Palliative care education in the developing countries.

Individuals who have experience in palliative care in wealthier countries with well-structured health systems see the palliative care needs of developing countries as forbiddingly huge. They are aware of an increasing incidence of cancer, but health delivery systems are often patchy and deficient, medications for pain management are not widely available, and cultural considerations limit opportunities to face advanced illness and focus on symptom control in terminal illness. An increasing prevalence of HIV infection compounds palliative care needs. Medical practice focuses on interventions that promise cure and earn a good reward, while nursing standards are variable and often unsatisfactory. There is a need for demonstrations of good care and effective symptom control, even if these reach only a small fraction of the needy population. On such demonstrations can be built education programs that take account of local realities, and promote attitudes, knowledge and skills capable of gradually introducing a greater professional concern and a better prospect of effective care for the dying.