Riga (Latvia)/St. Louis (Missouri) Partnership

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When a doctor diagnoses a life-threatening illness, what is his or her obligation to the patient? Must the doctor disclose the diagnosis, or must the patient be protected from this information? Rasele Saca, a physician in Latvia, thought she knew the answer to this question until she visited a hospice in St. Louis, Missouri, a decade ago.

“I was shocked. It was really something new for me. In our country the philosophy was different – you didn’t tell the patient the truth about his bad prognosis,” Saca explains. But in the St. Louis hospice, Saca saw terminal patients who weren’t suffering under the burden of this knowledge. In fact, they seemed to be enjoying life despite their illnesses. “I saw that these patients were really very happy and satisfied.” Saca’s eye-opening visit was made possible though an AIHA partnership between hospitals in Riga, Latvia, and the BJC Health System in St. Louis, a partnership that lasted from 1995 to 1998.

Artwork created by young patients of the pediatric palliative care team at Clinical Children's Hospital has been turned into postcards that are sold to support the Make a Dream charity. The hospital has instituted other innovative ideas to help sick children and their families. In “sand therapy,” for example, children draw pictures in sand to help express their feelings about their illnesses. “Memory days” bring together families of children who have died to help celebrate their children’s lives and support each other in grief.

After her visit to the United States, Saca collaborated with colleagues from both Riga and St. Louis to lay the groundwork for a hospice program at Bikur Holim Hospital in Riga. Rather than creating a stand-alone hospice, the Riga/St. Louis partners integrated palliative care services – pain management, social and psychological support, and rehabilitative services – into care provided not just to terminal patients, but to those suffering from other serious or chronic diseases as well. Seven years after the partnership ended, Bikur Holim has institutionalized its palliative care services, providing benefits to some 120 patients annually.

At the Latvian Medical Academy's Clinical Children's Hospital, the only full-service acute care hospital for children in Latvia, the AIHA partnership set the stage for a similar transition. Dr. Anda Jansone traveled to St. Louis in 1997 to learn about hospice care for children with the goal of establishing a pediatric palliative care team in her country. The following year, Jansone and her colleagues did just that, bringing together a doctor, nurse, social worker, and chaplain to work with young patients.

As at Bikur Holim, palliative care has continued to thrive at Clinical Children’s Hospital, which has successfully leveraged support from other governmental and international sources to continue expanding its services. In late 2005, the hospital plans to establish three mobile pediatric teams to provide palliative care to children not served directly by the hospital. The hospital and its supporters have also started the Make a Dream charity to answer the wishes of young, terminally ill patients. This charity serves a secondary goal of raising awareness about palliative care, and particularly pediatric palliative care, in Latvia.

The patient-centered philosophy of palliative care continues to grow as the groundbreaking work of those involved in the AIHA partnership gains momentum. Jansone founded a national palliative care society to advance the specialty in Latvia, and it is also being phased into university and postgraduate education of social workers and physicians throughout the country.

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