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Novosti
5th Symposium –Hospice and palliative care - on occasion of 10th Anniversary of starting the Moderne Hospice Movement in Croatia “Solidarity among the generations - better quality of end of life”
under the auspices of Jadranka Kosor, vicepresident of Government Republic of Croatia
Zagreb, Croatian Medical Association, Šubićeva 9,
14-16 October, 2004


Symposium president: Anica Jušić

Honorary committee: Bajer-Feketić Ana, Biserka Belicza, Enisa Benaš, Mary Callaway, Eugenija Cividini Stranić, David Clark, Anton Cvek, Tomasz Dangel, Theodor Durrigl, Tanja Dobrić, Milan Ferković, Kathleen Foley, Furst Karl Johan, Katica Groš, Josipa Gazibara, Rudolf Gregurek, Sanja Jurjec, Eduard Klain, Eberhard Klaschik, Stjepan Krajačić, Slobodan Lang, Branko Lovrec, Jacek Luczak, Ivo Mlinarić, John Morgan, Dubravko Orlić, Branko Richter, Natalija Rulnjević, Ivica Ružička, Ruža Sabol, Mirko Šamija, Mladen Štulhofer, Iva Ujević Birtić, Biserka Valjak, Vittorio Ventafridda, Janko Vodopija, Barbara Wolf, Anton Zimolo, +Roko Živković

Professional-scientific committee: Ranka Baraba, Egidio Ćepulić, Desa Grubić-Jakupčević, Chris Humphreys, Milica Katić, Ivanka Kotnik, Nada Kraljević, Višnja Majerić Kogler, Anne McMurray, Fliss Murtagh, David J Oliver, Štefanija Ozimec, Marijana Persoli-Gudelj, Dubravka Pezelj, Valentin Pozaić, Ankica Prugovečki, Matija Rimac, Mirjana Sabljar Matovinović, Ranko Stevanović, Melita Stipančić, Vlasta Vučevac, Žarka Zalar, Marija Žagar

Organizing committee: Ruža Andlar, Zlata Bojanić, Silvija Brkić, Biserka Budigam, Suzana Cukrov, Ksenija Duka, Maja Filippi, Krešimir Golub, Danica Horvat, Ružica Ilić, Dražen Jerabek, Nada Kasun, Nada Ključec, Dragica Kravaršćan, Vesna Lopina, Mirjana Majurec, Đurđica Mihoci, Marica Mihoković, Ivanka Mitrović, Željka Novak, Zlata Padarčić, Ivanka Pavetić, Marija Preprotić, Silvija Radinger, Žana Stanzl, Gordana Špoljar, Ksenija Tomašegović, Jadranka Zdeličan



Introduction

The dying and death of any person may be the reason of getting together and reconciliation of the close and remote family members within the many generations. Everybody has the right that those last hours meetings happen without significante disease symptoms, especially pain, in the selected surroundings and with acceptance of the event comming - end of life. Palliative care and Hospice movement have the aim to help to the dying and his/her family with what is unavoidable, during the patient’s life and afterwards during berievement.
We started with, first of all, educational activities ten years ago already. We were overcoming obstacles difficult, step by step - now we are tired! Maybe this anniversary celebration and retrospective will help us a bit to reach social/health system acceptance, the palliative care in other transitional countries as Poland, Hungary, and Romania already got. The achievements in England, USA, in Sweden, Spain or Ireland we can only imagine.
In 2003 year the home care team based at Regional hospice centre, Hirčeva 1, Zagreb accepted 81 new patients with their end of life and their family’s problems. During the first three months of 2004 the number of accepted new patients increased to 170. It was done with the same number of voluntary interdisciplinary team members with the special education in palliative care, as in the year before. It is understandable that with such an increase of efforts we entered into the “ burn out syndrome”. Without the financial help and support of the community, another well-organized and successful action will fail.
The time has come that the four years voluntary activity should be changed into full time job engagement. Palliative care should become the governmental responsibility. It should favor development of new medical specialization, specialization in palliative care for physicians and for nurses. This way only, we shall be able to reach the quality of palliative care units in European Community and in North America or at least that one of some transition countries..
Help us to be helped!

