| Narrative History of Palliative Care in Bosnia |
| Before the war of 1992-5, there had been some evidence of an interest in palliative care among individual health professionals within Bosnia and some palliative care was delivered in the University Clinical Centre at Sarajevo. The war caused many deaths, thousands still unaccounted for, and brought about the widespread separation of family members; it also led to war injuries on a massive scale and created new epidemiological trends and patterns. In the fragile peace that followed, two NGOs began to address the possible contribution which palliative care services could make to the country's problems. |
| The Sisters of the Cross and Passion, based in the UK, sent some of its sisters to Bosnia to explore how their order might develop its mission there. They decided to focus on palliative care and were able to draw on the expertise of staff at St Gemma's Hospice in Leeds, England, which is owned and run by the sisters. Sister Anne Cunningham and Sister Rosaleen Murray developed discussion with the Canton of Sarajevo's Primary Health Care Sector with a view to providing a service to people dying of cancer, in their own homes. Collaboration also developed with oncologists at the University Clinical Centre. Integration with the health care system was a feature of the service from the outset, coupled with the provision of training for Bosnian staff at St Gemma's Hospice in England. The service, entitled NJEGA, began caring for patients on 1 August 1999. |
| At the same time an English public health consultant and aid worker, Stephanie Simmonds, who had represented WHO in Bosnia during the war and lived in Sarajevo throughout the siege which it endured, began in 1996 to consider the need for palliative care services locally. She went on to establish Sarajevo Hospice in November 1998 as a Bosnian NGO in Sarajevo Canton 'to help develop the concept of palliative care, and its practice in a hospice'.10 The group is concerned both with the care of people affected by cancer and of those with war injuries and trauma; and is particularly interested in where these two sets of problems interconnect. So far its main achievements relate to public information and professional education in palliative care. |
| Almost all the key developments in palliative care in the country so far relate to individuals and organisations based in Sarajevo. |
| NJEGA has also produced a narrative account of its early activities, from which the following case history is taken.11 The description is given by one of NJEGA's nurses, Emina Milsic: |
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One of our first patients was Admir, a forty year old man with stomach cancer. He suffered nausea and vomiting, lymphoedema and pain. Our first meeting made a big impression on me and his life story was very upsetting. |
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Before the war he lived in Visegrad and worked as a baker. |
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When the war started he had to leave everything he had worked for and journey into the unknown. |
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He and his family were walking through the woods for days trying to find a way into safe territory. |
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The came to Gorazde where they stayed for two years until his health problems began to show. The doctors then sent him to Sarajevo for urgent surgery. This was the second time in two years that he had to leave a home behind and look for help. |
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In the meantime his brother went missing in the war somewhere near Gorazde and Admir feared for his brother's life. |
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When the family came to Sarajevo they had no place to stay. They found a house destroyed by the shelling of the war and started to live there. Conditions were hard but it was the only home they had. After surgery Admir's health got worse and it was at this point that the family asked for our help. |
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When we met we grew to be friends and I was impressed by his strength and persistence. He tried to live a normal life, even though conditions were bad. He was full of zest for life and longed to walk through his old town again. |
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He liked to talk about his problems, hopes and fears and his condition improved. |
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Two months later he discovered that his brother was dead and he had to go and identify the body. |
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Once again he lost his will to live. Our conversations became longer and deeper but the look in his eyes was empty. He told me that he felt he had no reason to live any more but feared for his wife and children, that they would have no place to live and no one to take care of them. |
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Admir didn't actually know that he had cancer and was going to die, but he didn't have any will to live because of all that had happened to him. He died five months after my first visit. |
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When he spoke about his brother's death he often said that it might be better to be dead than to suffer as he was suffering. The day he died he thanked me for my help, kindness and friendship and asked me to help his family if something happened to him. He died that night. |
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His family, who already had such pain in their lives, were very upset. Everything seemed to be going wrong for them. |
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I tried to speak to his wife but found it very difficult to say something that would comfort her, and it was hard to see the sadness in her eyes. She was incredibly brave and said "What can we do? It was God's will and I can't do anything about it". |
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Admir's dream did not come true. He never saw his beloved town again and his family still live in that destroyed house. |
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| In April 2001 NJEGA hosted the first palliative care conference for nurses in Bosnia and Herzegovina, with almost 300 participants. Also in 2001 one of the NJEGA doctors completed the Diploma in Palliative Medicine at Cardiff and another completed the Diploma in Palliative Nursing. |
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