• Prof. Dace Gardovska. Head of the Children's Disease Clinic at the Children's Clinical University Hospital (Riga), Head of the Pediatric Department of the Medical Faculty of Riga Stradins University.
• Dr. Anda Jansone. Founder of palliative care for children in Latvia, Chairwoman of the Board of the Society for Child Palliative Care, Head of the Service for Psychosocial Rehabilitation and Palliative Care for Children, International expert of the International Children's Palliative Care Network.
• Sofia Tomase. Deputy Head of the Children's Palliative Care Service at the Children's Clinical University Hospital, Riga.
• Irina Bisiniece. Psychologist of the Children's Palliative Care Service at the Children's Clinical University Hospital, Riga.
• Dr. Yulia Cirule-Galuza. Head of the Liepaja Children's Palliative Care Service at Liepaja Regional Hospital.
• Gundega Blizneca. Senior nurse of the children's department of Liepaja Children's Palliative Care Service at Liepaja Regional Hospital.
• Janis Balodis and Varis Bogdanovs. Chaplains of the Society for Child Palliative Care.

1. Before paediatric palliative care was officially established, we had already had an approach and an interest in providing such care to patients who were being discharged from the hospital when the hospital could no longer help them.
2. There is, of course, the aspect of collaboration, namely, developing a network of contacts.
3. Our hospital also plays a role in developing political programmes, lobbying the importance of paediatric palliative care.
4. We focus on supporting families and providing consultations.
5. We provide comprehensive care.
6. Of course, education and training are essential aspects.
7. Research and innovation are equally important.

1. service accessibility;
2. education;
3. lobbying for palliative care in government, because without a legal framework, it is impossible to develop and expand access to paediatric palliative care.

1. Life-limiting disease – a disease that leads to death, such as trisomy, Patau syndrome, or Edwards syndrome. Last year, 53% of our patients fell into this category.
2. Life-threatening disease – premature death occurs, but there is a chance that children may reach adulthood. This accounts for 32%.
3. Incurable diseases – a relatively small percentage, only 15%, which are terminal diseases where death is inevitable. So far this year, only 16 children have died. Most families of these children chose home as the place of death, which also speaks to the quality of palliative care and home support.

• Specialist consultations. The patient has access to a palliative care doctor, nurse, and psychologist.
• We fully equip our patients with the necessary medical devices, such as a pulse oximeter, stationary oxygen, or a feeding pump.
• Medical nutrition is provided throughout Latvia, in any region.
• Disposable materials, such as catheters, tracheostomies, gastrostomies, and pump systems, are all provided free of charge, covered by the healthcare system.
• Psychological support is vital. How do you cope with such a difficult situation? Probably the hardest thing in life is when your child is incurably ill, and our wonderful psychologists help parents cope with this. Psychological consultations are always free for our patients and their families, with no long waiting times. We provide support during crisis moments: at home, in the hospital, online, or by phone.

