A Model for Regional Peace and Compassion in the Middle East

The Middle East Cancer Consortium is a unique inter-governmental health organization established in 1996 by a multinational agreement endorsed by the Ministries of Health of its six member states in the Middle East: Cyprus, Egypt, Israel, Jordan, The Palestinian Authority and Turkey and the USA. Against all odds, and despite ongoing political turmoil, MECC has continued to launch and sustain academic-based medical programs that bring together scientists, academicians, and clinical professionals from its member countries, joined by medical personnel from many other countries in the Middle East.

MECC established a successful Middle Eastern Network of Cancer Registry Centers as part of a US National Cancer Institute (NCI) initiative.
Prof. Michael Silbermann

MECC - Palliative Care

MECC established a baseline of information on palliative care services in its six partnership jurisdictions, examining barriers to the delivery of palliative care that might exist, and proposing solutions.


Late presentation of cancer patients -

has serious medical, social and economic consequences for the patients, their families and the community, yet palliative care for cancer patients is still a largely unknown and unrecognized discipline in most Middle Eastern countries.

Education of clinicians, administrators and ministerial representatives -

was and remains the first step in overcoming the obstacles and barriers that physicians, nurses, social workers and psychologists face in their efforts to develop palliative care services.

Michael Silbermann, DMD, PhD -

the Executive Director of the MECC, believes that palliative care is often the best form of treatment; however, it’s not always offered or utilized, and even when drugs and palliative care services are available to patients they’re not always accepted.

Palliative Care - The Book

Perspectives, Practices and Impact on Quality of Life - A Global View. Volume 1
Michael Silbermann - Editor
Copyright © 2017 by Nova Science Publishers, Inc. † New York

With the 2014 World Health Assembly Resolution 67.19 calling on member states to “strengthen palliative care as a component of comprehensive care throughout the life course,” the countries whose narratives of palliative care process and progress are so engagingly described in this text now have the formal imprimatur and support of the World Health Organization.

This resolution is a powerful advocacy document in which the WHO urges member states to address the limited availability of palliative care services and access to essential palliative care medicines and to develop, strengthen and implement policies for comprehensive palliative care integration into national health systems with appropriate resources made available for the needed policy, educational, and financial reform.

This extraordinary compendium, edited by Professor Michael Silbermann, of palliative care practices and perspectives tells the remarkable stories of palliative care development from grass roots efforts by volunteer healthcare professionals in resource constrained countries like India, to the full integration of palliative care in high resource countries like the United Kingdom, New Zealand and Australia. What is so unique about this book is that it captures an enormous range and diversity of palliative care efforts: some nursing led (Iran); some government led (Turkey and Rwanda); many led by local charities and non- governmental agencies; some started by a hospice or hospital team.

Clearly, a focus on the cancer patient dominates many of these programs but there is a strong impetus for expansion to patients with non-communicable disease and HIV disease and to create programs to meet the needs of geriatric and pediatric populations as well as the mentally ill.

All of these efforts began with the premise that palliative care is a public health issue and the stakeholders have framed their programs on the WHO approach in which policy, education, and drug availability are essential components for palliative care development adapted to their specific cultural settings.

In contrast to the Global Atlas on Palliative Care that describes estimates of country needs for palliative care, these detailed chapters tell the narratives of a country’s experience, creating a rich resource of information about the barriers, challenges and successes as each effort progresses. We learn about the challenges of a government led initiative in palliative care in a post genocide era in Rwanda or attempts to provide palliative care services in conflict zones like Iraq, Palestine or Sudan and the special contextual issues requiring cultural sensitivity in Afghanistan and throughout Latin America and the Middle East and much more. These stand-alone chapters woven together paint a colorful real picture of both the exceptional leadership and contextual hardship that palliative care advocates face in their journey forward. Most importantly, these program descriptions give voice to the incredible vision, tenacity and resilience of the teams of professionals and their supporters who work in palliative care.

