Leave quietly
Irina Botuzova, St. Petersburg Vedomosti
One day, a friend of mine, who had been with her father dying of cancer for several years, said: "Life in the cancer field drags you into a depressive funnel. For a long time it seemed to me that I was surrounded by a palisade of official organizations, where there was not a single human voice. When Dad died, I realized one thing – we pray to God for a good life. And we must pray for a good death."
Despite all the achievements of medicine, thousands of Russians are still dying from cancer. Someone for a long time, screaming in pain, because such people, referring to the fact that they are "not heavy enough", do not prescribe painkillers. And next to them, their loved ones experience the same physical and moral torments. Someone has no relatives at all, and they find themselves alone with their misfortune and horror before leaving.
For some reason, for a long time in our country, the concept of "terminally ill" was hushed up: such patients were discharged home so as not to spoil statistics and not take up precious bed space. And the family found themselves literally in hell – they had to monitor catheters, treat decaying tumors and postoperative sutures, endure the screams and moans of the patient. After all, a strict taboo was also imposed on narcotic painkillers.
And when the Federal Drug Control Service appeared in the noughties, doctors were at risk at all: too many formalities had to be observed in order to anesthetize a person. Probably, many people remember the long trial of a doctor who prescribed a narcotic drug to a patient suffering from insane pains? Yes, in the end, the court acquitted her completely. But it became a lesson for other doctors: why take the risk?
And only in 2011, assistance to the terminally ill in Russia was officially recognized. This is how palliative medicine appeared. By the way, our city is the ancestor of this direction, it was in the northern capital that the first hospice for adults in Russia was opened.
Of course, over the past few years, the Ministry of Health and legislators have taken many steps to make pain relief available. Hospitals have increased the standards for the number of narcotic drugs, when a patient with a pain syndrome is discharged, they are required to give him a five-day norm of medication to be enough until he gets to the polyclinic. The procedure for issuing special prescriptions and the timing of their issuance has been simplified. Relatives no longer need to hand over empty ampoules. It would seem that no one should suffer from pain anymore. However, this is not the case.
Yes, there are medicines, visiting teams, and hospices in our city, but there is no single prescribed and understandable procedure for receiving palliative care.
The founder of the Vera Hospice Care Foundation, Nyuta Federmesser, gave the following data at one of the meetings with journalists: in 2016, 20,698 people needed opioid painkillers in Moscow, 10,754 in St. Petersburg. In the capital, 14,150 people received assistance, and in the city on the Neva – 2,100 people. That is, only 20% of patients.
And, despite the fact that in St. Petersburg, as well as throughout the country, federal order 1175-N is in effect, which provides for the issuance of painkillers to patients at home for five days, there is still no local regulatory document in our city that would allow this order of the Ministry of Health to be executed.
For example, in many European countries, a person who has been diagnosed with cancer is handed booklets with a list of services where he can apply, is provided with information about state guarantees, additional opportunities, and is given a specialist's phone number to whom he can call in a critical situation. In our country, it is not uncommon for doctors in hospitals to say nothing at all to patients and their relatives. A person experiencing pain does not know where to turn. The unfortunate man goes to the district therapist, who sends him to the district oncologist. And if there is no such, then full hell comes for the patient.
In order to eliminate this information vacuum, the AdVita Foundation began creating a palliative direction for several months, which was headed by Ekaterina Ovsyannikova.
After the surveys she conducted among the heads of palliative departments, hospices, and some cancer hospitals, Ekaterina concluded that there is no unified system for providing assistance to people suffering from pain in the northern capital. If one clinic can transfer a patient to a palliative care facility and describe to him the entire scheme of anesthesia, then the other does not even explain that after discharge the patient should contact a district therapist. Monitoring also showed that in one district there is a hospice with a visiting service, in another – only a hospice, in the third – a polyclinic therapist and the possibility of hospitalization in institutions of other districts, if there are places. As it turned out, only nine of the 18 districts of St. Petersburg are served by patronage services. Residents of the remaining ten districts can only hope for a polyclinic.
According to the AdVita Foundation, providing a patient with a decent life, even if it lasts for several months or days, is not an easy task, but it can be solved.
In the summer of this year, the AdVita Foundation received 5.5 million rubles as part of a presidential grant competition for the creation and development of a palliative care advisory service in the city. Its main task is to inform the residents of the city about the possibilities of palliative care.
The service has been fully operational since November 24 hours seven days a week. Callers to the service can get information about what kind of help a hospice can provide; when and where to go to get medical and psychological support; what to do if there are problems with getting painkillers; how to issue the necessary documents (for example, to get medical equipment and medicines from the state); how to properly organize patient care at home... And the staff of the service also helps institutions with consumables and hygiene products, organizes clean-up days, arranges leisure activities for hospice patients.
As noted in the fund, the number of calls to the service is constantly growing. If eight people applied here in the first month, today there are already about a hundred patients.
And finally: in ancient times, medicine was considered an art. Today it is called science, but there is an area in healthcare that is still called art - the art of compassion. This is palliative medicine, all efforts of which are aimed at creating comfortable conditions in the last days of a person's life with an incurable disease.
Important phone numbers
AdVita Foundation Palliative Care Advisory Service – 8 (812) 502-06-70 (toll-free call from any device).
The Vera Foundation Palliative Care Hotline is 8-800-700-84-36 (open around the clock seven days a week).
The "hotline" of Roszdravnadzor for receiving appeals from citizens about violations of the procedure for prescribing and discharging painkillers is 8-800-500-18-35 (operators respond during working hours on weekdays, on weekends appeals are recorded on the answering machine and then processed).
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