients’ access to palliative care by acting on the “Palliative Care and Hospice Education and Training Act” (PCHETA). The legislation (H.R. 3119/S. 2748) would increase federal research on palliative care and pain and symptom management, and enhance training for nurses, doctors, social workers, and other health care specialists to practice palliative care effectively. PCHETA would also establish a national palliative care public education and awareness campaign to educate patients and health professionals about the availability and benefits of palliative care.
The PCHETA legislation currently has 191 House cosponsors, including strong bipartisan representation from more than half the members of the House Energy and Commerce Committee and its health subcommittee. That alone should be sufficient to assure some action in Congress. 
We can make significant strides against cancer and other life-threatening conditions through patient-centered care that treats the person as well as the disease. We’re hopeful the Energy and Commerce Committee will hear testimony on the PCHETA bill when Congress returns and begin the process of enacting this smart legislation into law.
Dick Woodruff is vice president of Federal Relations of the American Cancer Society Cancer Action Network (ACS CAN).
site  http://thehill.com/