Palliative care development in Mongolia.

1
Palliative care development in Mongolia.

• Davaasuren Odontuya, M.D., Ph.D., president of
  Mongolian Palliative Care Society

2
Mongolia is a country with large territory
(occupies 1,565 million km 2 of land ) in Asia
bordered by Russia to the north, China to the
south. Population is very small (2.65 million).
One third of the population live in the capital
Ulaanbaatar, the rest in 21 provinces.
3
Cancer is a second course of death in Mongolia
4
Situation in Mongolia

• 166,7 cancer deaths per 10000 population
• 65-75 of cancer patients diagnosed in the late
  (III-IV) stage of cancer
• 64,3 of cancer patents die within first year of
  diagnoses

5
Home death rate in Mongolia

• Diseases Death
  ()
• Cancer 1627
  40,9
• Hypertension 1097
  27,5
• Cardiac failure 484
  12
• Pneumonia 200
  5
• Hepatitis 111
  2,7
• Nephritis 106
  2,6
• Total death 3976
  100

6
5 most common cancers in Mongolia leads to death

• 1. Liver cancer 43
• 2. Gastric cancer 15
• 3. Lung cancer 10
• 4. Esophageal cancer 10
• 5. Cervical cancer 5

7
Priorities and strategies on 5 common cancer in
Mongolia
8
The wishes of people in the terminal stage of
life

• Not to suffer from pain and other distressing
  symptoms
• Not to be dependent on others, not to be a burden
• Not to be abandoned
• To be around the family and close friends
• To leave good memories for others

9
Situation in Mongolia before

• Human rights violation
• Equality in health care services
• Not accessible for every patients
• No hospices or organizations for Palliative care
• No education on palliative care
• No policy on palliative care
• Not available essential drugs for palliative care

10
Mongolian Palliative Care Society was established
in 2000.
11
Developing palliative care in Mongolia

• Main WHO guides on palliative care translated
  into Mongolian and published in 2000-2002
• First palliative care education material was
  published for postgraduate education of family
  doctors in 2000, 2002.

12
Palliative care development in Mongolia

• Inpatient palliative care department with 10
  beds was established in the National Cancer
  Center in 2000 by OSI support

13
Basic Courses on Palliative Care were organized
for 330 medical workers (doctors, nurses,
medical teachers) through out the country in 2002
by financial support of OSI
14
Palliative care development in Mongolia

• Palliative care teaching programs adapted by
  National Medical University and 4 medical
  Colleges of Mongolia (Ulaanbaatar , Darhan,
  Dornogobi, Gobi Altai Medical colleges) in 2002

15
Palliative care development in Mongolia

• First voluntary palliative home hospices
  established in Zuun Kharaa and Huvsgul Aimags in
  2002.

16
Palliative care development in Mongolia

• Hope home hospice established and
  officially registered in July 2003 with 5 medical
  workers

17
Palliative care development in Mongolia

• The doctors and nurses of this hospice had
  more than 1100 home visits to 110 patients within
  a year

18
Palliative care development in Mongolia

• Green Home Hospice established in 2002 by
  financial support of Yonsey University (Korean)
  and gives home care, outpatient servicers

19
Leadership Conference for advocacy palliative
care organized in 2002 by support of OSI
20

• Participants of the Leadership conference
• 2 Parliament members
• Deputy Health Minister
• Social Policy Adviser of the President
• International consultant
• Head of Health Department of all provinces
• Directors of Medical schools
• Media

21
Palliative care development in Mongolia

• Basic and advanced training manuals for
  palliative care developed in Mongolian language
  by support of OSI

22
Palliative care development in Mongolia

• Family Medicine periodical journal published
  from 2002 in collaboration with MFDA, MPCS, MNU

23
Palliative care development in Mongolia

• Palliative care issues included in the
  postgraduate training programs and standards of
  family doctors and oncologists in 2003
• In the Doctors category examination tests
  included Palliative care issues.

24
Palliative care development in Mongolia

• 10 courses on palliative care were organized
  by MPCS in 2003-2004 and 800 doctors and nurses
  from 5provinces,3 districts of Ulaanbaatar and
  major Medical Centers participated in these
  courses.

25
4 Decision makers from Mongolia participated in
the Palliative Care Policy Development
Conference in Budapest in October 2003 by support
of OSI
26
Palliative Care Policy development Conference
organized in February 2004 in the Ministry of
Health by support of OSI.
27
Palliative care development in Mongolia

• Health Ministers order on establishment of
  Palliative care policy development with 4 working
  groups issued in May 2004
• PC Standard
• Financing of PC
• Drug availability for palliative care
• Undergraduate and postgraduate education
  programs on PC

28
Palliative Care Resource Training Center
established in March 2004 by support of OSI
29
Palliative care development in Mongolia

• Coordination and integration workshop of
  activities of working groups on policy
  development organized with technical assistance
  of international consultant Jan Stjernsward in
  April 2004.

30
Palliative care development in Mongolia

• National trainers are trained from all
  provinces of Mongolia, from all medical schools
  and districts of Ulaanbaatar in July 2004 by OSI
• support.

31
WHO recommendation for an effective national
program on palliative care
32
Palliative care services in health care system

• I level (Primary health care)
• Family doctors and nurses
• II level
• Home hospices, palliative care team
• Inpatient beds in the Regional or District
  hospitals
• III level
• Palliative care department in the NCC
• home care services

33
Drug availability for palliative care

• To insure the availability of pain relief drugs
  for palliative care patients for medical
  purposes.
• To improve essential drug list for palliative
  care.
• To import inexpensive IRMS
• To improve prescription right of medical workers
  to change the law without restriction the amount
  of drug prescribed or the duration of treatment.

34
If people were born They will dieThe death is
stage of life

• All people will die, because the death is stage
  of life.
• All people dont like suffer in the terminal
  stage of life.
• All people will need palliative care in the
  terminal stage of life and we have to improve
  palliative care

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Life begins with love and should finish with love
36
Thank you very much