The Omega Foundation

The Omega Foundation was created by Ms. Issa Fonnegra de Jaramillo in the late 1980s as a non-profit entity to care for terminally ill patients and their families throughout the disease process and into bereavement³⁰. Motivated by a great interest in matters of dying and death, Ms Fonnegra established international links to encourage and support the creation of a multidisciplinary palliative care team at a an already existing foundation named ‘Pro al derecho a morir dignamente’ (‘For the right to die with dignity’). The Omega Foundation was established with private funds in Bogotá to look after cancer and AIDS patients in their own homes. It functioned as a palliative home care programme led by a group of psychologists very much involved in bereavement support as well as circumstances of catastrophic and violent loss. Their palliative care work was supported by medical and nursing staff.

The Omega Foundation provided free support and care to a sector of seriously ill patients that could not afford medical assistance at a time when better quality analgesia and end of life care was the privilege of only the most prosperous social sectors in Colombia. However, in order to support the continuity of the palliative care service, small fees were applied to those who could afford them and also for educative activities undertaken by the Foundation. During the 1990s and until 2000, the members of the Omega Foundation pioneered the development of a palliative care culture in Colombia, providing knowledge and training opportunities for interested physicians, nurses and psychologists.

As a result of the 1993 law that entirely reformed the Colombian health system, the Omega Foundation was seen as a private organization outside the newly created public medical system. With no governmental support, the Foundation suffered progressive financial constraints that led to the closure of its palliative care service on April 21 st 2004. It continues to provide bereavement support to families and relatives of those dying from violence and other traumas.

 The palliative care programme in La Viga, Cali

This palliative care programme was created in 1989 with the aim of providing adequate symptom control and psychosocial care for cancer patients who for financial reasons were not cared for in other health care institutions in Colombia³¹.

La Viga was situated in a large green area on the periphery of the city of Cali. After 1979, it was known as the ‘House of Recovery La Viga’ and it was run by a congregation of Catholic nuns who looked after old people as well as tuberculosis and cancer patients. La Viga was a charity service providing humanitarian non-professional support to poor patients either while they were waiting for medical treatment at nearby hospitals or when they were dying.

In 1989, Ms Liliana De Lima together with Dr Pedro Bejarano led the development of a palliative care programme in La Viga³². Health professionals were appointed to form a multidisciplinary team to care for terminally ill cancer patients and for other seriously ill cancer patients who were on some oncological treatment at the local university hospital. The poorest patients were looked after free of charge while most income to the programme came from charity and from those who could afford the cost of their care either privately or through their social insurances.

Over a period of seven years from its creation, the palliative care programme in La Viga looked after around 7,300 patients a year either at their home or as inpatients. It also gained recognition as a place for gaining knowledge on palliative care for undergraduate and postgraduate students in the country.

In 1994, the main difficulties faced by the programme were³³:

• financial constraints
• prejudice and misunderstandings amongst health professionals and in the community, about caring for the terminally ill
• deficient opioid availability due to severe legal restrictions
• long distances between La Viga and the city of Cali that made access to the programme difficult for families

 In 1997, Ms De Lima resigned as the programme coordinator because of disagreements with managerial decisions made by the administrators of the programme. Following her departure, other professional staff also resigned, leaving the programme seriously debilitated and it was closed down some time later.³⁴ , ³⁵

 The Hospital Palliative Care Team at the National Cancer Institute

This team was created in 1997 as part of the hospital pain clinic and was supported by the hospital authorities as well as by international encouragement. It constituted the first palliative care service to be available at a main public hospital that cares for most people known to suffer from cancer in the country³⁶. A group of anaesthesiologists, an oncologist, a neurosurgeon, nurses, a psychiatrist, a psychologist, a social worker and administrative staff constituted the early palliative care team that undertook clinical as well as educative duties to promote palliative care. Being a main public hospital supported by the government, this palliative care initiative was crucial in influencing more favourable policies at the Colombian Ministry of Health and due to its position as a third level reference hospital with high complexity, the palliative care team could promote pain relief and palliative care in hospitals with lower complexity and at the regional level³⁷. The development of primary and secondary regional centres was encouraged to enhance the attention given to palliative care. The main difficulties faced by this pioneering group on establishing palliative care as a medical discipline were the widespread lack of knowledge about palliative medicine amongst the medical community, patients and the public; insufficient interest in palliative care development on the part of the hospital administrators; and the absence of national political and legal frameworks for practice, leading to scarce financial, human and pharmacological resources. The hospital palliative care team at the National Cancer Institute constitutes, however, one of the most consolidated and well-recognized palliative care initiatives in the country.