With the increasing incidence of illness and the success of modern medicine, more people are living with advanced life-threatening illnesses for much longer. As a result, the need for pain relief and palliative care has become a major public health issue and an urgent imperative, worldwide.

Medical experts working with the World Health Organization (WHO) estimate that more than 60% of the 50 million deaths worldwide each year, especially the six million who die of cancer and the three million who die of AIDS, could benefit significantly from palliative care services if they receive them early enough in the illness experience, i.e., palliative care would prevent and relieve suffering, improve quality of life, ensure a safe and comfortable death, and help the bereaved rebuild their lives. Some patients would even live longer. The 600 million elderly worldwide (greater than 60 years of age) are particularly vulnerable as their risk of developing one or more life-threatening illnesses e.g., cancer, congestive heart failure, diabetes, dementia, etc. and becoming dependent increases as they age.

Today, in Europe, North America and Australia/New Zealand (areas that have developed healthcare systems), approximately 1 billion of the world's population have access to palliative care services and many of the opioid analgesics needed to control moderate to severe pain. However, in most of these countries there is still considerable need for extensive education for all healthcare workers, expanded and enhanced palliative services, and earlier/broader use of opioids and other palliative care medications and therapies.

In most developing and transition countries, where more than five of the 6.7 billion people in the world live, including more than 50% of the 600 million elderly, there is almost no pain control or palliative care. Yet, given 1) their disease demographics (80% of new cancer cases in developing countries present with late-stage disease, e.g., stage III (advanced) or IV (metastatic) cancer), and 2) their lack of resources to purchase/provide medical therapies even for patients who present with early stage disease, palliative care is the most appropriate focus of care for most patients with life-threatening illnesses in these countries (rather than just abandoning them to die).

Annually, 10 million people worldwide are diagnosed with cancer (50% of these are in developing countries) and 6 million die from cancer. By 2020, global cancer rates are expected to increase by 50% to 15 million new cases a year. At the same time, each year more than 5 million people are infected with HIV disease and more than 3 million people die of AIDS. Cancer and AIDS are excellent entry points for developing palliative care capacity as these diseases cause so much suffering for patients and families. Up to 60% of patients experience moderate to severe pain that requires opioid analgesics to control it, as well as exhibiting a wide range of other issues that cause considerable patient/family suffering. Needs for care are often intense and protracted. Family caregivers may lose their future; families go bankrupt buying medications and therapies, and providing care.

To build in-country knowledge and skills, the IPMSDH International Programs offer a variety of in-country professional education programs customized to fit with participants' training needs, cultural values and the contexts within which they practice. IPMSDH also trains physicians and other clinicians who want to be palliative care consultants/master teachers/opinion leaders in their own country.

Sensitization workshops offered over 2-3 days build health professionals' awareness of the importance of palliative care and their knowledge of core palliative care competencies. A three-week Introductory Bedside-Training Course provides more in-depth instruction on the basic palliative care knowledge and skills needed to effectively care for patients. A 2-3 week Advanced Bedside-Training Course provides more in-depth learning. Both are based on the internationally recognized EPEC and EPEC-oncology curricula that were largely developed by IPMSDH faculty with input from hundreds of bioethics and palliative care experts.

The International Visitor Program provides palliative care training for physicians and other team members who want to understand and experience the clinical and organization aspects of palliative care and hospice as it is provided in the US by The Institute for palliative medicine at San Diego hospice across San Diego County. Visits can be arranged for up to 4 weeks.

Still to be put in the table in the right place (I will get that information for you shortly) Catherine Nakibuule

Download the detailed overview of the International Visitors Program (PDF 80 KB)

It enables physicians who received their medical training outside North America to receive classroom and bedside training in the core knowledge and skills of palliative care at San Diego Hospice. It also provides an overview of our comprehensive palliative care program that serves a large geographic region with a population of 3.2 million people.

Download the detailed overview of the International Visiting Scholars Program (PDF 140 KB)

Visiting Scholars

The International Palliative Medicine Fellowship Program, with the assistance of the San Diego County Medical Society, provides expert-level bedside training at IPMSDH and in-country for physicians who want to be consultants/master teachers/opinion leaders in their country. Over a 2-3 year training period, each fellow makes 5-6 visits to IPMSDH for an average of four weeks per visit. Based on the U.S. Palliative Medicine Fellowship training standards, a customized learning plan is developed for each fellow.

In the future, new Fellowship Programs for members of interdisciplinary teams will make specialty training programs available to nurses, pharmacists, social workers, spiritual and bereavement counselors.

Download the detailed overview of the IPMF (PDF 350 KB)

Fellowship Program Members

• Mohamed Hablas
• Lilian Hidalgo
• Agnes Calsina
• Paul Mmbando, MBChB - Tanzania
• Eddie Mwebesa
• Do Trong Thuy
• Khanh Thanh Quach
• Ioseb Abesadze (graduate)
• Tamari Rukhadze (graduate)
• Hassan Abbas (graduate)
• Mohammad Bushnaq (graduate)
• Mohammad Shtiat (graduate)
• Sewer Al-Salmany (graduate)
• Gantyua Tserendorj (graduate)
• Odontuya Davaasuren (graduate)
• Urska Lunder (graduate)

In collaboration with other international facilitators, IPMSDH faculty meet with clinical and governmental opinion leaders in each host country to discuss health policies, palliative medicine availability, opioid importation, distribution and prescribing practices, professional education needs, funding issues and other factors affecting the development of a comprehensive palliative care program. Findings from a comprehensive situational assessment, along with estimates of annual opioid need, are used to develop a multi-year strategy for increasing access to palliative care.

The IPMSDH International Programs offer technical assistance to help national champions and healthcare systems implement comprehensive palliative care programs. IPMSDH faculty assist with the development and implementation of strategic and business plans; quality standards, clinical practice and treatment guidelines and performance improvement strategies to establish expectations for palliative care delivery and specific criteria for evaluating and improving performance; data collection systems to support evaluation of implementation processes, service quality and clinical outcomes; and communications/marketing strategies to increase media and public awareness of the need for, and benefits of, palliative care for the country.

One of the International Programs' major goals is to identify policy, education, program implementation and quality improvement interventions that consistently produce positive outcomes across populations and clinical settings. To build this evidence base, all interventions include a rigorous evaluation of the structure, process and impact of the education and program implementation activities, and the experience of the participants, the host organization and the patients and families who are the recipients of the care. Examples include evaluation of knowledge, attitudes, and perceived competence; improvements in palliative care infrastructure, comprehensiveness of patient care, patient-reported pain scores, and the country's reported level of opioid consumption relative to estimated need.

In keeping with the vision of "bringing the experience back home," the IPMSDH International Programs share insights on the provision of culturally appropriate and integrated palliative care gained abroad with palliative care professionals locally and throughout the United States. Promising and proven approaches to educational interventions and palliative care program development, along with other palliative care resources, are publicized through a variety of communication channels, including publications, conference presentations and an IPMSDH web portal.