This is the first textbook to assemble such an archival resource of palliative care activities globally, and enormous credit and respect needs to go to Professor Michael Silbermann for bringing these authors together both virtually through this text and personally through his advocacy for developing palliative care in resource constrained settings. As the Executive Director of the Middle East Cancer Consortium (MECC), Professor Silbermann has worked tirelessly to establish cancer control programs in the region and has championed the need for palliative care and access to essential medicines for pain relief. More than 20 countries have participated in MECC educational programs and projects fostering cross border collaborations among nurses, doctors and other healthcare professionals interested in implementing programs in palliative care despite their different national and regional politics. The outcomes of his leadership are evident as we see the progress in countries like Jordan, Egypt, Cyprus and Turkey who, in turn, have become the leaders for other countries in teaching how to implement palliative care.

By assembling this array of chapters written by palliative care actors on the ground, Professor Silbermann shows us how global palliative care really is as it reaches across all continents, is represented in 11 regions of the world and universal in its goal to improve the quality of life for patients and families with life limiting illnesses. Public health experts and international palliative care advocates have much to learn from reading these distinctive country reports giving evidence to the belief that palliative care’s time has come.

Dr. Kathleen M. Foley
Professor Emeritus, Weill Medical College of Cornell University Attending Neurologist Emeritus, Memorial Sloan Kettering Cancer Center
Preface - Lodovico Balducci and Michael Silbermann
Countries Represented in this Book

Part I. North America

Chapter 1
- Palliative Care for Persons with Severe Mental Illness.
Shereen A. Gamaluddin, Senaida S. Keating, Ralph R. McKenzie and Kye Y. Kim

Chapter 2 - Principles and Practice of Palliative Care Across Cultures and Age Groups.
Meaghann Weaver and Ann Berger

Chapter 3 - An Interdisciplinary Approach to Integrating Palliative Care: Steps for Success.
Jeannine M. Brant, Barbara Holmes Gobel and Regina M. Fink

Chapter 4 - Beginning a Palliative Care Program: Start Small and Build.
Rab Razzak, Fatima A. Rashed, Mohammed J Al Ghamdi, Samer Abushullaih, Krister B. Anderson and Thomas J. Smith

Chapter 5 - Indications for Parenteral Nutrition in Cancer Supportive Care: An Acknowledgement of Cultural Interplay in Decision-Making.
Aminah Jatoi

Part II. Latin America

Chapter 6 - Embracing Life Quality and Palliative Care for Little Pilgrims and their Families: A Thriving Culture of Caring in Argentina.
Eulalia Lascar and Eugenia Rodríguez Goñi

Chapter 7 - Structuring a Palliative Care Service in Southern Brazil: Lessons Learned and How to Move Forward.
Leonardo M. Botelho, Andre T Brunetto and Lucia M. M. dos Santos

Chapter 8 - Current Challenges in Palliative Care Practice in Latin America and Prospects for the Future: Our experience in Southern Brazil.
Fernando Almeida, Andressa Azeredo, Lucia M. M. dos Santos and Gilberto Schwartsmann

Part III. Western Europe

Chapter 9 - Practical Perspectives in Palliative Care in the UK.
Catherine D’Souza

Chapter 10 - Awareness in Brazilian Palliative Care Professionals: Psychometric Study and Its Relation to Quality of Life.
Amparo Oliver, Laura Galiana, Davide Piacentini-Genovart and Fernanda Arena

Chapter 11 - Palliative Care Professionals’ Quality of Life: An Integrative, Systematic Review on Nurses’ Well-being.
Laura Galiana, Amparo Oliver and Noemí Sansó

Chapter 12 - Construction and Validation of Professional Quality Indicators for Hospices.
Stefano Limardi, Gennaro Rocco and Alexander Stievano

Part IV. Eastern Europe

Chapter 13 - Barriers towards Establishing Palliative Care in Eastern Europe and Prospects for Improvements in the Future: Romania as an Example.
Daniela Mosoiu and Alexandru Eniu

Part V. North Africa

Chapter 14 - Palliative Care in Sudan: A Journey to Reduce Suffering and Improve Quality of Life.
Nahla Gafer, Mohja Khair Allah and Halima Ali

Chapter 15 - An Example of an Active Palliative Care Service in a Developing Country: Our Experience in the Gharbia Cancer Society, Egypt.
Mohamed Hablas

Part VI. East Africa

Chapter 16 - Palliative Care: Kenya’s Current Profile and Prospects for the Future.
Tayreez Mushani and John K. Weru

