Palliative Care in Humanitarian Crises: Lessons From the Field

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| 21 October 2019

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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.