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National Cancer Control Programme (NCCP) & |
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Palliative care (PC) in Latvia started in 1994 when first lectures, seminars and conferences were dedicated to this field. Palliative Care Association of Latvia (PAAL) was established in 1996. Next year, in 1997 the first PC unit with 25 in-patient beds was opened at the Latvian Oncology Centre, Riga. In 2004 six specialized units in PC were organized in other cities of Latvia. At the present moment 127 in-patient PC beds operate in the country. Besides this an outpatient service and home care was available but the main obstacle to organize PC effectively throughout the country was the lack of PC as an integral system and no certification of the physicians and other multidisciplinary team members was offered. The crucial step to improve the situation of PC in Latvia was the National Cancer Control Programme (NCCP) which was accepted by the Cabinet of Ministers (CM) on the 29th January, 2009, Registry Number 48 [1]. The NCCP is designed from 2009 until 2015. I had a presentation at the Parliament Commission about the situation in PC in the country. The NCCP includes PC as a chapter and this is one of the main priorities in oncology. Regardless crisis things seem promising and again this is due to NCCP. The biggest factor now is a financial problem. But every crisis should end earlier or later. However, another important event concerning certification in PC in Latvia happened recently. These were the changes in Regulations forwarded to the Cabinet of Ministers on the 2nd February, 2009 under No 192 as “Regulations to Organize, Compile and Maintain the Registry of the Medical Persons and Medical Supportive Staff”. This document was approved by CM on the 24th March, 2009 and as recently accepted had no official list number yet. These are important changes in the Medical Law of Latvia concerning PC as an additional speciality (Chapter 26, the 1st and 2nd part, Chapter 27 and the 3rd part of the Chapter 33 ). Changes in the Medical Law states that Palliative Care is an additional speciality (not subspeciality e.g. concerning oncology or only for oncological patients) and is designed in Registry as PP 26 (in Latvian: papildspecialitāte = PP) [2]. PP26 defines the physician as the Palliative Care Specialist which after one year special training under supervision of the PC specialist can be certified according the accredited PC programme regulations. According the Medical Law this is the first or the second level of the Higher Professional Education and means acquired qualified specialization [3]. After passing the final exams the certified person is registered in the Speciality Classificator. Family doctors, internal medicine specialists, oncologists, gerontologists, pediatricians, rehabilitation specialists can be certified in PC. Additional speciality in PC means work both with oncological and non-oncological patients, HIV/AIDS, resistant tbc, etc in advanced phases of disease, improving quality of life both of patients and their relatives by reducing suffering caused by pain, other symptoms and solving psychosocial, existential or spiritual problems as needed. Knowledge of tumour nature, diagnosis, treatment options, care, clinical pharmacology, emergency, terminal care, legislation in medicine, multidisciplinary and interdisciplinary approaches to problems are included in the programme in order to obtain the certificate in PP26 stating that a physician is Palliative Care Specialist. Additional speciality (PP26) now designs a legal competence in educational programmes, acquiring theoretical and practical skills necessary for physicians receiving training and being certified in specialized palliative care. This means a good clinical practice in PC and background for further development of the PC as an effective and comprehensive system in Latvia. Dr. Vilnis Sosars () References
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