THE HARLEM PALLIATIVE CARE NETWORK (HPCN)

In addition to being less healthy, suffering higher mortality rates and having higher incidences of chronic disease, African-Americans even experience pain and death differently from white Americans.

In response to the disparities between pain management and end-of-life care between African-Americans and white Americans, last year North General Hospital launched the Harlem Palliative Care Network (HPCN), a program developed in conjunction with Memorial Sloan- Kettering Cancer Center and Visiting Nurse Service of New York.

According to the Visiting Nurse Service, each year more than 60,000 people die in New York City. More than 75 percent of these deaths are attributable to four common, progressive diseases-cancer, heart disease, chronic obstructive pulmonary disease and AIDS- diseases that disproportionately affect minority communities. Many of these people die without palliative care services to address medical, emotional, spiritual, social, pain management and medication, advance planning and bereavement support for themselves and their families and caregivers.

HPCN has developed a network of providers including 80 local physicians, clergy, community-based organizations, Legal Aid, and soup kitchens.

Eighty patients are currently active in the program. Each has received assistance in linking to an average of two community services to address their medical and social needs. In addition to health care, people with life-threatening illnesses must deal with myriad issues, including guardianship of children, advance planning/life directives, and resolution or closure in their relationships with family members and other loved ones.

• George Howard was living with every dancer's nightmare - constant, aching hip pain and leg weakness. Before discovering the HPCN, Mr. Howard was withdrawn, had difficulty obtaining his medication and was refusing corrective surgery.

• A 75-year-old former professional dancer who has not performed lately due to the increasing pain of his degenerative joint disease, Mr. Howard has been a client in the HPCN for the past year. His ordeal has been made more bearable through the network's provision of social, medical and counseling services. His hip replacement was successful and he will undergo knee replacement in early January. He hopes to return to teaching dance movements at a senior citizens centers.

• Judith Haylock is an eight-year cancer survivor who was referred to the HPCN following her most recent in-patient stay at North General Hospital. With the help of the HPCN, Ms. Haylock has been able to get emotional support, pain management education and work on her end of life care plans with her family.

In an April 2000 New England Journal of Medicine article entitled "Racial Injustice in Health Care," Dr. Harold Freeman, a surgical oncologist at North General Hospital and Dr. Richard Payne, a neuro-oncologist at Memorial Sloan-Kettering Cancer Center assert that "...differences in access to treatment and quality of care are at least part of the reason why the rates of death from some diseases are higher for Blacks than among whites."

To examine the disparate pain management and end-of-life experiences encountered by African-Americans and to find ways to improve care, more than a dozen health care experts from throughout the country addressed a cross-section of public and private sector leaders, clergy, social service and elected officials on Friday, January 4, 2002 from 8:00 a.m. to 5:00 p.m. at City College for the first national forum "Heritage, Health, and Hope" organized by the New York-based Initiative to Improve Palliative Care for African-Americans.

Keynotes included Dr. Payne, who is also the director of the Pain and Palliative Care Service at Memorial Sloan-Kettering Center; Dr. Freeman, who is also a former president of North General Hospital and Dr. LaVera Crawley a bio-ethicist at Stanford University.