University of São Paulo: Students from USP’s Faculty of Medicine volunteered at Hospital das Clínicas to help care for patients with covid-19

Common sense understands palliative care as a type of care indicated by doctors when a patient is close to death. “But, ideally, palliative care should start when the person is diagnosed with a disease that compromises their life,” says medical student Gabrielle Cordeiro Trofa, 24. A fifth-year student at the USP Medical School (FMUSP), this year Gabrielle volunteered in one of the wards that the Hospital das Clínicas (HC) of FMUSP set up to receive patients with covid-19. Her experience and that of other students who served as volunteers brought them together around one agenda: the inclusion of this type of care in the curriculum of the undergraduate medical course.

Gabrielle was a volunteer in the temporary palliative care ward. She was part of a group of five students who helped the health team in a communication project with the patients’ families. The young people’s main responsibility was to organize virtual visits: video calls made using tablets and telemedicine robots, in which inpatients and their families had the opportunity to see and talk.

“We were there to make these virtual visits, but ended up getting in touch in the practice of palliative care”, says Gabriele. “We participated in family meetings, which were also happening online, seeing how to communicate effectively, how to give bad news and, even far away, the professionals were able to show compassion, how much they cared for the patients, how much everyone was doing there. the best to take care of them. So we ended up attending a lot in that sense too ”, completes the FMUSP student.

With the practical activities of the medical course suspended due to the social distancing measures, students who dedicated themselves to volunteer work at the HC faced the worst period of the pandemic within the hospital complex. They were there when, in July, Brazil registered 319,389 confirmed cases of covid-19 and 7,714 deaths in just one week, according to data from the state health departments compiled by the National Council of Health Secretaries (Conass). Of that total, 1,870 were in the state of São Paulo.

What is palliative care?
According to Ricardo Tavares, from the HC Palliative Care Center, palliative care has been defined by WHO since 1990, but the concept has been undergoing improvements over time. The health field comprises palliative care as a multiprofessional practice that aims to promote the quality of life of a person who is suffering from dealing with a disease that puts their life at risk . The most modern definition also includes as beneficiaries of this type of care people in distress for other reasons, such as humanitarian crises. In Brazil, palliative care arrived in the early 2010s.

Far from graduation
Although the HC has had a palliative care residency program since 2014, students estimate that the topic is still far from graduation. Perhaps, therefore, physicians’ knowledge of the topic is still limited. “A lot of people still call us near death. Days, weeks before death. We have a performance that ends up being limited by a time limitation ”, laments Dr. Ricardo Tavares, coordinator of the HC’s Technical-Scientific Center for Palliative Care.

He explains that the association between palliative care and the moment of death comes from an outdated definition. “In the 1990s, it was a practice that was mainly linked to cancer and much more related to the end of life. Today, we understand palliative care as a promotion of quality of life. This is not necessarily related to death. It is quality of life for a patient who has a serious illness, with an imminent risk of death or not, but who is suffering for any reason. Psychic, physical, familiar ”, says Ricardo.

Ricardo Tavares, coordinator of the Technical-Scientific Center for Palliative Care of HC – Photo: Reproduction / FMUSP
“The focus is on human feeling of any nature, in a context related to a disease and, currently, even in other contexts, such as fragility contexts, humanitarian crises. How was the covid story, like the issue of refugees, minorities, oppressed populations ”, says the coordinator of the HC nucleus. The doctor is also keen to emphasize that practice is not only a medical practice area, since it always requires a multidisciplinary health team, composed of professionals with different backgrounds – including psychologist, nurse and physiotherapist.

FM students worked alongside HC doctors to care for patients with covid-19 in the palliative care ward
Experience of FM students with doctors at the HC Palliative Care Center inspired an initiative to encourage discussion on the topic at graduation (photo registered before the pandemic) – Photo: Personal archive
Learning in practice
It was seeing the results of this type of work that the students decided to organize themselves to put more colleagues in contact with the practice of palliative care. The first step was to propose to the nucleus coordination an expansion of volunteering, bringing students who were working in other wards of the HC to participate in the palliative care ward project.

“These virtual visits started in the palliative care ward, but other wards tried to make a project for the hospital, which worked, but with a much smaller number of visits. There in palliative care, we did it effectively every day. We propose to call these students who were involved in other wards to have access to what it was like to do palliative care and learn too ”, says Gabrielle.

The fifth-year student, who had already participated in the Academic League of Palliative Care in previous years, remembers the experience of caring for a patient who had advanced cancer, with no prospect of a cure. Like the other patients in the ward, she had developed a severe form of covid-19 after being diagnosed with terminal illness and the hospital staff estimated that an ICU stay would not benefit her.

“She was isolated, with covid, and suffering a lot from being there alone. She always said, ‘you have abandoned me, you are not coming to visit me’. And then, the moment when we were going to make the virtual visit was a moment of great happiness for her, who effectively saw all her children, talked and told a thousand things “, says Gabrielle.

According to the young woman, on one of these visits, the patient commented that she was very willing to drink a soursop juice. “I went to a store near here, bought the soursop juice and gave it to her the next day”, says the student, explaining that in the palliative care ward, “the priority, the urgency, is what brings the most quality of life for the patient. patient there. ”

Palliative Care League
It is one of the more than one hundred leagues maintained by FM students with the support of the teachers of the house. These leagues organize extracurricular activities and have the function of providing training spaces on certain topics. The leagues select participants through tests and offer introductory courses. But the experience of joining a league is quite different from the practice that the emergence of the coronavirus pandemic has provided.

Despite the terminal illness, this patient recovered from the coronavirus infection. And it was not the only one. “We had a very expressive increase. For this severity, for this condition in patients already terminally ill, we even discharged almost 25% of them. And everyone received a video call visit ”, says Ricardo.

With the end of volunteering, students decided to take the topic to the digital tools that are being used in distance learning, in order to disseminate it to more colleagues, and call a first virtual meeting to discuss the inclusion of palliative care in the grid. medical course curriculum. The objective, according to Gabrielle, is to start the discussion of a proposal that can be brought to the professors of FMUSP.

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