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Anna Voeuk

Palliative Care in Humanitarian Crises: Lessons From the Field

Quentin Tsang, MSc Candidate, Translational Medicine

We were honoured to host Dr. Anna Voeuk at Medical Grand Rounds on October 17th, 2019. Dr. Voeuk received her medical degree from the University of Alberta, before embarking on an intriguing career path, along the way receiving a diploma from the London School of Tropical Medicine and Hygiene and, most recently, a Master of Public Health from the University of Alberta. Her career as a palliative care specialist has taken her abroad to places of crises, such as Sierra Leone during the Ebola outbreak, and Mosul, Iraq to treat the wounded during the fight against ISIS. We were fortunate to be able to hear from her experiences.
 

Palliative care, according to the World Health Organization, which Dr. Voeuk has worked closely with, is aimed to improve the quality of life of patients, and their loved ones, through their course of life with a severe disease. Its primary goals are to relieve pain and suffering, neither speed up or prevent death, integrate psychological and spiritual aspects into care and provide an overall support system for the patient and loved ones. Dr. Voeuk emphasized that we may not be able to save all lives, but we can try to relieve suffering and preserve dignity for those who are nearing the end of life. Additionally, she explained that a common misconception of palliative care is that it is only employed immediately before death; it can start immediately following the diagnosis of a severe condition and the health care team will follow patients and their loved ones until the end of life, and beyond that for the patients’ family and friends.
 

40 million people around the world require palliative care, but only 14% of people who require care receive it. 78% of individuals who need palliative care live in low and middle-income countries. Astoundingly, 98% of children who require palliative care reside in low and middle-income countries as well, with almost half being in Africa. While the palliative care system is quite extensive and effective in Canada, as described by Dr. Voeuk, these statistics make it evident that developing countries, especially those experiencing humanitarian crises, are not receiving adequate (if any) palliative care. Thus, Dr. Voeuk, nobly, embarked abroad to offer her expertise to places experiences crises.  
 

Dr. Voeuk extensively described her experiences working abroad in humanitarian crises and how the theme of “resourcefulness” surrounded her career overseas. Her career has taken her to Sierra Leone during the Ebola outbreak where she was responsible for transforming a soccer field into a containment and treatment centre. She described her difficulties with the lack of resources available, such as no access to morphine or other conventional opioids. She also described the difficulties gaining the trust of patients, as she and her team were foreigners dressed in biohazard suits and were using equipment that was unfamiliar to the population. Dr. Voeuk also travelled to Iraq during the fight against ISIS. She described her fears of being in a warzone and the precautions that she had to take that physicians in Canada take for granted. One of Dr. Voeuk’s experience in Iraq that stood out to me was her treatment of a young boy that severely fractured his femur. There was a lack of resources needed to fix this fracture, however, Dr. Voeuk and her team were resourceful and fashioned a fix for the femur that would allow this boy to be mobile and have a high quality of life as he ages. Palliative care in humanitarian crises is similar to other scenarios, prioritizing pain relief, quality of life and dignity to those who have severe illnesses.
 

During our post-rounds discussion, we discussed the relevance of Dr. Voeuk’s experiences abroad to our population in Canada. While we do not have war-torn areas, our Indigenous and rural populations experience similar resource and personnel limitations and lack of trust in the health care system. While training as a rural family physician, Dr. Voeuk did not see the same access to health care and resources that were available in urban centers. Furthermore, she saw similarities in trust and unfamiliarity between those receiving care from foreign aid and working with Indigenous populations in Canada. Dr. Voeuk used these connections to emphasize that, while there are crises in care in low and middle-income countries, we have an abundance of health care adversities that need to be addressed at home.
 

On behalf of the Translation Medicine Graduate Students, we thank Dr. Voeuk for the privilege of sharing her unique and noble experiences.   

Comments

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Spencer Finn

Mon, 10/21/2019 - 21:36

Great post Quentin! I think you did a great job of summarizing both her Grand Round and discussion. At the end of your post you mention how Dr. Voeuk believes that we still have issues here in Canada's palliative care system, this being the reason why she doesn't want to commit to traveling full-time as she would like to try and solve some of these issues. I really found this surprising in her discussion because usually I'd believe that a well develop country like Canada would have a pretty strong program. Dr. Voeuk mentioned groups like indigenous (as you mentioned) and prisoners especially lack a good palliative care system in Canada. I was really surprised about the prisoners comment, as I never realized how much this group lacks. I was wondering if anyone felt the same way and if you see a way we can use what Dr. Voeuk mentioned in solving this problem?

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Spencer Finn

Excellent points Spencer. I think that many people in Canada also do not realize how lacking medical resources are for the Indigenous populations throughout Canada. Part of the problem lies in the lack of resources and health care professionals in these rural indigenous communities, and the long-term structural inequalities that pose barriers to these people seeking specialized care if they require it (i.e. financial barriers). I believe that part of the solution to this problem is educating people on the extremely inadequate way Canada serves its Indigenous populations so that we can advocate to increase these resources.

