| Current services in Bosnia |
| The following palliative care services are known to exist in Bosnia-Herzegovina: |
| |
Existing Services (2002) |
| Adult |
Inpatient - Freestanding |
0 |
| - Hospital Unit |
0 |
| - Hospital mobile team |
0 |
| Nursing Home |
0 |
| Home Care |
1 |
| Day Care |
0 |
| Total |
1 |
| Paediatric |
Inpatient |
0 |
| Home Care |
0 |
| Day Care |
0 |
| Unspecified |
0 |
| Total |
0 |
| Grand Total |
1 |
|
| Current Projects |
| The following palliative care projects are known to exist in Bosnia-Herzegovina; these are not yet operational services: |
| |
Known hospice/ palliative care projects (2002) |
| Adult |
Inpatient - Hospital |
0 |
| - Hospice |
1 |
| Home Care |
0 |
| Unspecified |
0 |
| Total |
1 |
| Paediatric |
Hospital |
0 |
| Hospice |
0 |
| Home Care |
0 |
| Unspecified |
0 |
| Total |
0 |
| Grand Total |
1 |
|
| In Bosnia-Herzegovina, the palliative care approach is adopted in within Sarajevo's oncology hospital: 'We provide palliative care as a part of total care for oncological patients during their stay at the Institute of Oncology and in their active treatment. We receive patients for palliative care only exceptionally'2. A department of pain management was opened in Sarajevo General Hospital in 1998 and has had Open Society Foundation funding for 'Project Palliative Care in the Hospital Setting'. The home care service NJEGA is operational in the city; and the Sarajevo Hospice takes forward a number of educational initiatives as well as giving support to local individuals and groups, including a clinic for young people with amputations. There is no institutional form of paediatric palliative care and no signs of its development. 3 |
| NJEGA is a service that aims to provide quality care to terminally ill people dying of cancer in their own homes in the Canton of Sarajevo, and is seen as pilot project which might be replicated elsewhere .Based in a health care centre, NJEGA comprises 2 doctors (who work closely with the senior consultant in oncology at the hospital), 4 nurses and 1 part-time social worker. Team members care for the patients and give advice and support to family members; they are also able to provide some medical supplies and materials. The first year of NJEGA's activities have been described in a prize-winning poster.4 In the year beginning August 1999, 345 patients were cared for (174 male, 171 female) for an average period of 45 days, in a total of 4,606 home visits. The most frequent diagnoses were lung cancer (93), cancer of the digestive system (84), breast cancer (48), gynaecological cancers (30). The most frequent symptoms treated were: pain, asthenia, vomiting and constipation; and the vast majority of patients were experiencing socio-economic problems. |
| Sarajevo Hospice does not yet offer direct patient care services, but its work in public and professional education is significant. It engages closely with local academic and clinical groups and with the Ministry of Health in assessing the need for palliative care and planning the relevant approach in the context of limited resources. In 1999 it began an annual international seminar in palliative care, attracting contributors from several European countries. It has translated palliative care textbooks and other educational materials and identified key local leaders to develop a postgraduate module in palliative medicine to be taught at the Medical Faculty of the University of Sarajevo. It has also fostered the development of a palliative care education unit and drop in facility within the Faculty of Medicine, to open in 2002. It wishes to support research into war injury survivors with chronic pain. Sarajevo Hospice has been given land by the Canton for the establishment of a hospice building, but so far funds to progress this have not been forthcoming. Sarajevo Hospice also works closely with Hope 87, an international NGO project that cares for young people who have had limb amputations. |
| Bosnia-Herzegovina currently has an estimated 4 physicians (including 2 family doctors) and 4 nurses with some form of palliative care training, together with 1 social worker.5 |
| Among our sources for Bosnia-Herzegovina we had a total of 12 completed question-naires, sent to us by those involved in hospice, palliative care and oncological work. One palliative care worker summed up the local problems in the following way: |
| |
'We are a post-war country. It is obvious that we need palliative care, but we do not have recognised specialisation for doctors and we do not have resources like doctors in western countries. We do not have enough staff in our team or access to all the drugs we need. We need better co-operation with other hospitals and clinics developing palliative care.'6 |
|
| Another senior figure observed: |
| |
'There is a great interest in and need for palliative care in Bosnia and Herzegovina. Its development is in the beginning. There is only one special palliative care service in Sarajevo. There are no palliative care units or hospices. Opioids are not available in the whole country and personnel don't have enough knowledge to handle the opioids. There is no support or understanding from politicians and health care authorities.'7 |
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