Palliative care units have one principal objective: to look after patients in the final stage of their life. The head of the joint Spanish Association against Cancer- Costa del Sol Hospital palliative unit, Juan Carlos Domínguez, says more of these facilities are needed, and more palliative doctors need to be trained.
What is the palliative care situation like in Malaga province?
Compared with other provinces in Andalucía and Spain I believe Malaga is fortunate. However, if you ask me whether it is sufficient, the answer will be no, obviously.
What resources are there to look after patients during this final stage?
As far as I know, there are palliative care units in the Axarquía, Civil, Clínico, Antequera and Ronda hospitals, and the Costa del Sol in Marbella, which is where our unit is. There are also the facilities at Cudeca.
How many patients does your unit look after?
So far this year we have seen 297 patients. At the moment there are 131, because the others have died.
As well as providing palliative care to cancer patients, do you help others?
Because our unit is also the one for the Costa del Sol hospital it sees oncological and non-oncological patients. Less than ten per cent are non-oncological. That's because it is very clear when a cancer patient needs to be given palliative care, but more difficult in other patients.
What type of assistance is provided in palliative care?
Our unit provides palliative care in patients' homes. From a medical point of view, we control symptoms and give advice. There is also nursing care, psychological help and assistance with social services. We also have volunteers, who visit and keep people company. Some people live alone, or there are couples with no family around them. We have equipment, such as adapted beds, wheelchairs, special mattresses etc, which we lend free of charge.
For patients who are in hospital we liaise with the internal medicine department at the Costa del Sol, with whom we collaborate. Also, the hospital doctors have been taking turns to cover our palliative care unit for the past 12 years.
What needs to be done to improve palliative care in Malaga?
In 2015, according to the National Institute of Statistics, the mortality rate was higher than the birth rate for the first time. I believe that in the same way that we have excellent resources to attend to births, we should also have them to say goodbye to people at the end of their lives. The comparison between the two in terms of resources is laughable. We want palliative services to be as well-equipped as gynaecology departments, because we need to have the same dedication to looking after people at the end of life as we do when they start to live it.
Is there a combined lack of resources and professionals?
Off the top of my head, I would say there are no more than ten palliative doctors in Malaga. On the other hand, the number of gynaecologists is far higher even though there are the same number, if not more, palliative patients than there are newborn babies in the obstetrics and gynaecology departments.
Are people really aware of the work of palliative units?
I believe so. I have been working in this area for 23 years and the situation has changed a great deal, but it still needs to advance because not everything is done yet. A lot still needs to be done.
What do you believe should be tackled most urgently?
I think we need to train more doctors to specialise in palliative care. It isn't easy, so people have to have a vocation for it. We also need to create palliative units which provide support at home and in hospital. Everyone should have the right to die where they choose, in their own home or in hospital. It wouldn't take a great deal of investment to increase the number of palliative care units.