Palliative care in Mexico is provided mainly by hospital palliative care teams that operate as part of the hospital pain service. Dr Francisco Mayer, palliative care specialist at the Instituto Nacional de Cancerología (National Cancer Institute) in Tlalpan, México DF describes the approach:

“ the model we have got in Mexico has been that people who have devoted their efforts to pain clinics, because both jobs [pain control and palliative care] are very close related, have also devoted their attention to palliative medicine. In fact, most of us that have been working in pain clinics, possibly only in the last two or three years have recognized ourselves as experts exclusively on the area of pain control [and palliative medicine]. In fact, we have developed both functions: palliative care and pain medicine ”⁶

Another well established palliative care team exists at the Instituto Nacional de la Nutrición (National Institute of Nutrition)

Palliative home care has not been formally established within the existing hospital palliative care programmes of Mexico, mainly because of financial constraints. Funding to cover the costs of health professionals transport, for instance, has not been obtained yet. Domiciliary care is, therefore, offered in very particular circumstances of uncontrollable symptoms or distress and inability to attend the clinic when the patient cannot be admitted into hospital. Experiences of domiciliary care have been reported, however, and the intention of formally establishing a palliative home care service exits at the Instituto Nacional de Cancerología and at the Instituto Nacional de la Nutrición.^7,8

Dr. Mayer adds an overall view of the current provision of palliative care in Mexico:

“ it is clear that in our country there is not an adequate vision of palliative medicine. There is a great vision in some people that this is something necessary, but a functional programme in this sense does not exist, officially. There is [palliative care] in some areas, such as the one [palliative care service] at the institute where I work. And in some other places, this vision of palliative care or medicine exits, and palliative care teams have started and they are effectively working, but not in an official way”⁹

Palliative Care is also provided at other hospitals in Mexico DF, such as the ‘Veinte de Noviembre’ Hospital, the ‘Siglo Veintiuno’ Hospital and the ‘General’ Hospital all operating within the public and social security sectors. There are also private initiatives, such as:

• a palliative care team at the ‘Ángeles del Pedregal’ Hospital
• a palliative care unit developed by Dr. Silvia Allende, who is a palliative care consultant and one of Mexican palliative care pioneers, and
• a more recently created private palliative care team directed by Dr. Francisco Mayer that operates in partnership with “Cristina” Hospice

Outside the capital city and in other states within the country, palliative care is provided in Guadalajara and in Monterrey through different initiatives including a palliative care institute, a palliative care unit and hospital palliative care teams (Table 1).

The level of development of these palliative care initiatives is, however, rather diverse. Some groups has fully consolidated as multidisciplinary specialized teams while other initiatives only represent one or two health professionals acting as advisors in the care of terminally ill patients in main hospitals’ services.

There are two hospices in Mexico named “Cristina” Hospice in Guadalajara and “Isabel Mexico” Hospice in Mexico DF¹⁰. Both hospices provide inpatient care, some home care and their members act as specialized advisors to the hospital staff when it is requested by other health professionals, patients or carers.

The following table summarizes current palliative care services available in Mexico:

Table 1: Palliative Care services currently available in Mexico

Issues and priorities

The following issues and priorities in the development of palliative care in Mexico were mentioned in interviews and found in the literature^{60, 61,62}

• need for educational programmes on palliative care and pain control
• need for an integrated approach to develop national policies and guidelines for practice
• need for more palliative home care services in the country and for more specialized palliative care available in public health institutions
• most existing programmes focus on pain and other symptom control, underestimating the importance of continuity in the care plan and the relevance of providing psychological, social and spiritual support to patients and families
• well-conducted epidemiological studies are mandatory to demonstrate the need for and the efficacy of palliative care
• a lack of provision of palliative care information to health professionals, health authorities and the public