Rui Tato Marinho is currently a Professor at the Faculty of Medicine of the University of Lisbon (FMUL) and the Director of the Department of Gastroenterology and Hepatology at the Northern Lisbon University Hospital Centre (CHULN). Recently appointed by the General Directorate of Health (DGS), he took the position of Director of the National Programme for Viral Hepatitis. It is one of the 12 priority programmes of the DGS.
On 9 October 2021, World Palliative Care Day was held, so we asked Professor Rui Tato Marinho to talk about these diseases.
But what are palliative diseases?
According to the Professor, the vast majority of cases are oncological diseases, dementias, for example people with strokes and who are bedridden, and others with neurological and degenerative diseases.
Palliative care is not yet recognized as a medical specialty. However, a doctor who is trained in this area identifies very early whether a patient will need such care, sending him/her early for a palliative approach. He mentions pancreatic cancer as an example, “where the average life expectancy is around 4 to 5 months, so we begin to prepare the patient and the family for the symptoms they will experience, the pain, the jaundice, the weight loss”.
Rui Tato Marinho says that society pays a lot of attention to pregnancy, children, teenagers, people in the active age of life, stressing that he does not see this attention as a negative aspect. However, we cannot forget the people we meet at the end of life, because they should also have more affection, more compassion (compassionomics), empathy, attention and more dignity.
“Increasingly, we are going to have more people who are older, more cancers, more dementias, so we have to prepare for the future (the repetition of more is deliberate). The future is technology, innovation, artificial intelligence, big data, but the human part must continue to care for the elderly, those who helped build the country”.
We are the fifth country in the world with most people over 65 years of age.
Let's keep talking in numbers.
Out of curiosity, he also reveals that the Portuguese population is not as healthy from 65 years of age onwards, as the Norwegians or the Danes are, possibly due to the lack of physical activity and the lesser attention paid to health care, namely healthy lifestyles.
It is urgent to invest in Care and Palliative Medicine. It is a social emergency and an ethical duty for all of us. They are our parents, our grandparents, great-grandparents and some children who were unlucky and have a health problem.
For nearly 20 years, the FMUL has offered a Master Degree in Palliative Care, a pioneering initiative in the country. This year, it is in its 19th edition and about 450 health professionals have had this training. The FMUL has played a pioneering role in the creation of a critical mass.
“I pay tribute to Professor António Barbosa, a visionary, who foresaw the future correctly 20 years ago. In the unit, we have a Palliative Care Specialist and a Psychologist who pay particular attention to the issue of Mourning and Communication, respectively Professor Paulo Reis Pina and Professor Miguel Barbosa, and secretariat by the Advanced Training Institute (Dr Antónia Ferreira) and Dr Vivelinda. Involving the ten training units, each for 3 days, in the master degree is an arduous but rewarding task. I feel that we are building and promoting literacy in this very global and humanistic area”.
The central themes of the training in Palliative Care are the physical component, symptoms, pain, nutrition, how to treat a person with cancer, mental support (helping in the treatment of anxiety, depression, insomnia) and also addressing the spiritual dimension. The Professor reports that spirituality is forgotten in scientific treatment, “when we are facing the end of life, but spirituality ends up being very present in our country and every day life, due to the fact that we are mostly Catholic, without forgetting all other religious and non-religious beliefs”.
"A person is not just a body, nor just an organ. It is also a mind, we must give a global dimension to the social, spiritual and cultural parts, so we will be happier".
Leonel Gomes
Editorial Team