1. The very first stage is need, when we have an idea but nothing else. No resources, no money, no people. At this stage, people often stop, leaving it just an idea, a dream, saying, like Ostap Bender, that we have a great project, and we will implement it for sure, when Europe gives us money. Or like this: the world is unfair, we have such a wonderful idea, but no one`s helped us. Or: there will never be enough resources for everyone, who are we to ask? It's also risky to stay at this stage and never offer your services for money, continuing to work on a volunteer basis. Because: who are we to ask for funding? But assistance based solely on volunteer labour is not sustainable.
2. Resources. When we already receive funding, technical assistance, and premises. At this stage, there is a risk of getting stuck. That is, we now only focus on finding resources. We are afraid that resources won't be enough. We try not to inform people about our existence so that there aren't too many patients because our resources are enough for only a certain number. And we might end up quarrelling among ourselves because there are as many resources as there are, and there are more people. We might compete with other similar organisations, or even, for example, with children's hospitals or palliative societies, fighting for funding. But you can't skip this step because every organisation needs to learn how to obtain the resources.
3. If you manage to successfully pass the first two thresholds, then the awareness of values begins. These values are built on what we can share with others, not just physically, in terms of material things, but also emotionally. We talk about how important life is, how important each child is, how by helping others, you yourself become better. The risk is that by focusing on values, you might forget about resources.
4. The next stage is information. It is important to create some informational content and share it, to let people know about us. In Liepaja, even municipal deputies could not pronounce “palliative care.” But over these years, we have created a lot of content that allows people to learn a lot about what we do. Information is already spreading from person to person on its own. We have published many brochures, frequently appeared on television, radio, and in newspapers.
5. The next stage is status, when you need to exert influence on the entire field of activity. This is the stage of gaining recognition from political structures and decision-makers. At this stage, we managed to create a centre. Ilze then became the Person of the Year in Liepaja, receiving many different certificates from ministries. Status does not provide any financial resources, but if you reach this stage, it's already a guarantee that you will be able to maintain the organisation, sustain the work, and obtain the financial resources necessary for development.
6. And the final stage is commitment. Rarely do individuals reach this stage; it’s more common for organisations. This stage is when you start influencing the entire world. It is important for an organisation to be able to change people's minds. When we started working, there were attitudes in society like “we don't have sick people, we don't have disabled people.” But then it turned out that we do have them, quite a few actually. Another attitude was “your family has this child because you sinned, this is karma.” No, on the contrary, such children exist to make all of us better. And it is important to convey this to everyone. If the organisation succeeds in shifting such attitudes, it is very likely that this organisation will stay and really be able to exert a beneficial influence on the world. I believe that through palliative care, society will change so much that people will understand that if a child's birth is a value, then death—whether of a child or an adult—is equally a value. These last, sometimes short, sometimes not so short, months need to be made as comfortable as possible, allowing a child to reach their purpose and change the world.

• Planned consultations at home with palliative care team specialists for patients living in Liepaja and the Kurzeme region, daily, by prior arrangement over the phone. For example, today we arranged three consultations for tomorrow.
• Consultations by the palliative care team specialists by phone 24 hours a day, 7 days a week. This is quite interesting because the office works from 8 am to 4 pm, but we consult via phone 24/7.
• Outpatient consultations by palliative care team specialists in the premises of the Baltic Rehabilitation Center or in the palliative care office at the regional hospital by prior arrangement.
• Outpatient consultations by a psychologist and psychotherapist, also by prior arrangement.

• The team works together on goals focused on the patient’s well-being. The most important thing is the patient, the child, and their family.
• A person-centred approach, taking into account the individual situation. Even in a situation where the illness is completely incurable, we look for realistic goals and work towards them together. Parents going through this difficult journey need some stability, some certainty. They need to adjust to the new reality.
• Communication within the interdisciplinary team. I want to emphasise that the interdisciplinary team is decentralised. We know that in a multidisciplinary team there is a hierarchy, and this is necessary because there has to be someone who takes the main responsibility—this is the doctor who is responsible for the child’s life. But in an interdisciplinary palliative care team, it is necessary for everyone to play their separate role, and it takes a lot of skill to stay in tune with colleagues, so that tasks and any other information flow freely from one team member to another.
• In an interdisciplinary environment, the team implements new ideas, alternative recommendations, not just conventional knowledge, but something someone gained, for example, during some training, and shares with the rest.
• Teamwork is the philosophy of palliative care. Some people think that an interdisciplinary team is just when you manage to get a doctor, a nurse, a psychologist, a social worker, a chaplain, and maybe some volunteers together. And now each of them will do their job, and you don’t have to worry about anything. This is not true. This is a philosophy, an idea on which the interdisciplinary palliative care team is based. The life of each child who comes under our care, as well as their family, has changed radically. We need to find a foundation on which people can build new dreams to replace those that were shattered when they heard the bad news. And in an interdisciplinary team, all members are involved in this work, interacting with each other. We share information with each other within the team — this is very important and necessary. This way, we can quickly respond to the patient’s needs and help.
• You can read more points on the slide, they are all important. But I don’t have much time, so I’ll move on.

• unity;
• realistic goals;
• openness;
• democracy;
• respect;
• subordination;
• and others.

Every person believes in something. Many people have a common understanding of faith and shared values.