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I met Dr. Mary Baines for
the first time in 2001, when
the Balkan palliative care
conference was held in
Romania. Since this first
contact, Mary has many times
proved her amity and willing
to help to develop the
hospice/palliative care in
Serbia. During our numerous
meetings, both in England
and in Belgrade, Mary has
made the entire BELhospice
staff attracted and
dedicated to the idea of the
hospice movement and the job
we were involved in. Her
friendly advices, subtle
spirit, loving dedication to
this job, are permanently
inspiring us for the right
way of staff patient -
family member relationship.
Mary has devoted her
professional carrier to the
care of people who are
seriously ill and dying and
is the longest serving
hospice doctor in the world.
In 1969 she was the first to
join Dr C. Saunders in St.
Christofer's hospice where
she mostly spent her working
period. She was also a
medical director in Ellenor
Foundation. She is one of
the founders of hospice
movement which has been
described as the greatest
gift England has given the
world in the latest century.
For this outstanding
achievement, HM the Queen of
England has honored Dr. Mary
Baines with medal of high
order. Dr. Mary Baines is
also honored with the
prestigious European Women
of Achievement Award.
We are sure that these
acknowledgments are in the
right hands, and we
wholeheartedly congratulate
our dearest colleague and
wish her all the best! The
following text about the
development of palliative
medicine as a special field
of medicine is written by
Dr. Mary Baines."
Dr Nataša Milićević |
Many people, both health care professionals and the public,
think that Hospice / Palliative Care is
a fairly recent branch of medicine.
This view is understandable because St
Christopher's Hospice was opened only 40
years ago, in1967, and it is from this
institution that Palliative Care has
developed. But, in reality, Palliative
Care is a rediscovery and advancement of
the medicine practiced a hundred years
ago when virtually no diseases
could cured by doctors whose role then
was to relieve symptoms and to comfort
patients and families.
Over these 40 years there have been enormous advances in the
control of pain and other physical and
psychological symptoms. Clinical
practice, confirmed by careful research,
has shown that, in almost all patients,
pain from cancer can be fully
controlled. Analgesics, commonly
morphine, are given regularly by mouth
and in individually optimized doses.
Psychological dependence (addiction)
never occurs and tolerance is a minor
problem, easily resolved by a slight
increase in dose. Certain types of
cancer pain need adjuvant medication as
well, for example, antidepressants or
anticonvulsants when the pain is caused
by nerve damage.
Relief of other symptoms is also possible. The unpleasant
feeling of breathlessness is often
reduced with a small dose of oral
morphine and the nausea caused by bowel
obstruction can be relieved with the
appropriate antiemetic. Psychological
symptoms require careful diagnosis to
obtain the best response to treatment.
For example, it is important to
distinguish between a patient's natural
sadness when facing a terminal illness -
requiring emotional and spiritual
support - and clinical depression when
medication is usually helpful.
The amount of information now available to those caring for
people nearing the end of life has been
acknowledged in the UK where Palliative
Medicine was recognized as a
Medical Specialty in 1987. Doctors
require 4 years of training in this
field before they can be accredited
and, from 1990, every UK medical school
has included some aspects of Palliative
Care in the curriculum. Worldwide, there
are now 38 professors in the specialty.
From the beginning, the aim of St Christopher's Hospice was
not only to care for patients and their
families living in South East
London. It was set up to be a model
which could be widely copied, but with
variations due to different resources
and cultures. In the UK now there are
220 inpatient hospices for adults, 327
home care teams and 307 hospital
Palliative Care teams. More importantly,
figures show that the great majority of
patients with advanced cancer receive
help from Palliative Care services which
are now reaching out to patients with
other terminal illnesses, for example,
intractable heart failure.
Worldwide, there has been a remarkable spread with about
8000 established services. A recent
survey, done by the International
Observatory on End of Life Care, looked
at the development of Palliative Care in
the 234 countries of the world. In 35
countries Palliative Care is approaching
integration with health services. In 80
countries there is localized provision,
with one or more services.
41 countries have no Palliative
Care yet but planning is underway. In
78 countries no interest has been
identified.
(
www.eolc-observatory.net )
With the launch of BELhospice in October 2006, Serbia
changed from the third to the second
category, from planning to localized
provision. The country is very
fortunate in having the work led by Dr
Natasa Milicevic. She was a senior
oncologist but has undertaken extensive
training in Palliative Medicine and
keeps on touch with developments in the
field. She is ideally placed to offer
skilled medical care to the patients
cared for by BELhospice, to teach
hospice staff and to conduct training
sessions in Belgrade and other parts of
Serbia.
Dr Mary
Baines |
