2016; Volume 17, No 12, December
IAHPC Traveling Scholars’ Reports: Bangladesh, Cameroon and Zambia
Twenty-first International Congress on Palliative Care, Montreal: A springboard to the global family of palliative care
In October 2016, three IAHPC members from Bangladesh, Cameroon and Zambia received grants to travel to Montreal, Canada, to attend the 21st International Congress on Palliative Care.
As a requirement of the scholarship, grantees deliver an oral presentation and/or a poster and are asked to give a glimpse of palliative care in their countries and how they hope to adapt some of the knowledge and experiences gained at the congress to their own settings.
Dr. Romance Djoumessi Nguetse, a physician at the Bafoussam Regional Hospital in West Cameroon where a mobile palliative care unit was created in July 2013, writes:
As a doctor striving to implement a palliative care project in the West Region of Cameroon, participating in this international congress was enriching. I learnt a lot from the experiences of other countries: from the ‘Pallia Family’ in the Congo, from Tanzania, Mongolia and about how the Livingstone Central Hospital has integrated palliative care in Zambia. They all have in common an extraordinary commitment to provide essential palliative care while striving to involve the decision-makers to gain recognition, assistance and help in scaling up to national levels.
The Bafoussam Regional Hospital is the referral hospital of the densely populated region of West Cameroon, with a total population of 1,834,812 inhabitants (2005 census). With the prevalence of HIV of 4.2 percent, the cancer and HIV/AIDS-related need of palliative care is estimated at 9,357 patients for this region.
We manage physical symptoms and pain with oral liquid morphine, psychosocial support of patients and their families, home visits and campaigns to raise awareness of the service. This unit was the only one in the region until the start of the ‘HoPE’ project (Hospital Palliative Care Engagement), funded by the African Palliative Care Association (APCA) in 2015, which aims to integrate palliative care into the healthcare system in the Western Cameroon. So far, the project has trained 43 doctors and nurses in palliative care; created and equipped 18 mobile palliative care units in district hospitals in West Cameroon, and mentored the activities of those units.
We face many challenges. The need for palliative care in our region is great, but most patients cannot afford to come to hospitals and prefer integrated healthcare centers, where there are currently no palliative care workers. There is a need for further training for new staff and to extend provision of services, but as palliative care is new in this region potential local funders are reluctant to support it.
As well as providing new information on clinical topics, the congress gave opportunity to network with, and learn from, several non-governmental organizations such as Pallium Canada, Pallium India and the Canadian Virtual Hospice. Their approaches were inspiring for newcomers like me.
Participating in the conference was a springboard to get into the great global family of palliative care. As we struggle for quality care in our region, the knowledge in core subjects will help us to address our daily clinical issues. It will permit us to integrate palliative care into services such as cardiology and intensive care.
Dr. Mwate Joseph Chaila, a palliative care physician from Livingstone, writes:
Livingstone, with a population of 142,034 (2010 census), is the tourist capital of Zambia and previously the capital of the Southern Province. It is home to the Victoria Falls, and borders Zimbabwe, Botswana and Namibia. Livingstone is also home to a vibrant hospice and palliative care services.
Palliative care (PC) in Livingstone started in 1993 when the Franciscan Missionary Sisters for Africa, in conjunction with the Ministry of Health and the Catholic Diocese of Livingstone, established the St. Francis Community Integrated Care Programme (St. Francis Home-based Care). In 2008, St Joseph’s Hospice opened having been inspired by Brother Rudolph, a Franciscan Capuchin Missionary, who had observed that many terminally ill patients were left to die without human dignity because of lack of proper palliative care. A needs assessment showed that a hospice was necessary and would be supported by the community.
In 2012, the Palliative Care Alliance Zambia (PCAZ) trained the first team of 15 healthcare workers from Livingstone Central Hospital in the basics of PC and pain management. This later became the Livingstone Central Hospital Palliative Care Team (LCH-PCT) and defied all odds to become a model of integrating PC within a government hospital setting.
- Building on the presence of other PC units in Livingstone, the LCH-PCT incorporated the hospice, home-based care unit and the district health management team to form the Livingstone Palliative Care Team.
