Nursing Homes Provide Palliative Care for Older Persons in Bogotá

Although the dominant culture in Colombia traditionally values familial care for dependent elders, that culture is being eroded by the modern imperative of small families where both parents work and also care for small children. Care is becoming increasingly professionalised, subsidized through an agglomeration of public and private entities, from insurance companies to faith based organisations.

I was privileged to visit a couple of these nursing homes when I was in Bogotá for a palliative care advocacy workshop hosted by the International Association for Hospice and Palliative Care and the two Colombian national palliative care organisations, ASOCUPAC and ACCP,  Asociación Cuidados Paliativos de Colombia.

Dra Maria Lucia Samudio, a palliative care physician who specialises in geriatrics, was my expert guide around the two nursing homes.

Both Dra. Maria Lucia, and Dra Mercedes Franco, a psychologist located in Cáli, who founded a palliative care foundation that works with the most marginalised populations, are involved with the Colombia Compassionate Communities, Todos Contigo. Declaración de Medellín.


Representatives of these Compassionate Communities can participate in the Agenda 2030 High Level Political Forum in 2018, which will consider Goal #11, among others, concerning sustainable cities. Since the “Todos Contigo” project includes the provision of community based palliative care, which will be a novelty for the High Level Political Forum, it will be great to hear the Colombian colleagues present at the UN next year.

At the two nursing homes we visited — one of which was state subsidised, the other run by a lay Catholic organisation and funded by donations, the staff were welcoming, the patients appeared to receive meticulous attention, and everything was clean. Both facilities, like most nursing homes, are struggling to make ends meet, sometimes staff don’t get paid on time, and there is strong competition for scarce resources. They still maintained an atmosphere of loving, patient centered care, though. Families were visibly welcome, providing care and attention to relatives and friends.

According to my companion, Colombia is considering a law similar to Costa Rica’s Ley de Cuidadoras, which pays caregivers a basic income. Of course, this is key to achieving several of the Agenda 2030 Goals, including #4 Quality Education, and #5, gender empowerment.

Since the chronic care facility is located in a beautiful historic part of Bogotá, none of its essential features can be remodeled.

IMG_8078.jpgWhile it can be a tedious and expensive proposition to maintain an old building, there are some benefits, such as the sunroom, where patients and families can come and enjoy some daylight and socialisation.


The gorgeous old chapel is the only part of the interior that has not been remodelled. It contains C17 paintings of the Annunciation and St.Catherine of Sienna (patron saint of the sick), which hang under the original latilla and plaster ceiling.


The second facility we visited was only for older adults with palliative care needs.  Of 26 patients, 23 had dementia diagnoses. When operating at full strength a few years ago, they had around double the number of older adults, and also had children, so it was a multi-generational care home.  The children and abuelos together painted the mural at the top of this posts, on the occasion of the first World Hospice and Palliative Care Day in 2005.

The bedrooms are beautifully kept, and as homelike as possible with keepsakes in every one for a family like atmosphere.

IMG_8096I met Señor L. in the dining room, after all the “abuelos” as the staff called them, had lunched. Not a dementia patient himself, he had lost his wife to cancer and dementia a few months previously.  Their family photo, hung with a rosary, is on the wall of his room, which used to be theirs.

The topic of palliative care for older persons will be on the agenda of the Open Ended Working Group on Ageing next year at the United Nations, and IAHPC welcomes all palliative care team providers to submit their stories, photos, and videos (with permission of the elders of course) for a special series of articles on Ehospice focusing on palliative care for older persons.  We are beginning to gather a body of evidence from all our partners in many countries regarding the state of palliative and long term care for older persons. We are planning a campaign to promote this very exciting and timely topic at the Open Ended Working Group in July 2018, including with side events, expert panels, and testimony of civil society providers of palliative care for older persons. We invite you to join us and submit your stories!


Sturm, Drang, and the Busted Drug War Consensus: The Decline of International Law

Sturm, Drang, and the Drug War. The Decline of International Law

Katherine Pettus, PhD

There is a great deal of Sturm and Drang afflicting the leading lights of the drug policy reform community at the moment concerning the “breakdown of consensus” of UN drug policy and gloom over the prospect of anything new or progressive coming out of the UNGASS in New York next week.  What was once global drug policy based on international law, is more likely to drift into loose alliances based on convergences of national and regional interests.  In the words of international relations scholar Hans Morgenthau “Where there is no balance of power and no community of interests, there is no international law.” There is no consensus at CND on “harm reduction,” the death penalty for drug offences, evidence based treatment, or just about anything concerning drug policy, except (fortunately) the need to ensure the provision of controlled medicines for the treatment of pain and suffering.  That is because there is no longer any community of interest at the UN and no balance of power.

