In Hungary, education and training initiatives are regarded as significant contributors to the development of palliative care. The Hungarian Hospice Foundation was formally established on 29 April 1991, led by Dr Katalin Muszbek who recalls:

‘Our first activity was education. We didn’t work with patients at all. We organized courses – a lot of courses – here in Budapest, and those people who participated or attended our courses, they started their own group in the country to establish another small hospice group.’⁴⁸

As a result, a number of grant applications was made during the 1990s to ensure the continuation of educational activities. These grants meant that key personnel could attend international conferences held outside of Hungary; they also guaranteed the presence of palliative care experts at conferences within Hungary. In addition, funds were allocated for the development of courses at postgraduate and undergraduate levels. Extension courses on the ethical and psychological problems of death and dying began at Semmelweis Medical University in 1993; a further series was offered in 1994. These courses proved to be popular, each course attracting between 100 and 120 participants. Arising from them, a monograph entitled Close to Death was published in 1994, followed by Close to Death II in 1995. Katalin Hegedus, Professor at Semmelweis University, has played a major role in the establishment of palliative care education. She describes how she became involved as follows:

‘My mother died of lung cancer [in 1990] and that’s why I began to deal with the problems of dying people. I went to France to learn about hospice and palliative care and I had a lot of study tours and different courses…First I was a sociologist, it’s my profession, the second one is a psychologist…at first I was a volunteer, but after I gave psychological care to hospice palliative patients, I organised a national education system of palliative care in Hungary.’⁴⁹

To support the education programme, a series of textbooks has originated from Semmelweis University of Medicine, supported by the European PHARE programme. They include titles such as Hospice basic knowledge,⁵⁰ Cultural anthropology of death and dying,⁵¹ Psychology of death and mourning,⁵² and Basic knowledge of palliative care.⁵³ Another series of booklets is available for physicians, nurses, chaplains, social workers and physiotherapists, published by the Hungarian Hospice Association. In 1997, the thanatalogical journal, Kharon Thanatological Revue, began to include a section on palliative care and to accept papers on palliative care subjects.⁵⁴

Curricula, guidelines and standards for palliative care (for example WHO- standards, Council of Europe documents etc.) have been translated into Hungarian. Additionally a one-year post-graduate educational programme for nurses exists, which, following a law decreed in June 2001 by the Ministry of Health, began in 2002. A national training program for Palliative Care, organized by the Hungarian Hospice-Palliative Association was accredited by the Ministry of Health and includes a basic course spanning 40 hours as well as an advanced course of 40 hours.⁵⁵

Much hospice/palliative care education is organized by the Hungarian Hospice-Palliative Association, in association with the Institute for Basic and Continuing Education of Health Workers and the Semmelweis University of Medicine. A grant from the Open Society Institute supported the education programme from September 2000 until 2005, with Katalin Hegedus the grant holder and programme co-ordinator.

Hospice services can now draw from nursing personnel trained in standardised national basic and advanced courses and possessing at least a basic knowledge of palliative care. Yet while hospice and palliative care training for nurses is expanding, there is a severe shortage of doctors with palliative care knowledge, and palliative care content hardly exists within the medical curriculum.⁵⁶ Katalin Muszbek highlights some of the inherent difficulties in this area:

‘Well we have a barrier, a big barrier, it’s the doctors. Because the palliative care issue is not acknowledged in Hungary and not recognised in Medical Universities, it means that in the undergraduate medical courses there are only one or two sessions about it, whether it is called palliative care or not. So it is not built into the undergraduate courses and there is no specialisation in it and that’s why the doctors are not very interested in it…for me the undergraduate level is more important now because I know for all professors the communication will not change between the old professor and the patient, but for the young medical students I believe and I am sure because I have been working at the university for 20 years and I know it’s more important now, and for the older physician I don’t know exactly how we can involve them.’⁵⁷

At undergraduate level, hospice courses have been run for future health care workers (nurses, social workers, physiotherapists) consisting of 20 hour modules (accredited since 2002). Palliative care courses for medical students have also been run: ‘Palliative care of terminally ill patients”, consisting of 30 hour modules (accredited since 2003 by Semmelweis University and Pécs University), and attended by approximately 200 medical students.⁵⁸ Yet generally, under-graduate attendance on palliative care education and training initiatives remains insufficient, and Katalin Hegedus highlights the need for more physicians to attend:

‘…we need physicians because physician, nurse and coordinator are the obligatory members in the team and the other team members are not obligatory but recommended. And the education they need to finish some palliative courses, for nurses it is obligatory 40 accredited hours, for physicians a palliative care course and for other team members too, and for the coordinator nurse there is a one year course, it is obligatory too…but I think that under this health authority scheme it will be obligatory to finish a one week course for every GP, in two years and I am sure that it will be a good result; for nurses it is excellent, for nurses, we have a very good post graduate accredited course with a lot of nurses and we have this one year course for the hospice nurse and coordinator.’⁵⁹

At postgraduate level, 40 hours basic and 40 hours advanced post-graduate hospice and palliative courses, accredited by the Ministry of Health, and organized by the Hungarian Hospice Palliative Association and the Institute for Basic and Continuing Education of Health Care Workers have been run, attended by about 3,500 health care workers and volunteers. Other postgraduate courses, organized by the Hungarian Hospice Foundation, Budapest, Erzsébet Hospice Foundation, Miskolc and Social Net, Pécs have been attended by about 1000 health care workers and volunteers. At the specialist level, a skilled hospice nurse and coordinator course has been run, consisting of 750 hour modules (accredited since 2002), attended by approximately 200 nurses.⁶⁰

At a board meeting of the Hungarian Hospice Palliative Association (HHPA) on 13th March 2007, it was revealed that access to training and education initiatives had improved drastically as a direct result of the 2006 National Cancer Control Program. It was also stated that at the forthcoming EAPC Congress to be held in Budapest (organized by the Hungarian Hospice Palliative Association), from a total of 1050 submitted abstracts, a record 200 had been received from Central and Eastern Europe, and 30 abstracts had been accepted from Hungary alone. Most of the plenary sessions were to involve an interpreter, so many health professionals from rural Hungary were expected to attend, although it was noted that the three day minimum registration fee for the congress had caused some financial difficulties for people from the Hungarian countryside.⁶¹ Katalin Muszbek describes plans for the Congress:

‘So first of all we are very proud of it as it is organised in Budapest and also because there are plenty of developments in Hungary and it seems to me that the preparation is going well, we have almost finished the scientific part of the preparation and a lot of local organisations are going now and we would like to make this meeting very remarkable…also what I am very happy about is that many Eastern delegates are going to come because its much cheaper for them to find cheap accommodation, and now maybe there are 200 registered persons from Eastern Europe in the last meeting there were 60, so it’s a big increase, and also I think that it will influence the Hungarian palliative care development because we will involve plenty of decision makers from Hungary.’⁶²

By May 2007, there were 1934 registered participants for the Congress; 336 from Central and Eastern Europe/Commonwealth of Independent States (including 94 from Hungary).⁶³