Making life easier for patients

Living Waters accepts patients with any diagnosis for end-of-life care. They operate in much the same way a traditional hospice would have done around the times of the crusades, in that they don’t really say no to anyone, their criteria for acceptance are quite relaxed. Although not a specialist palliative care unit, their patients are very well cared for with mainly volunteer/untrained staff. The facility is run by the Living Waters Catholic community and not subject to the regulations of a regional health authority.

Vitas House accepts only patients with end stage cancer with a prognosis of six months or less. Like Living Waters, Vitas will look after patients approaching the end of life and manage any symptoms so that patients have a pain-free and comfortable last few days.

Says Dr Nijhawan, “The Caura Palliative Care unit is a different ‘animal’ altogether. It is what would be recognised in the United Kingdom as a specialist palliative care centre. We accept referrals for patients with a diagnosis of “any” active, progressive, life-limiting illness, not just cancer. For example; end stage cancer, end stage organ failure (heart, kidney, dementia).” Referrals are accepted for the following reasons - Symptom Control of physical/psychological symptoms; i.e. address a patient’s symptoms and then they return home

- Respite admissions (two weeks) to give caregivers a break, then the patient returns home

- End of life care; caring for a patient for the last weeks/days of life.

“We are unique at Caura in that it is the only palliative care unit within the government health service rather than the voluntary/private sector. This means that the way in which we operate is subject to much more regulation and scrutiny and also means that Caura is a consultant-led service, led by a physician with subspecialty training in palliative care. There are unfortunately only two physicians in Trinidad with formal palliative care training, Dr Ravindra Maharaj and myself.

“Living Waters and Vitas House essentially offer only end of life care, whereas, Caura offers:

- End of life care

- Outpatient palliative care clinics

- Symptom control admissions and

- Ward-based consulting service at EWMSC, Mt Hope hospital

“Living Waters and Vitas House are what most people typically associate a ‘hospice’ with. Again terminology is important, in the US, hospice care refers to end-of-life care often at home, whereas in the UK, hospice refers to the building where palliative care services are offered. Because of the way Vitas House operates, they have to limit their admission criteria to patients with end stage cancer with less than six months to live. Because we only have 12 beds at Caura, admission to the in-patient unit for end-of-life care is also limited to those patients with an expected prognosis of weeks-short months.

“At Caura, we can start treating patients at the point of diagnosis (either in hospital or outpatient clinic) while they have concurrent anti-cancer treatment.

For example, someone diagnosed with a new stage four lung cancer (stage four/advanced at the point of diagnosis) - can start having palliative care input at the point of diagnosis (which will help with symptom control and improving quality of life) as opposed to only having palliative care input after many rounds of chemo/radiation and evidence of treatment failure.

“Many of the patients we see at Caura for pain/symptom control are having contemporaneous chemo/surgery/radiation etc. It is important to stress that just because someone is having palliative care doesn’t mean that they are unable to have their disease-specific treatment.”