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Matthew James

Great summary Quentin. As you mentioned, Dr. Voeuk described various situations where hard decisions had to be made in terms of caring for patients due to the absence of vital resources. This sometimes resulted in thoughts like, "If we were in Canada...". However, her resolve to do the best she could with the available resources in order to save lives, relief pain, suffering and preserve dignity is quality that is noteworthy. I believe this a great quality that is worth emulating.

As Spencer stated, it is sometimes surprising that some vulnerable groups and areas in Canada do not have strong palliative care programs. However, as Matthew mentioned there are various and somewhat complex barriers that pose challenges to healthcare in these communities. I believe that in order to become better advocates for these vulnerable groups, we need to be well informed. I am looking forward to Medical Grand Rounds by Dr. James Makokis on the topic: " Making Medicines Equal Again: The Two Row Wampum and Rebuilding the Indigenous Medical System".

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Edwin Ocran

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Sophia Linton

Tue, 10/22/2019 - 16:54

Great post, Quentin!

I encourage everyone to read this article about bringing palliative care to the homeless in Victoria, BC.

Based out of UVic, the Palliative Palliative Outreach Resource Team (PORT) is a great example of solving palliative care problems in our own backyard!

Here is the article: https://www.martlet.ca/uvic-researchers-bring-palliative-care-to-those-…

I'd be curious to hear what people think!

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Sophia Linton

Great find Sophia! What a great idea to bring palliative care to those in need! I think we could translate this to other areas and populations in Canada that lack palliative care. This story is a great example of how it only takes a few people to get a program like this started and off its feet!

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Marty VandenBroek

Hi Sophia,
This initiative from the University of Victoria is an example of a great start to tackling the problems with the access of care we have here at home in Canada. Looking even closer to home, we have a great resource in Kingston with KFL&A Public Health. I had the fortune of working closely with them during my undergraduate education at Queen's. Perhaps, there is a way to integrate public health units into the palliative care situation (i.e. lack of access to vulnerable populations) as they are often the first-line workers that interact with those from lower socioeconomic status.

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Quentin Tsang

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Reem Alzafiri

Thu, 10/24/2019 - 09:17

This is a great summary of Dr. Voeuk's talk! Dr. Voeuk has given me a new perspective of the medical practice through her unimaginable journey overseas making life saving efforts with such little equipment available, having to use her medical expertise to find novel and different ways to approach situations that would be taken for granted in the west (more developed countries). Having learned about palliative care for the first time in this talk, I believe that this topic should be more outsourced and should be encouraged to be taught and practiced in the medical field because, as Quentin has mentioned, millions of people are in need of this type of care yet only a small percent are given that care.

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Reem Alzafiri

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Austin

Fri, 10/25/2019 - 15:16

Still can't believe the dedication that palliative care physicians like Dr. Voeuk have, traveling to areas of active conflict to provide medicine to anyone who needs it. Amazing that Dr. Voeuk is able to do what she does all over the world, and return to Canada to help spread the importance of palliative care in places which are often otherwise neglected by western society.

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Austin

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Jay Kataria

Mon, 10/28/2019 - 18:07

Thank you Dr. Anna Voeuk on you inspirational talk and thank you Quentin for the post and directing discussion. Dr. Voeuk effectively described exactly what palliative care is and the state of palliative care around the world. One thing that resonated from her presentation is how 40 million people from around the world require palliative care, but only 14% of people who require care actually receive it. One of the issues I found particularly interesting is how western medical teams break the cultural barrier in countries that were mentioned such as Iraq and Sierra Leone. One technique that was mentioned was to train locals and raise awareness about the issue at hand. Can you think of other ways that medical teams can break cultural barriers while maintaining a good relationship with the government and people of the country?

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Jay Kataria

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Daniel Rivera

Wed, 10/30/2019 - 20:26

Thanks for your summary and thoughts, Quentin.

I particularly found Dr. Voeuk's discussion on resourcefulness to be interesting. With less medical supplies in and permanent local infrastructure for the clinics she worked in, she had to adapt her knowledge and learn new skills to do her job - from using soccer fields, partnering with locals, and using medicines effectively outside of their primary use.

I found it particularly interesting to know that she was able to study at the London School of Hygiene and Tropical Medicine and while there, learnt specific skills that helped her adapt to work in the field. I wonder if Canadian physicians might benefit from similar specialty professional diplomas/training to perhaps better address the variable health needs of groups with unique needs, such as First Nation or Northern-Canadian communities or perhaps even low-income urban communities. I believe Dr. Voeuk alluded to the how while there are crises abroad that warrant attention, there are also those within Canada that would also benefit from a similar approach to health care.

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Daniel Rivera

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