Part VII. West Africa

Chapter 17 - Inspiration, Initiatives and Progress: The Struggle to Improve Quality of Life through Palliative Care Provision in Cameroon.
Catherine D’Souza, Esther Mbassi Dina Bell and Romance Nguestse Djoumessi

Part VIII. Central Africa

Chapter 18 - An Example of Integration of Palliative Care Service in Africa’s Healthcare System: Strengthening Intervention at Kibagabaga Hospital in Rwanda’s Public Health System.
Christian R. Ntizimira, Mary L. Dunne, Olive Mukeshimana and Scholastique Ngizwenayo

Part IX. Middle East

Chapter 19
- Experiences Associated with Developing Nationwide Palliative Care Services in the Community: What Can One Learn from It for the Future?
Ezgi Simsek Utku, Ezgi Hacikamiloglu, Murat Gultekin and Bekir Keskinkılıç

Chapter 20 - The Current Status of Palliative Care in Iraq: Reality and Ambitions for the Future.
Samaher A. Razaq, Amir F. M. Al-Darraj, Raghad M. Al-Saeed and Ahmed H. Sabhan

Chapter 21 - Palliative Care in Lebanon: Current Practices, and Perspectives for the Future.
Michel Daher and Myrna Doumit

Chapter 22 - The Cypriot Model for Home-Based Palliative Care Services: Facts and Prospects.
Yolanda Kading, Antonis Tryphonos, Nicolas Philippou and Simos Malas

Chapter 23 - Hope, Grief, and Belief in an Immigrant Community: Ethiopian Jews in Israel.
Lea Baider and Gil Goldzweig

Chapter 24 - Palliative Care Evolution in Jordan and Prospects for the Future.
Rana F. Obeidat

Chapter 25 - Palliative Care Initiative in a Developing Country: Using Palestine as an Example.
Mohamad H. Khleif and Amal I. Dweib

Part X. Central Asia

Chapter 26 - The Long and Winding Road Towards Quality Palliative Care in Kazakhstan.
Gulnara Kunirova

Chapter 27 - A Case Study of a Culturally Sensitive Home-Based Palliative and Hospice Program in a Conservative Society.
Mohammad Shafiq Faqeerzai and Abdul Tawab Saljuqi

Part XI. Southwest Asia

Chapter 28 - Palliative Care Perspectives and Practices in the Islamic Republic of Iran and Their Implications for Quality of Life in Patients.
Maryam Rassouli, Azam Shirinabadi Farahani and Leila Khanali Mojen

Chapter 29 - Palliative Care: Progress and Challenges in Pakistan.
Rehana Punjwani, Muhammad Shamvil Ashraf, Aneela Abbas and Durr-E-Fatima Siddiqui

Part XII. Southeast Asia

Chapter 30 - Palliative Care in Asian Countries: Current Practices and the Future Outlook
Wendy Wing Tak Lam, Tai-Chung Lam and Richard Fielding.

Chapter 31 - Networked Neighbours to Heartening Hospices: The Exciting Journey of Palliative Care Development in India.
Srinagesh Simha and Naveen Salins

Chapter 32 - Palliative Care in Myanmar: Accessibility, Barriers, Capabilities and Prospects for the Future.
S. Mon, A. A. Naing, W. W. Myintzu and H. M. Han

Part XIII. Far East

Chapter 33 - The Chinese Way of Breaking Bad News: An Integral Part of the Practice of Palliative Care to End-Stage Patients.
Lili Tang

Chapter 34 - Progress and Future of Palliative Care in Japan.
Daisuke Fujisawa

Part XIV. Oceania

Chapter 35 - Australia’s Contribution to the Development of Global Palliative Care.
David W. Kissane and Natasha Michael

Chapter 36 - Development of Paediatric Palliative Care Services in New Zealand (Aotearoa).
Karyn Bycroft, Emily Chang and Ross Drake

North America

Latin America

Western Europe
United Kingdom

Eastern Europe

North Africa

East Africa

West Africa

Central Africa

Middle East

Central Asia

Southwest Asia

Southeast Asia
Hong Kong

Far East

New Zealand