The development of palliative care in Argentina began with a small number of practitioners working with terminally ill patients during the 1980s,¹⁹ which coincided with the beginnings of a democracy and the ending of years of violence. Progress, however, was slow, due largely to financial constraints. Eduardo Bruera:

‘Unfortunately, the evolution of palliative care in Latin America has been extremely slow because things change slower there because there's not enough money, because education costs money. And if there is no money, you don't have education, and so medical/ nursing education, and other disciplines, goes generally slower in those areas. What we have learned…is that the ladder or organisation, and command in the Third World in general, but specifically Latin America, unfortunately is not reliable. And so the changes need to be bottom-up.’²⁰

Two events were crucial. In San Nicolas - a city with 150,000 inhabitants – the anaesthetist Roberto Wenk established the Argentinean Programme in Palliative Medicine to provide palliative home care for seriously ill cancer patients. In Buenos Aires, a multidisciplinary team working at the Prager-Bild Foundation began a palliative care programme that emphasised professional education and academic activity.

Both of these projects developed outside of the existing health system and prompted other initiatives. By the close of the 1980s, activists in major cities were exploring ways to provide and develop palliative care. Eventually, the first palliative care unit was established at the ‘Hospital Privado de la Comunidad de Mar del Plata’, located on the Atlantic coast around 400km south of Buenos Aires.

In 1988, a small number of practitioners founded Pallium, a palliative care program that provided hospital based-care to terminally ill patients and education to health professionals. Since its origin, this program has been based at the ‘Bonorino Udaondo’ National Hospital. Its distinctive characteristic has been a close and collaborative relationship built between the oncology department and palliative care services.³

During these early stages, support from the international community was invaluable. Advice on educational, philosophical and organizational issues was sought from experienced palliateurs in the United Kingdom and the United States. Once links were established, physicians and nurses gained opportunities to receive palliative care experience in more developed services/ programmes outside of Argentina.

In 1991, the first palliative care meeting in Latin American took place in San Nicolas. Encouraged by Eduardo Bruera, this meeting took the decision to found a national association. By 1993, twenty teams - made up of a physician, a nurse, a psychologist and (occasionally) a social worker - were reported to provide palliative care in 14 Argentinean cities. In 1994, the Argentinean Association for Medicine and Palliative Care (AAMPC) was created to bring these initiatives together and give them formal representation.

As the 1990s drew to a close, two multidisciplinary palliative care programmes began in Buenos Aires: PALLIUM Latinoamerica and the Tornú Hospital-FEMEBA Foundation palliative care unit. These were charitable, non-government organisations, designed to provide clinical care to hospital inpatients and outpatients. Pallium Latinoamerica also established strong university links and developed post-graduate training courses at local and regional levels.

In 1999, the Argentinean Ministry of Health invited a number of health-related institutions to form an advisory committee to draft national standards for palliative care. In keeping with these standards, palliative care services would be organised on three levels and patients would be referred to an appropriate service according to their needs. The standards were approved in August 2000, whereupon palliative care was recognised as a medical discipline which should be available at all levels of the health care system. Accompanying legislation emphasised the importance of adequate analgesic provision. Currently, however, the legal and political frameworks designed to support palliative care remain poorly defined; operational standards have failed to be implemented;and national palliative care provision has yet to be achieved.