Slovakia/Scranton (Pennsylvania) Partnership

What We Do › Palliative Care › Slovakia/Scranton (Pennsylvania) Partnership

“It was a personal experience with a patient in January 2003 that inspired me to implement a hospice program at our Hospital,” explains infectious disease specialist Vladimir Krcmery, dean of Trnava University School of Nursing and Social Care’s Public Health Department, and member of AIHA’s now-graduated Slovakia/Scranton partnership. “She was dying amidst very poor conditions, alone, afraid, and in considerable pain. Touched by this woman’s situation, I promised her that I would do everything I could to make sure that other terminally ill patients would not have to suffer through their last days in the cold, clinical setting of a hospital ward. And, from that day, it became my mission—and the mission of several dedicated colleagues—to make good on that promise.”

At that time, Slovakia had no comprehensive palliative care policy for terminally ill patients and no actual hospice programs in place, although there were a number of home-based services that provided end-of-life care and support, notes Patricia Dobrikova-Porubcanova, a clinical psychologist, social worker, and assistant professor at Trnava University who collaborated with Krcmery and internist Andrea Doczeova on the hospice project.

Eleven months from the day of the promise made to the dying woman, the three colleagues presided over the opening of a 10-bed hospice unit at Trnava University Hospital. During those months, a team of Slovakian care-providers that included specialists in oncology, geriatrics, and other fields traveled to Scranton, Pennsylvania, where their partners at the University of Scranton helped procure start-up financing for the venture through the Edward R. Leahy, Jr. Center for Faculty Research and also arranged a series of exchanges designed to introduce participants to various palliative care models being employed at local hospitals, long-term care centers, and hospices.

Back in Trnava, the team—which includes three physicians, eight nurses, one psychologist, one social worker, a priest, and 11 lay volunteers—visited hospice programs in the Czech Republic and began building a fledgling network of care-providers dedicated to expanding hospice care in both countries. They also took part in targeted training seminars to learn more about pain management, end-of-life care, the multidisciplinary approach to care, and patient and family counseling. Because nurses play such a key role on the palliative care team, particular attention was paid to their training and hands-on preparation.

“We faced many obstacles as we worked to get this project off the ground, not the least of which were obtaining the necessary financing and raising awareness among the medical community and the public at large about what the hospice concept actually entails,” Doczeova, who is an associate professor at Trnava University where she also serves as assistant dean of international affairs, acknowledges. Both remain ongoing challenges for the team as does continuing education and training.

“Soon after the hospice unit opened its doors, we arranged for our nurses to undergo additional practical training at several Czech hospices and conducted information sessions for hospital department heads to explain the palliative care philosophy, teach them how to determine which patients are suitable for placement in the hospice unit, and introduce them to our procedures for admitting patients,” Dobrikova-Porubcanova says. “Since the facility opened, we’ve had more than 100 patients and the feedback we’ve received from clients and family members alike has been very positive,” she continues, noting that the occupancy rate consistently exceeds 80 percent. “We generally have a waiting list most of the time and plan to start home care services in the near future to better meet the needs of the community.”

To that end, the hospice unit also serves as a practical training site for social work, psychology, and public health students at Trnava University and the team is in the process of applying for national accreditation as a teaching facility, Doczeova explains. “Our hospice is perhaps the best working model of a multidisciplinary team approach to palliative care that exists in Slovakia today and we are using our strengths to teach a new generation of care providers,” she points out.

Doczeova, Dobrikova-Porubcanova, and Krcmery all admit that working with terminally ill patients is demanding and emotionally draining, but they remain dedicated to the promise of helping these patients and their families find peace. “It may sound strange, but, for me, the most rewarding aspect of this work is also the most challenging. Helping people work through what has to be one of the most difficult and painful situations they will ever face is very fulfilling and, at the same time, very tragic,” explains Dobrikova-Porubcanova.

Her colleagues both nod in agreement before Krcmery concludes, “We’ve made considerable progress with the hospice movement in Trnava, but we still have a lot of work to do to ensure this philosophy spreads to Bratislava and other cities throughout Slovakia. Some religious groups have been involved in smaller projects, but doing everything possible to make dying with as much dignity and comfort as possible is not solely the responsibility of the church or a small group of clinicians. Making this a basic human right is the responsibility of all civilized societies.”

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