Prof. dr Anica Jušić, MD
President of Croatian Society for Hospice/Palliative Care, CMA




Program

Thursday – 14th October, 2004

Celebrating the 10th anniversary and opening of the 5th Symposium

Coordinators of the session: Anton Cvek, Anica Jušić, Valentin Pozaić, Branimir Richter.
17:00-17:30 Zagreb’s Physicians Singer Choir
Greetings by patron and representatives
17:30-18:00 Nigel Sykes (London): Introductory lecture on palliative care in year 1994, Zagreb. Palliative care in the world 10 years before and
nowadays
18:00-18:20 Anica Jušić: 10th anniversary of starting hospice movement in Croatia Remembering years 1994 and 1996

Book promotion
18:20-18:40 solo concert
19:00-20:00 Terezija Salajpal: Donated Knowledge - on Dying”
20:00-20:30 Reception at Croatian Medical Association Club





Friday – 15th October, 2004

Implementation of palliative care into the existing health system
Coordinators of the session: Stjepan Krajačić, Egidio Ćepulić, Anica Jušić
1. 09:00-09:30 Michael Wright (Lancaster, England): Palliative care in
international context
2. 09:30-09:50 Anica Jušić: Starting the integration of palliative care into the Croatian health system. Regional hospice center - the first private Institution for palliative care
3. 09:50-10:00 Stjepan Krajačić: Palliative care committee of Ministry of Health and Ministry of Health and Welfare.
4. 10:00-10:10 Egidio Ćepulić: The conference in Brussels-u and Press
Conference on Recommendations of Council of Europe Ministers

4.a 10:10-10:20 Mirjana Adzič and Miroslav Bojadzijevski: Implementation of palliative care into the actual health sistem in Republic of Macedonia

10:20-10:35 Coffee break

Coordinators of the session: Ana Bajer-Feketić, Ankica Prugovečki, Žarka Zalar
5. 10:35-11:15 Ruža Andlar, Anica Jušić, Ivanka Kotnik, Mirjana Majurec, Ankica Prugovečki and Matija Rimac: Interdisciplinary palliative home care visits - statistics and cases presentations. Regular meetings of professional teams and administration.
6. 11:15-11:30 Katica Groš and Ana Bajer-Feketić: Starting the palliative care at Virovitica
7. 11:30-11:45:Žarka Zalar: Starting the palliative care at Koprivnica - working group for palliative care
8. 11:45-12:00 Karmen Kukolja: Starting the palliative care at Varaždin

12:00-12:45 Break for lunch

Education in palliative care
Coordinators of the session: Marijana Persoli-Gudelj, David Oliver, Štefanija Ozimec
9. 12:45-13:15 David Oliver (Rochester, England): English palliative care courses across Croatia. The first official nomination of palliative care teacher on Medical faculty Zagreb. Twining with Wisdom hospice Rochester.
10. 13:15-13:45 Anica Jušić: Education through Symposia, Conferences, Courses, Workshops in Croatia Education at courses in England, Poland and Austria. Publications in croatian linguage.
11. 13:45-14:00 Marijana Persoli Gudelj: Education in algology
12. 14:00-14:10 Višnja Majerić-Kogler, Anica Jušić and Marijana Persoli-Gudelj: Postgraduate courses on malignant pain treatment. The future of undergraduate education in palliative care at the Medical faculty Zagreb.
13. 14:10-14:20: Milica Katić and Anica Jušić: Postgraduate courses for primary care/family medicine physicians
14. 14:20-14:30 Štefanija Ozimec: Optional lectures in palliative care at High
Health School-Zagreb
14:30-14:40 discussion


