IAHPC’s Faculty Development Award
IAHPC FUNDED PALLIATIVE CARE FACULTY DEVELOPMENT PROJECT
FINAL 2006 REPORT
BENEFICIARY: Ocean Road Cancer Institute (ORCI)/ Muhimbili University College of Health Sciences
IMPLEMENTER: ORCI
AWARD RECIPIENT: DR. DIWANI MSEMO
PROJECT SUPERVISOR: DR. TWALIB A. NGOMA
The Challenges of incorporating Palliative Care in the Medical and Nurse training curriculum in Tanzania
Background:
In 2002, I had an opportunity to lead a team of 7 members from various government sectors to carry out a WHO initiated situation analysis and needs assessment for palliative care services in Tanzania. Being the person who set up the 1 st palliative care unit in the country, I was given an opportunity to share my experiences with would-be palliative care stakeholders. The task of the team was to determine if there was significant demand for palliative care in the country, evaluate the current status of palliative care and finally to assess if it would be cost effective to establish such services countrywide? The team was appointed by the Permanent Secretary of the Ministry of Health and was provided with terms of reference. The project was funded by the WHO.
In this study, the findings were clear and loud that the demand for palliative care was great and it was cost effective as well. It was noted that the untold suffering brought by HIV/AIDS, cancer and other chronic debilitating conditions made these patients face their death without dignity and in agony. Since the study showed that current training in our medical schools is disease/cure oriented and does not produce professionals who are well equipped with knowledge and skills to address palliative care needs, it was recommended that this problem should be urgently addressed. Other recommendations which were made include the need to formulate a clear policy on palliative care at the national level. It was also suggested that the existing home based care networks/infrastructures be used as a vehicle to deliver palliative care at home. This was thought to not only relieve the suffering that a lot of these patients are enduring, but it would also relieve hospitals of overcrowded wards and reduce in-patient costs. It was also pointed out that there is a great need to provide palliative care education to doctors and nurses in practice and to incorporate palliative care into the curriculum of medical and nursing students in order to equip them with these important skills.
The recommendations on policy issues fall under the ministry of health while education falls under the university of which I am a faculty member. I therefore thought that I was duty bound to promote/champion it. After careful consideration and upon balancing my administrative duties as the Executive Director of ORCI with my academic duty as a Senior Lecturer in the medical school, I decided to seek the faculty development support offered by IAHPC. This would permit a dedicated person to assist with introducing palliative care as a separate discipline in the Muhimbili University College of Health Science’s medical and nursing curriculum.
Dr. Msemo Diwani, a young and dynamic man, was due to return here. He studied palliative care in Uganda in mid nineties and later became the head of palliative care at ORCI before leaving for oncology training in South Africa . Having involved himself in palliative care while in Johannesburg , and championing the introduction of palliative care at the University of the Witwatersrand Medical School , Dr. Msemo indicated that he wanted to dedicate all of his time doing the same at ORCI. His agenda was to promote good palliative care services at the Institute, train the faculty and develop advocacy for palliative care policy in the country. This motivated me to write a proposal and submit it to IAHPC in order to secure a grant for his post. This would give the Institute/faculty time to prepare to continue supporting the program after the conclusion of the 24 months of IAHPC support. Our proposal was accepted and on 1 st December, 2004 the work began and the work continues today!!
Success & Failures of the Project.
During the first month that Dr. Msemo assumed his post one of his objections was to persuade the ORCI management to create 4 more permanent posts for 2 nurses, one assistant doctor and a social worker. He made it clear that palliative care can only succeed if it is given equal priority with other services and that it is not practised on a part time basis. The staff was trained in palliative care, but because of shortages of manpower at the Institute, these individuals were also assigned to additional primary duties. This made it very difficult because it meant that 4 additional staff had to be employed to take on their responsibilities. We now have 5 palliative care team members, four of which are paid by ORCI while Dr. Msemo’s salary is being supported by IAHPC. I also offer my time and service to the team whenever it is needed.
Palliative Care Services
There has been a dramatic improvement in the services given to our patients at ORCI. Patients are referred to us for difficult pain and symptom control by the surrounding health facilities because we have a team dedicated exclusively to palliative care. We conduct daily wards rounds, palliative care OPD clinics for HIV/AIDS cancer patients on ARV and we have implemented improved documentation and record keeping. Outreach services have also been started after we received a grant from The Diana, Princess of Wales Memorial Fund and is aimed at supervising various home based care providers in the district that we trained.
Training & Advocacy
Significant progress has also been made in this regard, however a lot still needs to be done. Several workshops, both academic and advocacy, have taken place and various potential stakeholders and policy makers were involved. Dr. Msemo is the leader of the champion committee and now is the Board Chairperson of the Tanzania Palliative Care Association. During numerous meetings, he has done significant work to bring palliative care into the national agenda. Over the next three months the team has planned to conduct palliative care training for home based care providers in 2 more districts using ORCI funds provided by the government for community services.
Training of the faculty is still carried out under the oncology program. The medical school has not yet allocated a special time for palliative care in its curriculum - despite their admission that there is a great need. Naturally this has made Dr. Msemo frustrated as he feels that he has not achieved all that he had planned, but as a matter of fact, he has achieved quite a lot. In-service training for health workers at ORCI is going well and plans are in the final stages to do the same for Muhimbili National Hospital , the largest referral and teaching hospital for our medical school. Dr. Msemo also has enrolled in the Mphil program at the University of Cape Town , RSA, special thanks to IAHPC which supported his travel for contact workshops and to UCT/OSI for sponsoring his tuition fees. I would like to mention three ladies who have been an inspiration and strong supporters of our program, they are Liliana De Lima of IAHPC, Liz Gwyther, the mentor to our program and the convener of the palliative care program at UCT and, last but not least, Dr. Debbie Norval from South Africa who introduced us to IAHPC as well as encouraged us to apply for the grant. I thank them all very much for their understanding and their true palliative care spirit.
Conclusion
Owing to the conservative/bureaucratic nature of our medical school, curriculum changes take a rather long time. This makes it difficult for an ambitious young man like Dr. Msemo who would like to see immediate results. I have encouraged him to look at the example of HIV/AIDS medicine which has only recently been included in the medical curriculum despite the fact that it is long over due and very important to the health care in our country. Personally, having observed cancer services evolve slowly in Tanzania over the last two decades, I strongly believe that palliative care will one day be a recognized discipline in the medical schools in Tanzania . The work continues!!!
DR. TWALIB A. NGOMA
Executive Director of ORCI
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