While critical international relations theory can easily explain the first part of the equation — the Sturm about the breakdown of consensus at the UN level — the Drang, or fury, that nothing progressive is likely to come out of the watershed meeting —  reveals general public naïveté about international relations in general and the UN system in particular. As a member state organisation the UN is based on sovereignty and equality of all its members.  Membership requires neither democratic credentials nor adherence to human rights standards.  Positions issuing from the General Assembly necessarily reflect the range of shifting political realities, national interests, and imperatives to which each state is subject. It rarely, if ever reflects a global civil society agenda, however intuitively appealing or convincingly located on the moral high ground. In a multi-polar, rather than bipolar world, the UN is not the institution to produce a progressive new consensus on drug policy!

As the historians of the drug policy system more than competently remind us, the multilateral conventions that govern it were negotiated by elites, and the elites in the nineteen fifties, sixties, and eighties were very much creatures of the bi-polar Cold War world. Many were barely emerging from a century or  more of brutal colonial regimes, eager to join the new post-war international order, one small price of admission among many being allegiance to a drug free world   Democratisation and vibrant civil society movements based on awareness of economic, social, and cultural rights were not the order of the day when the Single Convention was being drafted and ratified during the mid-twentieth century.  Just because they are the order of the day in many European and high income countries in this century, promoting the right to health of people who use drugs, for instance, does not mean that such civil society movements are the order of the day in countries now dominated by post-colonial elites whose survival depends on their ability to prop up neo-liberal globalisation policies run by the IFIs.

As President Cardoso rightly points out in his essay on the UNGASS, the Latin American countries struggling with the high burdens of drug market violence imposed on them by the consumption patterns of the wealthy north, were the first UN member states to reject the earlier elite consensus and lead the current call for reform.  But that is because the political histories of those countries have moved them from military dictatorships, usually US funded and trained, to civilian constitutional governments premised on electoral accountability and respect for human rights.This process of regime change and reform has taken decades, and has birthed all kinds of new foreign and domestic policies, of which a new look at drug policy is only one. 

Other UN member states, such as many in Africa, East Asia, and the Pacific, that have not undergone such seismic domestic regime changes, or have not suffered the consequences of drug market violence in the same way as the Latin American countries (“so far from God, so close to the United States” in Porfirio Diaz’ immortal words) unsurprisingly have a less sanguine view of drug policy reform and human rights.  Their foreign and domestic policies will be based on what their governing elites perceive as best for themselves, and for their countries — nothing new about that in the policy universe of international relations, so why does the drug policy reform movement even harbor what will be a disappointed expectation that “global” drug policy will change next week?

There is no longer a global drug policy consensus because what global consensus there was during the bi-polar Cold War world has dissolved into a multi-polar world characterised by many different political regimes at many different levels of political development.  The progressive, democratised, newly energised UN member states who believe they have history on their side as they reject the twentieth century drug war consensus can provide only normative and discursive leadership to the rest of the world, just as the drug warriors provided that leadership in the previous cycle. Unlike their predecessors though, the new thought leaders will be unable to impose their will on the naysayers whose political regimes exclude civil society and pay only lip service to human rights. And these regimes cannot rely on any “Great Powers” to maintain the old consensus, however fragile, since countries where civil society is now vibrant and pluralistic will no longer play ball.

The global drug policy reformers predicting next week’s disappointing outcome envision a shared cosmopolitanism based on public health, human rights, and solidarity with the marginalised, but as Emmanuel Kant, the pre-eminent philosopher of cosmopolitanism well knew, the cosmopolis can only consist of states that enjoy a republican form of government. Republican forms of government are those in which the demos, or the people, are sovereign, and keep their political representatives accountable through regular elections.  States that are oligarchies, tyrannies, or military dictatorships are structurally misaligned with the idea of Perpetual Peace, universal rights, and a categorical imperative based on autonomy and rationality. 

Those of us who want to reduce the harm of the century old drug policy regimes can work productively with member states themselves, with civil society in those states, and with regional organisations committed to the wellbeing of their populations.  This would represent constructive engagement and possibly produce a more intelligent conversation at the 2019 UNGASS, the institutional endgame set up in 1989.