Regional Reports in Hospice Palliative Care

The Seychelles archipelago is a group of 115 tropical islands in the Indian Ocean . The three largest islands are populated with 84,000 people. Tourism and fisheries are the main income resources.

The capital city of Victoria is the headquarters of the secondary level health service, whereas primary health is provided by an organized community service in the districts. Health care is free at the point of consumption.

The population of Seychelles is aging with a life expectancy is 67 years for males and 77 years for females. There are 6,660 people over the age of 65. There are about 70 new cancer cases per year and malignancy is the second major cause of death in the country with a mortality prevalence of 16%. The incidence rate for almost all cancers is lower than in Europe and HIV/AIDS is on the rise with 0.2% of population infected.

The health sector is well developed and has good indicators - it ranked 53rd in the WHO 2000 health report. The health service is not offering radiotherapy in the country and patients must be treated overseas, mostly in India . Almost 95% of deaths occur in the hospital environment. Comfort care is primarily offered in the acute care Victoria Hospital (260 beds). Patients with chronic illnesses are treated in the North East Point (NEP) Hospital (44 beds) and the Fiennce Institute (140 beds for health and social problems in the elderly age). A small percentage of terminally ill patients are treated at home by a patronage service in the districts or by allocated home careers. There is not a coordinated or organized palliative care system or philosophy. Specialized care in hospice is not available and doctors and nurses are not trained in palliative care. The Government of Seychelles, the Ministry of Health in Seychelles , the Rotary Club of Victoria, the Cancer Concern Association of Seychelles, and many other groups of religious, NGOs and individuals are now ready to join forces to create a palliative care system in the country.

This process is now in the research and project proposal phase. In the health sector, the advocacy process is going on within the public and professional domains. A workshop on palliative care was given at the national level, and the next phase is to create a hospital/primary health/palliative care steering committee. The Rotary Club of Victoria is committed to refurbish a building for hospice headquarters that will include 6-8 rooms on the grounds of the NEP hospital. It is also initiating a Palliative Care Fund with the help of other service clubs in Seychelles in order to provide further financial support for the continuity of the project. The project is supposed to provide palliative care, terminal care and bereavement care.

Of great importance to the country is that we successfully develop this project and implement education and training for doctors, nurses and the public, and to study public opinion. We also need to secure financial support for the project and identify trustees that will manage the funds. The renovation of the building that will house this project is also vital to providing an environment in which to run the system. A national policy and guideline for palliative care as well as the identification of non-medical activists to support this project are important components for a “good start.”

As both the Director General of Hospital Services in Seychelles , and this year’s Rotary Club president, I initiated and promoted this project. We contacted Dr Anne Merriman (Hospice Africa, Uganda ) for help with our educational programs and our national seminar on palliative care. We wish to thank her for all the support and assistance she is providing.

Dr.Miodrag TODOROVIC, MD FCS(ECSA)
Senior Consultant Surgeon and Director General Hospital Services, Ministry of Health Seychelles
Po Box 52
Tel +248 722 135
Email: [email protected]

Following the recent introduction of opioid analgesics in Nigeria, it was recognized that there was a need to provide education on safe handling and use of these substances. Our group, the "Centre for Palliative Care (CPC), Nigeria" in collaboration with The University College Hospital, Ibadan held a one day workshop for nurses and resident doctors on March 2, 2006.There were 50 participants. The topics covered included: pain and its assessment, pharmacology of opioid analgesics, routes of administration and use (including oral morphine), regulations of opioid analgesics, procurement, distribution, dispensing, monitoring and complications of use. There was an amazing amount of interest in the program and we discovered a knowledge gap among the participants. We believe that this workshop should be provided to all doctors and nurses in the country. We are particularly pleased that Mrs. T A Arilesere, the head of the narcotics control division of the National Agency for Food and Drugs Administration and Control (NAFDAC), Lagos, and the zonal director, Mr Asemota, were able to participate. We have been assured that there will be a sustained supply of opioid analgesics. Our group will continue to work with the government and other stakeholders (National and International) to ensure the safe use of opioid analgesics.

Olaitan Soyannwo Project director, CPC Member, IASP council and APCA Board Professor of Anaesthesia/Consultant College of Medicine,
University of Ibadan/University College Hospital
P O Box 1089,
Agodi, Ibadan
NIGERIA
www.westafricanbioethics.net

FHSSA is in the midst of compiling a list of possible candidates to be entered into our Loan Technical Expert Roster. We are seeking interested, experienced palliative care and hospice professionals to serve as consultants to international organizations, non-governmental organizations and/or African palliative care organizations. Potential consulting assignments may range from 2-8 week assignments. The goals for the Loan Technical Experts vary according to their roles; however they may include:

The Foundation for Hospices in Sub-Saharan Africa
1700 Diagonal Road, Suite 630
Alexandria, Virginia
22314

DISCLAIMER: The Loan Technical Expert Roster is a database of names for possible contractual agreements in the future and not an offer of employment by NHPCO/FHSSA.

The American Academy of Hospice and Palliative Medicine now offers a free "International Corresponding" membership to physicians from countries on the HINARI list. The description is as follows:

"International Corresponding membership is available to physicians at the postgraduate level for whom a significant portion of their professional activity is related to palliative care, and who reside in a nation included on the HINARI lists of eligible countries (http://www.who.int/hinari/eligibilit ). Applicants must provide documentation that they reside in an eligible country. International Corresponding members receive electronic access only to periodicals and may not vote, hold office, or serve on AAHPM committees or task forces."

The Pain & Policy Studies Group (PPSG) would like to inform you of a recent Spanish-language report which provides information about the availability of opioid analgesics in the world and for countries in the region of Latin America . The report " Descripción de la Disponibilidad de Opioides en América Latina," was prepared for presentation at the 3rd Congress of the Latin American Association of Palliative Care in Isla Margarita, Venezuela.
It can be accessed on the PPSG website click here (A new window will open)

	International Association for Hospice & Palliative Care
	Promoting Hospice & Palliative Care Worldwide