[:en]Palliative care and it’s accessibility in the north-eastern part of Romania[:ro]Îngrijirile paliative şi accesibilitatea acestora în regiunea de nord-est a României[:]

[:en]Ioana Dana Alexa, MD, PhD, professor, senior specialist internal medicine and geriatrics, Head of Geriatrics Department University of Medicine and Pharmacy “Gr. T. Popa” Iaşi, Clinical Hospital “Dr. C.I. Parhon” Iaşi, Romania

Address for correspondence: e-mail: ioana.b.alexa@gmail.com

Abstract

Introduction:
Providing palliative care to all persons in need is a big challenge in Romania due to a massive imbalance between the constantly bigger demand and the modest offer. This situation is true all over the country but is even more severe in the North-Eastern part. One of the main cities in this region is Iasi, with a total of seven centres of palliative care. However, just a very small part of the places from these centres belongs to the public system, the majority being in private facilities. This private care is expensive and, therefore, still out of reach for most patients in this part of the country.

Materials and methods:
We present the case of an older female patient from a rural, outside of Iasi county area, without any family or domicile, and a small pension. She had a history of stage III B uterus carcinoma, and she received radio and chemotherapy. However, the evolution was not favourable, with the extension of the tumour to the nearby organs, inducing several mechanic and anaemic complications for which she was hospitalized in several medical services. No matter how successful the treatments of complications were, the main problem remained the generalized pain, which very soon induced bed immobilization and cognitive decline, with alterations of her personality and behaviour. She demands obsessively to be transferred to a centre of palliative care but we couldn’t find any place in the public system and she could not afford the private one.

Discussions:
We consider that the transfer in a palliative care centre would have been extremely beneficial for her, the sooner, the better, as it would have greatly improved her quality of life and restored her dignity before dying. In this case, the lack of space in a public palliative care service induced multiple admittances in several medical services, each new admission altering the cognitive function and inducing aggravation of personality and behavioural alterations. Moreover, the lack of any social system to provide psychological support for this patient, all alone in this world, contributed significantly to her desperation and sense of abandonment.

Conclusions:
Romania is one of the countries that needs a much larger number of palliative care centres in the public system, especially in connection with medical services that deal on a regular basis with senior patients with severe diseases or disabilities, such as neurology, geriatrics, internal medicine, surgery. This initiative should be doubled by the implementation of a proper geriatric network that could recognize the moment when palliation is needed for a dignified end of life.

Key worlds: senior patient, palliative care

(Full text in Romanian)

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