Developing palliative care in Serbia and e-learning for paediatric palliative care

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Published: 21 Apr 2015
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Dr Julia Downing - International Children's Palliative Care Network, Assagay, South Africa

Dr Julia Downing of International Children's Palliative Care Network in Assagay, South Africa talks to ecancer at IAPCON 2015 on the developments her team made to implement palliative care in Serbia. Some of their outstanding achievements include setting up services and making sure that policies are being put in place.

Dr Downing also discusses the free paediatric palliative care e-learning course that has been created for varying levels of training and is also available in many languages including Spanish and French. Click here to take you to the course.


The project in Serbia, it was an EU funded project and it was to help the government to develop palliative care in Serbia.

So it had many different components.

So obviously education was a key component.

In the three years we trained over 1,500 health and social care professionals in different aspects of palliative care and then some in children’s palliative care.

We also managed to get palliative care integrated into the undergraduate curriculum for doctors, nurses and social workers.

It was really exciting because it was the first course ever that all of the universities have accredited together and accepted a handbook together.

We also managed to get palliative care accepted as a subspecialty within Serbia.

So quite a lot happened in the academic and education front but also actually in developing services.

We helped to set up over fifteen palliative care programmes across the country, both within facilities within hospitals but also at the primary healthcare level and in the communities.

So trying to help set up palliative care services and trying to develop a model of palliative care service delivery for Serbia including things like standards of care, audit, indicators, best practice guidelines.

And also developing some palliative care materials in Serbian because many of the nurses in particular don’t speak English so accessing palliative care materials has been difficult.

So they now have a handbook for palliative care in children, a handbook for palliative care in Serbian, along with best practice guidelines.

So it was quite an exciting project.

Also looking at things like legal issues, availability of medicines.

In looking at the public health model for the development of palliative care it covered all areas of that.

Tell us about the work you have done in Malawi

In Malawi, in Uganda and across Africa working to develop palliative care, very much looking at that public health model.

So looking at how palliative care is implemented, different models of care, trying to draw out best practices.

Some of the work we’ve done with the International Children’s Palliative Care Network is looking at what has made children’s palliative care services successful in different countries in Africa.

So trying to draw out what are the key components to a successful model.

Looking at implementation of services, looking at education, and I’ve been involved in different aspects of education, both in terms of continuing education, education for volunteers, for religious leaders, but also in terms of academic education.

At Makerere University with Hospice Africa Uganda we run a BSc in palliative care and they’re looking at developing a Masters programme.

So looking at education at different levels, looking at issues of drug availability, availability of medicines, in particular opioids, and looking at some of the barriers and how we can reduce those barriers.

And looking at research as well.

So I’ve been very fortunate because I’ve been able to work in various different aspects of palliative care and policy development.

Tell us about the e-learning course and what it aims to do

One of the challenges for us, particularly in children’s palliative care, is that there are not that many education programmes available.

Often where the greatest need for education is there are no education programmes.

Also obviously there’s a challenge of who will facilitate those programmes.

We did a needs assessment of all of our members and one of the areas that we’ve been looking at is e-learning.

So we set up an initial pilot programme which was based around the new pain guidelines from the WHO for children and we undertook a pilot, reviewed the results of that and then we’ve been developing that programme further.

So we now have I think it’s eight courses available and because not everybody obviously speaks English we have those programmes available in various different languages, so in English, French, Portuguese, Spanish, Serbian, Russian and we’ve just got this week here in India the Hindi translation and somebody is translating it into Punjabi.

We’ve just put up the first Mandarin modules and Arabic is on its way as well.

So trying to make children’s palliative care programmes accessible to more people.

The Netherlands, the Dutch children’s palliative care programme, they’ve taken this on board as well.

One of the challenges is to have education that’s accessible, not just in terms of actually being available, but also in different countries the health professionals, particularly nurses, have a different level of education.

So as soon as you start having, say, a degree programme many of the nurses don’t meet the criteria to actually do that programme.

So as the International Children’s Palliative Care Network we’ve been looking at making our training available at different levels.

So for those who haven’t got entry level to a degree or a diploma and for those who have putting them in touch with where they could do those programmes.

And looking ahead at developing programmes at different levels for children’s palliative care.

You can access them through the ICPCN website or if you just google ICPCN e-learning the website will come up and you can register for the courses. They’re all free of charge and you can register online.