Presented by: Santiago Corrêa
Primary care settings are where most ’formal’ palliative and end of life care is delivered. Yet we see few studies of palliative care patients in the context of their own communities, families and cultural circumstances. Significantly, the concept of ‘total pain’ includes several elements, some of which only make sense by understanding the social and psychological life of the patient and family. However, in much palliativecare discourse it is the element of physical pain which predominates. Cicely Saunders described some notable cases of ‘total pain’ which continue to influence the teaching of palliative care. This study examines six ‘cases’ taken from the work of the Estar ao Seu Lado project, based in Rio Grande, Southern Brazil. It focuses on the concept of ‘crisis’ in these cases and shows both the strengths and limitations of formal services in responding. The cases raise further questions about how mobilising community resources and community compassion might prove an additional approach in responding to suffering of this kind, in all its aspects. We conclude with some action points about how ‘crises’ in community palliative care can be addressed through a detailed examination of ‘cases’ in their social context.