About palliative care for terminal illnesses

1. HISTORY OF
PALLIATIVE/HOSPICE
CARE

2. ANCIENT HISTORY
 To understand palliative care, it begins with
the story of hospice.
‘Hospice’ comes from a Latin
word hospitium, meaning hospitality, and was
used in the Middle Ages (500AD-1500AD) in
Europe and Mediterranean regions to describe a
place of rest for travellers and pilgrims.
Hospices were run by religious orders, they
were places that offered special hospitality and
care to travellers who were far from home and

3. HISTORY OF HOSPICE AND
PALLIATIVE CARE
. For some time there were no hospices, but
then they re-emerged in the 19th century in the
UK and France particularly, again, run by
religious orders to care for people who were
terminally ill, but also provide accommodation
for the incurable and destitute.
These centers were for the most part run by
community volunteers and civic organizations,
and hardly interfaced with the health care

4. ETHIOPIAN HISTORY
Ethiopians have a long history of caring for strangers
and travellers. The sense of communal responsibility
for the sick and dying is also deeply ingrained in the
culture and tradition. Historians have documented how
Ethiopians accepted and cared for both Christians and
Muslims who were displaced during the various holy
wars.

5. MODERN PALLIATIVE CARE
MOVEMENT
The modern use of the term ‘hospice’ dates from
1967 with the opening of St Christopher’s Hospice,
London, established by Dr Cicely Saunders (1918 –
2005).
 At that time there was a growing awareness that
20th century medical advances, while offering a cure
for many illnesses, also resulted in the health system
ignoring those people who could not be cured.

6. Cicely Saunders, originally a nurse, then a social
worker (almoner), finally studied medicine to meet
this challenge, the neglect of the suffering of those
with life-threatening illnesses.
 Dr. Cicely Saunders first articulated her ideas
about modern hospice care in the late 1950s based
on the careful observation of dying patients.

7. Her work in building St
Christopher’s Hospice and her
approach to pain and symptom
management, recognizing the
multi-dimensional nature of
suffering and the need for
emotional, psychological and
spiritual support for both the
terminally ill patient and their
family was the foundation for
modern hospice and palliative
care practice.

8. DAME CICELY SAUNDERS
‘You matter because you are you,
and you matter to the last moment
of your life.'- Cicely Saunders
She said: "I once asked a man
who knew he was dying what
he needed above all in those
who were caring for him. He
said, 'For someone to look as if
they are trying to understand
me'. It is impossible to
understand fully another
person, but I never forgot that
he did not ask for success but
only that someone should care
enough to try."

9. PALLIATIVE CARE
The term ‘palliative care’ was first used in 1975 by a
Canadian surgeon, Balfour Mount. He had learned
about hospice care from Cecily Saunders. Returning to
French speaking Quebec, he needed to avoid the word
‘hospice’ because of the connotation it had with the
destitute institutions in France. Mount developed a
comprehensive hospital-based service at the Royal
Victoria Hospital, Montreal that included an in-patient
ward, consultation service, home care programme, and
bereavement support service under the name Palliative
Care service by which he meant non-curative therapy
aimed at improving the quality of life.

10. WHAT DOES ‘PALLIATIVE’
MEAN?
Palliative comes from the Latin word ‘to
cloak or cover’

11. ETHIOPIAN HISTORY
The modern hospice movement in Ethiopia
started more as a response to the health
system’s inadequacy to respond to the
HIV/AIDS epidemic, than a desire to provide an
alternative care setting.
The first HIV positive sera were recognized in
1984 and the first two AIDS cases were
reported in 1986.
The disease spread rapidly with hospitals and

12. The National and International response to
HIV/AIDS in Ethiopia has helped strengthen the
health care delivery system in general.
 Palliative care was incorporated into the care
and support element of the response to the
epidemic.
 However, the amount of resources dedicated
to PC in HIV/AIDS care is erroneously inflated,
as unrelated services such as opportunistic
infection prophylaxis and pre and post-test
counseling are reported as PC.

13. The training of personnel in PC is an integral
part of the effort to expand services in Ethiopia.
Two nurses were trained in PC at Hospice
Africa, Uganda in 2006.
 One of the trainees opened “Hospice
Ethiopia”, a community based PC service
providing valuable assistance for patients with
advanced disease.