The development of palliative care in Colombia started during the 1980s. It developed as a result of a growing interest in end of life care and in adequate pain control programmes amongst active physicians. It emerged out of two main types of initiatives: 1) private, non-profit, charitable foundations 2) hospital pain clinics.

The earliest non-profit initiatives were led by highly motivated psychologists, such as Ms Isa Fonnegra de Jaramillo who created the Omega Foundation in Bogotá, and Ms Liliana De Lima who established a palliative care programme in La Viga in Cali during the late 1980s. Both foundations aimed at providing end of life care, adequate pain and other symptom control, as well as bereavement support to a social sector that could not access to appropriate medical care in the country at the time.

During the 1980s and 1990s, hospital pain clinics and palliative care services proliferated in Colombian main cities. Overall, they aimed to improve the management of chronic pain and the support provided to chronically ill, cancer and dying patients²². For instance, Dr Tiberio Alvarez and his team provided care for low-income patients at the pain clinic at the ‘San Vicente de Paul’ Hospital in Medellin - a teaching hospital for medical students with close links to the local private university. Dr Tiberio Alvarez established an educative programme that included a course on pain relief and palliative care for undergraduate students and published a monthly pamphlet on the treatment of terminally ill patients.

In 1986, a pain clinic at the ‘del Valle’ University Hospital emerged in Cali²³. Initially, it aimed to provide training opportunities to advanced students of psychology and to offer emotional support to chronic pain patients. Over the following five years, the demand for care increased to include terminally ill cancer patients and anaesthesiologists, pain and palliative care specialists were appointed. Since 1990, Dr Jorge Alvarez, together with other health professionals, forms a multidisciplinary team that provides palliative care to terminally ill patients referred to the pain clinic. He has also developed educative programmes on pain control and palliative care for undergraduate students of medicine, psychology and social work; for junior doctors and for geriatricians.

In 1991, Dr. Rene Rodriguez alongside other professionals formed the Pain and Palliative Care Clinic at the Social Security Service also in Cali. This service provides care and support to chronic pain and cancer patients, and to their families. It is linked to the ‘Universidad Libre’. Since 1993, it provides teaching support to undergraduate students, and training opportunities to postgraduate students of anaesthesiology at the ‘Universidad del Valle’. It also holds a national symposium on pain medicine and palliative care once a year.

In the early 1990s, a group of oncologists encouraged the creation of a hospital palliative care team at the pain clinic of the ‘Instituto Nacional de Cancerología’ (National Cancer Institute) - one of the most influential cancer centres in the country and more recently a palliative care team led by Dr. Jairo Moyano operates from the ‘Fundación Santa Fe’ (Santa Fe Foundation), within the private health sector²⁴.

Similar pain and palliative care initiatives emerged at the Pain Medicine section of the ‘Valle del Lili’ Foundation in Cali, and at the pain clinic of the ‘San Ignacio’ private Hospital, in Bogotá.

The first Colombian Palliative Care Congress took place in 1987 in Bogotá and it was organized by the Omega Foundation²⁵. Although the congress was successful in terms of raising medical interest, it was never repeated. Dr Sanchez Torres, a retired gynaecologist, academic and bioethicist very much involved in end life care issues in Colombia, refers to this event as follows:

“Towards the end of that year … Omega organized the first Colombian Palliative Care Congress; its development was a complete success. However, a second congress was never organized. Why? It was because Dr. Fonnegra’s initiative was never welcomed. Probably not within the medical community, but within those [private sectors] that could use this service because it is expensive, isn’t it? For this reason, the provision of palliative care, in a holistic way, could never be consolidated”²⁶

International opportunities for training as well as moral support were crucial for starting the development of palliative care in Colombia. Dr Retrepo describes the process as follows:

“Towards the year 1994, Dr. Jairo Moyano went, for instance, to Canada [to gain palliative care knowledge]; Dr Rene Linares gained experience in Paris; Carlos Rodriguez was in Milan with Dr Ventafridda; and I myself gained knowledge at the Gregorio Marañón at the Pain and Palliative Care Unit directed by Juan Manuel Núñez Olarte [in Madrid]. As a result, we all had different experiences: Jairo came with experience gained with Eduardo Bruera, the other doctor with experience gained with Ventafridda and this group arrived in Bogotá to consolidate these experiences There were other people working in Bogotá; in Cali [there was] Liliana De Lima and it was [as if] many things were happening at the same time. It was a movement that was emerging from more or less 1990. There are many pain units, palliative care units at the primary and secondary levels of attention in our country. And a network has been consolidated in what we think is the way palliative care should develop in our country”²⁷

Palliative care programmes emerged mostly with very little or no support from the government. The situation of palliative care, however, seemed set for improvement following the approval of the “Ley 100” (100 Law) in 1993. According to this law, the Colombian health care system would be reformed to guarantee that the country’s entire population would perceive the benefits of adequate health care by the year 2000 and pain control was considered a patient’s right in legal terms for the first time²⁸. But, palliative and end of life care issues were very poorly defined in the documentation and strategies for practices and education on palliative care across the country failed to be established.

In 2004, palliative care is mostly provided in hospitals and exists as a specialization within pain clinics. Following the disappearance of some palliative care programmes, such as ‘La Viga’ and the ‘Omega’ Foundation that provided home care and bereavement support, most current services care for hospital palliative care out- and in-patients. In this sense, Dr Sanchez Torres observes:

A few days ago, exactly on April 21 st [2004], Omega was closed down. That means that we haven’t got palliative care services to provide holistic care in the country. When I mention ‘holistic palliative care’, I refer not only to medical care, but also to the psychological and spiritual care of patients and families. This implies specialized teams and an adequate place or centre for care. And as I said before, these types of services are expensive. ‘Holistic palliative care’ is not included in the Colombian health care schedule. Only symptom control is offered; that is, particularly pain control”²⁹