Free medical training at a (pro-life) Home Care Hospice for children in Warsaw, Poland

Doctors and nurses from anywhere in the world interested in palliative home care programs are welcome to apply for a free of charge training at the Warsaw Home Care Hospice for children. This highly specialized institution offers courses in pediatric palliative care, conducted in Polish, English or Russian. Doctor Tomasz Dangel, founder and head of the hospice wants to spread the idea of home care for both disabled and dying children:

'Our hospice offers one month individual training both for doctors and nurses who would like to learn pediatric palliative home care. We offer accommodation and trainig free of charge. We do not reimburse the cost of travel.'

The idea of a home care hospice came from the USA. In the 1970's a nurse named Ida Martinson established a pioneering program of care for dying children in their home environment. Martinson has been advocating the idea ever since. The Warsaw Hospice was the first in Poland to open such a model of medical care in the early 1990s. They soon managed to train many doctors and nurses who in turn popularized the idea around the country. There is currently a network of 37 hospices in Poland which provide home-based nursing and end-of-life care. Together they meet 83% of the demand for hospice care in the country. Dr. Dangel and his staff are fighting the mindset that the only place for the dying is the hospital.

'The main message is that we provide good medicine at home and children don't need to stay in the best and most specialized pediatric hospitals at the end of life.'

The Warsaw Home Care Hospice also runs a dental clinic for mentally disabled children who require special care and a prenatal ultrasound clinic for early diagnosis of defects in unborn children.

'Prenatal diagnosis of incurable disease not necessarily should lead to abortion or euthanasia because some children with severe congenital defects may die just after delivery or may still live and we offer palliative care just after prenatal diagnosis. So after delivery we may take the child and family home and provide good palliative care for them.'

There are about 30 volunteers regularly working at the hospice. Monika Zarzyñska is one of them. At 31, she is married and a mother of two but she still finds free time to help at the institution. still finds free time to help at the institution.

'I dreamed about this for many years but I didn't have time for this and now I can find some time and I do it with pleasure. Few years ago I heard about a girl who helped here because her brother had died. When I heard her, my heart began to beat very strong and I felt that I would like to do the same.'

For Monika, working at the hospice is a rewarding, but not always a joyful pastime.

'A child died at the beginning of my work here. Her name was Victoria. I saw the mother cry... and I think I will never forget her cry... and I asked God what I should do with what I saw and some priest told me "You know, Monika, this is the true life."

The hospice organizes public relations campaigns to raise money for nursing care programs. They also appeal for the dignity of suffering and dying people.

'In our campaigns we use a quotation from a Polish poet, Father Jan Twardowski: "Let us hurry to love people, they depart so quickly."

Doctors and nurses already working at or planning to open a palliative care institution are welcome to receive free training at Warsaw Home Care Hospice for Children. They can contact the hospice by telephone at +48 (for Poland) 22 (for Warsaw) 678 16 11.

For information in Polish see the hospice website www.hospicjum.waw.pl or telephone +48 (for Poland) 22 (for Warsaw) 678 16 11.

More on the hospice:

here

Dignity in suffering

Dr Dangel talks about his experience working with terminally ill children.

Today we meet doctor Tomasz Dangel, the founder of Warsaw Home Care Hospice - a highly specialized institution of palliative care for terminally ill children.

The idea of a home care hospice came from the United States, but the Warsaw Hospice was the first in Poland to offer good medical care for dying children in their home environment.

Doctor Tomasz Dangel and his team have trained many other doctors and nurses who popularized the project of home-based palliative care around the country. There is currently a network of 37 centers of palliative home care in Poland.

Doctor Dangel talks about his experience working with terminally ill children:

'I've been working as a doctor for 28 years now. I moved to pediatric palliative care 12 years ago. Then I realized a new option to treat patients at home, not in hospital, when they need palliative care at the end of life.'

'Home environment is most adequate for children, they feel more safe and the family is complete. It's just natural. As we are still a traditional society, Polish families work quite well, so the majority of our patients have good parents. I visited some inpatient hospices for children in the UK, in Canada, in Australia and Israel, so I am aware of this option. However I think it's too far from children's and family's needs.'

'Palliative care covers the whole family, not just the patient. The majority of our patients are children with neurological diseases, so quite often we just can't communicate with them. Sometimes we offer much more much more time and work to the parents and siblings.'

'Does it really help families deal with the grief?'

'You mean the grief after the child's death? Yes! Grieving parents meet here every week. They have excursions together. There are some support groups of mothers who lost their neonates or fetuses. We have one group for teenagers and one for children - the siblings of the children who died. As I can see, it's really good, and it's so good for us because we see this positive process of coming back to life.'

Monika Zarzynska is a lively 31 year-old, a wife and a mother of two. With her husband, they are waiting to adopt a third child. Monika has always dreamt of being a volunteer. Now, that she has some time, she is happy to spend it helping at the hospice. The job is rewarding, she says, but recalls some difficult moments as well.

'A child died at the beginning of my work here. Her name was Victoria. I saw the mother cry... and I think I will never forget her cry... and I asked God what I should do with what I saw and some priest told me "You know, Monika, this is the true life." '

'I noticed quite a few crucifixes on the walls and there is a chapel in the hospice. Does being Catholic help with your work?'

'For me, personally, it's very helpful. I need spiritual support from my priest or from my wife, who is also Catholic and a doctor. Every hospice worker should be aware of his own spiritual needs and how to deal with what we call burnout syndrome which in my opinion is not only a psychological problem. 'Burnout' is a condition which has been described in people who work in very difficult situations, like hospice, where you cannot achieve a cure in your patient. You may get frustrated. So, especially in medicine, we should know the borders of how competent we are and how effective we are. There are some areas of human suffering where we can't help. If you don't accept it, you can't work with dying and suffering people. Perhaps religion is helpful in this respect that part of the job you may leave to God and you can do just what you have been trained in. I think I'm good in pain management, so I'm doing pain management. I don't try to be omnipotent.'

'Spiritual support is one of the basic parts of palliative care, like psychological support, social support, medical support. We have to recognize that every person regardless of religion has spiritual needs connected with searching the meaning of life, of death, of suffering and the hospice should offer not answers but some kind of support.'

Dr. Dangel believes palliative care has much more to offer to the terminally ill than euthanasia. Pointing to the euthanasia movement's eugenic roots, he disagrees with those who see death on demand as a solution to the problem of pain and suffering.

'It was practiced by German doctors during the Second World War. Children with the same diseases as those that we have in the hospice were almost all killed by doctors and nurses and nowadays euthanasia is practiced in the Netherlands in children. Our answer to that is prenatal ultrasound clinic. Prenatal diagnosis of incurable disease not necessarily should lead to abortion or euthanasia because some children with severe congenital defects may die just after delivery or may still live. And such children in Groningen, the Netherlands, are just killed by doctors. In Poland we offer palliative care just after prenatal diagnosis. So after delivery we may take the child and family home and provide good palliative care for them. According to the Polish law, abortion is acceptable when the child is diagnosed with a disability but I would like offer those women a second consultation by a pediatric palliative care specialist. That's the difference.'

'In our campaigns we use a quotation from a Polish poet, Father Jan Twardowski: "Let us hurry to love people, they depart so quickly." '

The Warsaw Home Care Hospice for Children offers training for doctors and nurses working at or planning to open palliative care institutions. The courses, in English or Russian, are free of charge and accommodation is provided. To learn more about the Warsaw Home Care Hospice for Children, log on to www.hospicjum.waw.pl or call them at +48 22 678 16 11.

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