According to the 2020 edition of the Atlas of Palliative Care in Latin America, Mexico has only 20 palliative care (PC) teams, and just one specialized paediatric palliative care (PPC) unit: the “Pablo Jiménez Camarena” Paediatric Palliative Care Unit, known as PediPali, located at the Civil Hospital of Guadalajara “Dr. Juan I. Menchaca” in Guadalajara, Mexico.
PediPali was founded by Dr. Yuriko Nakashima-Paniagua, a paediatrician who, in 2003, travelled to Costa Rica for PPC training. After returning to Mexico, she began working at the Civil Hospital of Guadalajara in 2005, offering paediatric care with a palliative approach in the outpatient clinic. This marked the first time paediatric patients with complex chronic conditions in the region received care under this model, significantly improving their quality of life.
The unit officially opened on December 18, 2018. It is publicly funded through the hospital itself and the University of Guadalajara, with additional support from civil associations and private donors. The team offers interdisciplinary care, composed of paediatricians, PPC specialists, paediatric palliative medicine residents, nurses, psychologists, nutritionists, physical rehabilitation therapists, social workers, administrative and cleaning staff, and a chaplain.
PediPali provides personalized daytime care Monday through Friday, tailored to the needs of each patient. All first-time patients are seen by the full team, and follow-up care is customized accordingly. Hospitalized patients are attended through consultations requested by their treating physicians, focusing on pain management, symptom control, end-of-life care, and decision-making support for patients with life-limiting conditions, including prenatal cases with poor prognoses. Stable patients are seen in the outpatient clinic, while those requiring management of refractory symptoms or specialized medication are treated in the day hospital.
Volunteers, such as the therapy dog team from the civil association Patitas de Ayuda, play an important role in supporting patients’ and families’ emotional well-being. Remote follow-up is also provided via phone, video calls, or messaging based on family needs. Home care has decreased due to pandemic-related limitations and rising violence in the country. While many families prefer to care for children at home, limited financial resources often make hospital care necessary. This highlights the importance of educating families on home-based care strategies.
In 2024, a historic milestone was reached with the launch of Mexico’s first Paediatric Palliative Medicine subspecialty program, based at the Civil Hospital of Guadalajara and accredited by the University of Guadalajara. The program currently trains four residents.
PediPali aims to become a national model for PPC, with short- and medium-term goals that include expanding the interdisciplinary team, strengthening academic training, and developing evaluation tools to assess its clinical and social impact.
Lessons learned:
- “Don’t run before you can walk.” When the palliative stage arrives, it’s tempting to do everything at once—take it step by step.
- Young people are your greatest allies. PediPali was made possible thanks to interns and trainees.
- Education is essential—at all levels: healthcare providers, hospital staff, patients, and the public.
By Yuriko Nakashima-Paniagua,
Paediatric Palliative Care Physician.
Head of Paediatric Palliative Care Unit – PediPali, Hospital Civil de Guadalajara.