14:40-15:00 Coffee break

Coordinators of the session: Vlasta Vučevac, Desa Grubić-Jakupčević, Ivanka Kotnik
15. 15:00-15:15 Vlasta Vučevac: The redesigning and staff education at the Homes for elderly and sick. Possibilities of opening small palliative care departments inside of “Homes”
16. 15:15-15:30 Ruža Andlar and Suzana Havelka- Noršić: Meetings and education of volunteers
17. 15:30-15:45 Melita Stipančić and Ruža Andlar: Bereavement Courses
18. 15:45-16:00 Desa Grubić-Jakupčević and Ranko Stevanović: What is meant by “good death” in Croatia

16:00-16:20 Break

Pain management

Coordinators of the session: Anica Jušić and Višnja Majerić Kogler
19. 16:20-16:50 Ranka Baraba: Neurogenic pain - diagnostics and management
20. 16:50-19:00 Round table discussion (structured discussion):
The most frequent mistakes in practical pain management of advanced malignant processes (seven main sins)
Contributors: Ranka Baraba, Mira Fingler, Ivanka Kotnik, David Oliver, Marijana Persoli Gudelj, Ankica Prugovečki, Matija Rimac, Nigel Sykes and Franjo Šuperina


Saturday – 16th October, 2004

Futile treatment
Coordinators of the session: Ivan Šegota, Matija Rimac and Svjetlana Čala
21. 09:00-09:30 Ivan Šegota and Iva Sorta-Bilajac: Analysing Pessini’s Dystanasia
22. 09:30-09:45 Ankica Prugovečki and Anica Jušić: Did we fail?
23. 09:45-10:05 Svjetlana Čala and Iva Ratković: When to stop dialysis?
24. 10:05-10:40 Discussion


10:40-11:00 Coffee break

Family as the care unit
Coordinator of the session: Ruža Andlar and Anne McMurray
25. 11:00-11:15 Anne McMurray: Family as the unit of care
26. 11:15-11:30 Chris Humphreys: The significance of the family history
27. 11:30-11:45 Ruža Andlar: Fear of death
11:45-12:40 group discussions (five groups, the one at “huge hall” has simultaneous translation. The group leader are two guest lecturer, croatian physicians involved in palliative care, Ivanka Kotnik, Ankica Prugovečki, Matija Rimac)
12:40-13:00 Presentation of summaries of group discussions led by coordinator of the session Ruža Andlar

13:00-13:30 Break for lunch

Spirituality in end-of-life issues
Coordinators of the session: Valentin Pozaić, Melita Stipančić, Dražen Jerabek
28. 13:30-14:00 Michael Wright (Lancaster, England): Spirituality - the forgotten dimension of palliative care
29. 14:00-14:15 Tonči Matulić: Bioethics of human dying
30. 14:15-14:30 Valentin Pozaić: What to answer to the patient asking “Why me?”
31. 14:30-14:45 Anton Cvek: Practical approach to the death and dying
32. 14:45-15:00 Dražen Jerabek: What is death?
33. 15:00-15:30 Melita Stipančić: Neurolinguistic psychotherapy and bereavement
15:30-16:30 general discussion

Closing of Symposium
16:30-17:00 Anica Jušić and Egidio Ćepulić: Conclusions and Plans for future


Instructions for participants

Oficial languages: croatian and english
Simultaneous translation from english and to english during the whole Symposium


Manuscripts: The lecturers are invited to bring along the manuscript of presentation or at least Power Points Copies for simultaneous translators or send it by e-mail to be multiplied for hand-outs of Symposium participants

Symposium fee: 500,00 kn/ 70 Euro (It includes attendance to the Symposium, meals and materials)
The fee will not be paid by retired persons, jobless, students, lecturers and members of the three committees.

