The past Wednesday we had the opportunity to spend the day at the palliative care center of the Barretos Cancer Hospital (HCB) system. Hospital São Judas Tadeu, as it is officially known, or Unit II, is situated in the original building where the hospital first began. In 1991 the main hospital moved to the outskirts of Barretos in order to expand into the huge facility it is today, and it is where Nikhil and I are based. The original unit was transformed to tend to solely palliative care patients. Within each branch of HCB people are undertaking some amazing initiatives, and the palliative care unit is no exception. Dr. Luis Fernando, a doctor at the palliative care center, mentioned they always prefer the situation where a patient can be living and receiving treatment within the comforts of his/her home with loved ones nearby. One of this center’s unique aspects is the department of “Atenção Domiciliares”, or home care visits, which we were able to shadow for a day. They visit patients that are well enough to be living at home and to be receiving treatment from a multidisciplinary team only every fifteen days or so. These patients live in Barretos and in the 19 cities that are in the region (please refer to the map below).

You may be asking yourself how this team visits these 19 cities. In order to introduce you to this special service Unit II of HCB provides to its palliative patients I am going to tell you a story. When I was younger, I read the “If you give a mouse a cookie” book along with it’s companions (“If you give a moose a muffin”, “If you give a pig a pancake”). Because I feel like the story of an endearing protagonist who starts small and is ever more ambitious fits well here, I am going to describe what I have learned from my time at the palliative care center by relating to you an HCB’s palliative care center version of this timeless children`s tale. So here we go…

If you give the palliative care center a van, they would most definitely place the Hospital de Cancer de Barretos logo on it. It would become a proud member of the fleet of vehicles entrusted with increasing access to quality care.

Once the transportation is all set, they will undoubtedly recruit an amazing team to ride in it. A nurse to assess the patient’s physical health, A psychologist to address the emotions of both patient and caretakers, A social worker to tend to the non-medical aspects of these tough times, A technician to draw blood, take vitals and administer IV fluids when needed, and A physical therapist to ensure mobility. Regardless of profession, all members are dedicated to the wellbeing of the patient and family in all aspects and are genuinely happy to be working for this cause.

After the team is sorted out, they will then need some supplies. From simple hand sanitizer, boxes of medication to IV setup materials everything is packed into plastic boxes and cozily placed in the trunk of the van.

With team and transport ready, the palliative care center will need some patients. Before and during a patient’s time in palliative care, their health, home and family situation is considered for eligibility to receive treatment at home. Frequency of home visits then varies depending on the stability of the patient’s health.

When patient recruitment is finished, the team will want to start making their rounds, reaching 9 cities and making visits four times a week. Barretos, Guaraci, Olimpia, Severina, Cajobi, Monte Azul, Colina, Viradouro and Taiúva are all on the itinerary. No palliative patient in the 18 cities surrounding Barretos is left behind.

Then the team will probably just get started. With fondness, patience and expertise they care for their patients and the families, assess their symptoms, evaluate their medication status and take on site action to minimize pain and maximize physical, mental and emotional health.

The idea here at the palliative care center is “Não podemos curar mas podemos cuidar” (though they can not cure it, they can care for it). And oh how they care. With a model this effective, the team aspires to increase their reach, so they will most likely… want another van to go with that.