The Palliative Care service of the El Bolsón Area Hospital, Río Negro, carries out its activity in urban and rural areas as well as organizing workshops and walks for bereaved patients and family members.
Invisible: Value and fame do not always coincide; Not even the most dedicated doctors are the most visible. They value the gratitude of those who need them more than a few minutes on television. They are part of their communities and are committed to them. They have nothing to sell; rather they share what they have, what they know. They care for humble families in remote locations, they do not want to leave any disease orphaned. They heal when they can and always take care. They are those who with their feet in the mud give meaning to an ancient profession. IntraMed wants to honor them with this series of interviews that aims to give visibility to the “Invisibles”.
The Palliative Care Service of the El Bolsón Area Hospital was born 7 years ago out of necessity. From the guard, a group of health professionals detected that there were patients who required other types of care. The task and the desire preceded the specialization. Today the service is made up of doctors Marcela Fernández (Medical Clinic), Gimena Ingenieros (Mental Health), Silvia López (General Medicine) and José Lobos (Nursing).
“Our task is comprehensive, we do not divide it by specialties and that makes everyday life more enriching”, explains Gimena Ingenieros while José Lobos adds that “when considering everything as a team, there are almost no individual tasks”.
For her part, Marcela Fernández points out that it is important “to continue betting that there are more and more palliative care teams in different places that take care of people’s needs.”
Finally, the team celebrates the Palliative Care Law that equalizes rights between patients, regardless of economic level or whether or not they have medical coverage. In dialogue with IntraMed, the professionals talk about the history of this service, its current task and its special activities such as walks and workshops for patients.
How did they get to palliativism?
Dr. Marcela Fernández: It was a work process in which we detected that certain patients needed another type of care continuously or more follow-up at home. Looking back, we first noticed that lack and then we began to do a task that at first had no name, but over time it became more demanding, because when resolving situations, other patients sought the same care. We had to train ourselves, acquire tools to face the tasks in the best way. We did postgraduate studies in Palliative Care and were able to name the work we were already doing.
Mr. Jose Lobos: Before we provided this attention from the guard, which is not the place, but there was no other. The concern of wanting to offer something more and not knowing how arose, which is why the project of assembling a palliative care team was born, without having all the tools at that moment but the desire. With Marcela we each saw patients on our own and we always met, we shared experiences, I sometimes needed the medical part and she needed the nursing part and that is how the service was put together 7 years ago.
What reflections can you make about caring and accompanying when healing cannot be done?
Mr. Jose Lobos: The look. Looking at the person and not at the disease and, based on that, put together a care strategy to improve the quality of life. Our focus does not go through curing but on the other side and we must deconstruct the “looking at the disease”, which is so rigid, hegemonic and comes from so long ago. But when you manage to do it, you see that the results are very rewarding.
Dr. Marcela Fernández: It is very incorporated into our society that if it does not cure it is useless, that medicine has to be to cure. We, with our patients, have to dismantle that idea that if they are sent to palliative care it is because there is nothing to do. And we always remember that as long as there is life, there is a lot to do. There is a look, a listen, a word to generate well-being. Curing is not the only goal of medicine. He already said it in his statements, Epicurus, one of the first doctors, that “medicine is there to care, to accompany, alleviate and sometimes to cure.” But in our success-oriented society, we are left with the fact that only what cures works and we forget about 90% of medical situations that go through to alleviate, accompany and be there.
What is the most worked from mental health?
Dr. Gimena Engineers: One of the things that is worked on the most is coping with the diagnosis, the prognosis, the finitude. And to be able to integrate, not just stay with something physical or emotional happening to us, the spirit also happens to us, it all goes together. That’s when we don’t make many differences between our specialties. So we don’t see only from mental health the coping with the diagnosis, the prognosis and the finitude, we see them all.
Dr. Marcela Fernández: The fact that there are different disciplines working in an area such as palliative care gives the sensation of “fragmentation”, but the training in our specialty is comprehensive. We all have the same tools to face difficulties in the social, emotional, and spiritual spheres; we train ourselves to understand the wholeness of the patient. So, the contributions of knowledge and the specialty of each one are punctual: Gimena can help us choose a medication from the mental health area, I can contribute something from the clinic or José from the nursing area, but our task is very horizontal and all We work continuously with patients. That is a value of the team, it is not that the patient has to go to three consultations for us to take care of her three problems. Because if we don’t fall into a fragmented attention and ‘don Juan’ is lost, he feels pain and is anguished because he can’t work.
What differences exist at work in rural and urban areas as well as at home and in the hospital? What difficulties arise?