Resolution of the seminar “Palliative Care in the Republic of Moldova”
Chișinău, 17-18 June 2004
In the Republic of Moldova (RM) about 6000 people die from cancer every year and about 20 000 people die from other chronic and progressive diseases including AIDS and tuberculosis. These people suffer pain, dyspnea and other symptoms that are present in advanced stages of a terminal disease. Thus their desperate families suffer too. Palliative care/hospice offers to the terminally ill people care and treatment free of charge to alleviate pain and other symptoms and also supports psychologically and spiritually the patients and their families.
In connection with the above said, we want to mention that the access to the basic strong opioids – morphine is not satisfactory:
1. Oral morphine, a golden standard of WHO for strong and moderate pain management in cancer, needs to be introduced in the pain treatment urgently.
2. The limited quantity of injectable morphine in RM causes big problems to the dying patients and its substitution with other opioids like Omnopan and Promedol – are not recommended by WHO.
3. The quantity of administrated morphine – 10 ampoules per prescription, prescribed by the family doctor, is not sufficient for the majority of patients (according to WHO normatives). Moreover the relatives of the patients are put to some humiliating process to return the empty ampoules to the local medical institutions.
4. Taking into consideration the above mentioned facts, we ask to create a working group having the aim to change and improve the legislation of RM about opioids administration according to the recommendations by WHO and the experience of other countries with old traditions in palliative care. The working group will be composed by the representatives from the Ministry of Health, National Drug control Center, other interested organizations, including NGOs.
5. Elaborating national standards of PC according the recommendations by WHO is a matter of urgency in Moldova.
Due to the restricted policies the dying patients rarely die in hospitals, the majority die at home in great sufferings. About 87% from these categories die without an adequate care.
In RM there were founded 3 nongovernmental Hospices (Chisinau, Balti, Zubresti) and other nursing initiatives having the aim to alleviate suffering and to improve the quality of life of the dying. These organizations offer free of charge palliative care to the patients. The services which are offered by professionals in PC are not included in the National Program of Medical Insurance. It is a matter of urgency to change the governmental policies, that need to contain PC/Hospice in the National Program of Medical Insurance financially covered by CNAM. The support and the collaboration with the Ministry of Health is very important and should be done through the Council in PC composed by representatives from the Ministry of Health and interested people who will be able to reach the above mentioned objectives.
On behalf of the participants of the Seminar, Irina Baicalov, director, Gerontological Association, “Second Breath”, the organizer of of the Seminar
Jacek Luczak, professor, the president of ECEPT, director of the Hospice “Palium” from Poznan, the Chief the Chair and Department of Palliative Medicine, Poznan University of Medical Sciences