- Maramba Old Peoples’ Home was incorporated and continues to provide PC services to the home.
- Mentorship from PCAZ has continued with further training at diploma level at Makerere University in Uganda. To date, five staff members have been trained at the diploma level.
- The team has shared its experiences at local and international conferences and meetings, including Canada, Kenya, Singapore, South Africa, Uganda and Zimbabwe.
- The hospice remained open at a time when many other hospices were closing because of lack of funding. A partnership with government, which provided the core clinical staff, has allowed the hospice to spread its limited resources widely.
- We have continued to host international and local organisations in Livingstone to share our experiences of integrating PC.
While Livingstone has recorded successes in palliative care provision, other districts, and the country as a whole, are still struggling. Lack of funding to PCAZ has negatively affected palliative care advocacy in Zambia. Financial support remains a challenge especially at the hospice. Continued resistance from healthcare providers to adopt palliative care principles.
Lessons from the Montreal
The conference has given me the zeal to start advocacy for PC at the national level with the support of the team at Livingstone Central Hospital and St. Joseph’s Hospice. I’m encouraged to do more research and to share our experiences across the country and the globe to influence policy on PC, which may help us to attract funding and partners for our work.
In countries like Zambia, where hospice and palliative care is a relatively new concept and there is a lack of any policy and institutional framework, lobbying government (through institutions such as PCAZ and religious bodies) about the significant and complementary role of hospices is critical for long-term sustainability. Integrating palliative care in government hospitals is possible – and this is probably the way to go.
Dr. Mohammad Shahinur Kabir, palliative care physician and founder of Hospice Bangladesh, Dhaka, writes:
I have been working in palliative care since 2009, first with ASHIC, the first and only pediatric palliative care service in Bangladesh. In 2014, I founded a home-based palliative care service, Hospice Bangladesh. The team of two doctors, a medical social worker and 27 nurses provide 24/7 home care within Dhaka. More than 200 patients have been supported at home in the past two years. Pressure on home care is high and the cases are very different: cancer, stroke, renal failure and others.
The chance to participate in the 21st International Congress on Palliative Care, supported by the IAHPCA scholarship, was a unique experience … a great opportunity to discover the most recent advances in palliative care and to meet people face-to-face whom I have previously ‘met’ only through the Internet. It was exciting news for me that my poster was selected for the ‘Poster walking’ session, which was a new session at the conference.
I learnt more about new methods of treating and evaluating physical and psychological symptoms and understand better the idea that patients and their family members have the same needs. What makes the difference is the availability of high quality palliative care.
IAHPC earns permanent spot on GlobalGiving website to support Traveling Scholarships
In September 2016, the IAHPC began a fundraising campaign with GlobalGiving, a crowdfunding community that connects nonprofits, donors and companies, by creating a project titled ‘Travel Scholarships for Palliative Care Workers’. The goal of the campaign is to raise $50,000, which would double the number of Traveling Scholarships in 2017.
In order for the ‘Travel Scholarships for Palliative Care Workers’ project to qualify for a permanent spot on GlobalGiving’s website, the project had to raise $5,000 by the end of September. Thanks to our friends, we met the challenge and earned a permanent spot enabling us to participate in the 2016 #GivingTuesday campaign.
#GivingTuesday was formed in 2012 and established a global day of giving. In 2015, more than 45,000 organizations in 71 countries participated to bring awareness and raise funds for their organizations.
This year, Giving Tuesday was November 29th. Thanks to the IAHPC community, we were able to raise a total of $10,812 between 1 September and 29 November 2016.
The IAHPC team would like to thank the many donors (and those who donated anonymously) who supported our Traveling Scholarships Program. You can view a list of donors on the IAHPC Membership Matters page.
To find out more about IAHPC’s Program Support Grants, and our Traveling Scholarships and Traveling Fellowships, please visit our website. Through these programs we support projects and individuals around the world, especially in developing countries in Africa, Eastern Europe, Asia and Latin America.
You can contribute to this program and help palliative care workers attend and participate in congresses and courses by donating to the Traveling Scholarships Campaign in the Global Giving website.