A Global Perspective: the Role of Palliative Care for the Trauma Patient in Low-Income Countries
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PALLIATIVE CARE IN TRAUMA (L MAERZ, SECTION EDITOR)
A Global Perspective: the Role of Palliative Care for the Trauma Patient in Low-Income Countries Christine C. Toevs 1,2 Accepted: 3 November 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review This review focuses on the use of palliative care in trauma patients in low-income countries. Recent Findings There is very limited use of palliative medicine in low-income countries for any disease condition. The use of palliative medicine for trauma in low-income is not addressed in the medical literature. Summary This review article highlights many changes that need to occur to offer high-level palliative care for all needs, including trauma. The author has made many medical mission trips both as a trauma surgeon and a palliative medicine physician. Personal observation is included. Keywords Trauma . Palliative medicine . Low-income countries . Hospice
Introduction Palliative medicine continues to grow as a specialty around the world. However, the focus of palliative care tends to be untreatable cancer. Palliative care in low-income countries is rarely used for other medical conditions such as heart failure, chronic obstructive pulmonary disease (COPD), or trauma. Part of this limitation may be related to shorter life-expectancy in lowincome countries, such that chronic diseases are less prevalent. Part of the issue may be related to limited health care resources throughout these countries. This review will include the state of palliative medicine and the state of trauma in low-income countries, personal observations, and suggestions for next steps.
Palliative Medicine in Low-Income Countries Advances to medical care extending life continue to spread around the world and are now available in countries where
previously they did not exist. Along with these advances comes increase in diagnosis of life-limiting illnesses, including cancer. Life-extending treatments and interventions have allowed for an increase in chronic illnesses within the population of low-income countries. Hospice has often been present in low-income countries (i.e., Mother Teresa), creating a choice between treatment and death. Few options exist for symptom management, goals of care, or relieving suffering, as in high-income countries utilizing palliative care [1, 2]. The WHO estimates 70% of all non-communicable disease deaths (NCD) occur in low-income countries, and only 14% of those patients have access to any form of palliative care [3]. Part of this limitation extends to lack of opioids in low-income countries. It is estimated that 94% of the world’s opioids are used in high-income countries [1, 4]. Palliative care in lowincome countries is almost exclusively applied to patients with cancer [5, 6]. However, part of the problem is lack of access to cancer screening and treatments, such that when the patient is diagnosed, the only option is hospice [2]. Pediatric palliative care is mostly non-existent [7, 8].
This article is part of the Topical Collection on Palliative Care in
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