Registration, fee, accommodation: O-Tours Agency, Gajeva 6, Zagreb, tel. + 385 1 4831 444, fax: + 385 1 4813 010, e-mail: kongresi@otours.hr Mrs. Tijana Bogdanović

Addendum

Elisabeth Kübler-Ross died - from the article by Joe Holley: “Psychiatrist - writer- changed the perception of death” Washington Post Staff Writer, Thursday, August 26 2004 page AO!
Elisabeth Kübler-Ross, 78 years old, psychiatrist born at Swiss died on Thursday, August 24, at her home group at Scottsdale, Arizona. She learned the world to speak openly about the death and dying. Her “best seller” -.”About the death and dying” gave the vocabulary for such a conversation.
The book was published 1969. It gives to the reader the simple device easy to remember
(the critics would say - to simple) which makes experience of death universal. As the part of popular expression you describe five stades of trouble: negation, anger, bargaining, depression and acceptance.
The small woman speaking with swiss-german pronunciation, Kübler Ross knew to be charismatic, cynic and open. She insisted that the physicians and nurses threat dying with respect and dignity. Her work brought to hospice care, permitting to the person to die surrounded by friends and family, instead in the impersonal institutional unit.
Kübler-Ross wrote: ” You should not fear the death. It could be the most beautiful
experience of your life. It depends on how did you live.”

End of Life/Palliative Education Resource Center, September 3, 2004 E-News


Quotations from Cicely Saunders’ articles, already published as the addendum to the program of 2nd Symposium Hospice and Palliative Care, 1996. Zagreb

The dying respond much more to our thoughts about them, than to the words. You got to treat them with respect and expectance to be brave, not with the pitty. You should be quiet, listen to them, and be just there. The physician who has overcome the fear of death will know, how, when, what to say to the dying.
St. Christopher’s hospice will be a kind of family and home giving the hospitality in which the dying are accepted because they are themselves and can relax in security.
God’s love is coming to the patient because the love is offered through the staff in the way, how they care for them. Christ should be present in all performances, and especially in serving - in “sacrament of cold water jug and washing the feet”.


“Seven main sins” in analgesia

Sin 1.
The different pain origin is not observed: nociceptive (visceral and somatic), neurogenic and psychogenic. The differentiation is necessary for different therapy for different pain source.

Sin 2.
In introducing analgesic therapy the three steps therapy by WHO is not observed, they start with Durogesic patches. (Great sin!)

Sin 3.
The crescendo modality of introducing opiates is not observed and decrescendo stopping of opiates as well, so that difficult sideeffects or abstinence crisis appears.

Sin 4.
The short-term preparations (Sevredol, Tramal drops or caps or Heptanon drops) are not used for titration (they can be repeated after few hours already). They start with Durogesic patches, whose analgesic action starts after 12 hours only (great sin!)

The rotations are not precise; the changes are too approximate.

Sin 6.
Commentary to Durogesic applications:
 The preferred location is not observed and actual temperature local and general
 They do not think of respiratory crisis possibility
 They forgot of Nalokson application!
 The big initial dosage of 50ųg/hour even 100ųg/hour for significant pain
 Titration with changes of 25 ųg/hour even during the day or every 3 days
 Immediate stopping with 100ųg/hour
 Discontinued application “according the need”
 Indication in terminal patient in which the resorption conditions are severely changed

Sin 7.
The indications for local interventions are not clear- it is important to reduce before opiates.

Additional information: special warning to maximally rational use of opioids. It is and article revised by many experts for pain, narcomany and law. Robert Wood Johnson foundation and Soroš’s Project did financing on death in America. It points to an increase of abuse of opiods, not expected.

“People die in unnecessary pain” New WHO study calls for urgent development of palliative care


We are grateful to donators who were helping us during the past 10 years of activity

Open Society Institute New York, project “On Death in America”
Open Society Institue - Croatia
Help the Hospices, London
St.Christopher’s Hospice, London
Wisdom Hospice - Hospice Friends Society, Rochester

Medical Faculty, University of Zagreb
Croatian Medical Association
Croatian Medical Chamber
Ministry of Work and Social Welfare
Ministry of Health
Ministry of Health and Social Welfare
Ministry of Science and Technology
City Department for Health, Work and Social Welfare
Health Home Maksimir/Health Home Zagreb-Istok
Tourist Office Zagreb
Croatian National Theatar Zagreb
Museum Mimara

and to many private donators especially to Štefanija Pečnik, Ivana Turković-Ostrogović and Ines Merčep


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