2009; Volume 10, No 1, January



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A Report by an IAHPC Board Member
Dr. Richard Harding

Sharing knowledge and resources- are we looking in the right places?

I worked for a number of years as a teacher and researcher in palliative care for resource poor settings. Since the advent of antiretroviral therapy in Europe, USA and Australia, the skills of HIV pain and symptom control and holistic care have been largely forgotten. In Sub-Saharan Africa there are working models where palliation, antiretroviral therapy and outpatient care integrate. While I don’t believe that we should  transfer models of care in a “culturally blind” manner, neither should we overlook the opportunity to learn inexpensive, innovative and feasible models of palliative care delivery from our “resource poor” colleagues. The IAHPC, in which I am a board member, strives to provide clinical, teaching and research opportunities for those interested in palliative care in resource poor settings. The IAHPC’s Traveling Fellowship, Traveling Scholar, and Faculty Development programs provide educational opportunities for healthcare providers in these countries with the goals to share scientific, policy, teaching and financial resources.

Certainly we are not graduating a sufficient number of generalist or specialist palliative care providers in rich industrialised countries. We haven’t all the answers but we do have greater coverage, access and financial resources allocated to palliative care than is found in middle and lower income countries. The question remains whether our efforts to help globalise palliative care has been equitable? The HIV epidemic has brought a flow of financial resources to Africa, and this has catalysed strategic and highly professional organisations such as APCA and HPCA. But what about other regions? Palliative care is needed in Asia and Latin America, but it seems to me that local associations such as the Latin American Association for Palliative Care, Asia-Pacific Hospice Palliative Care Network, and the Indian Association of Palliative Care have few funding opportunities available to them. For those of us in higher income countries palliative care professionals find it very difficult to obtain funds to enable them to establish working partnerships in less well off regions.

We need to educate funding sources about the lack of funds, palliative care opportunities and the need for research in resource poor countries. We should assist those in these countries who have achieved progress to share their knowledge, strategies, successes and failures with others not only in the region but with all that may benefit. For example, at King’s College, London along with our African colleagues, conducted the first full scale clinical palliative care audit cycle in Africa. Five specialist palliative care centres in two countries participated. Based on patient and family outcomes, strategies where developed to improve and implement programs that will lead to highly skilled clinical palliative care researchers with the engagement of local government agencies. Following the work in Africa, several of our UK and African project staff met to share their experiences and models of quality improvement with colleagues in India. In return, our team in London has learned a great deal about the application of clinical audit methods.

Our concept of how one learns requires that we to take into account the need for an exchange of experiences and knowledge between high and low income countries, as well as among those living and working in the poorer regions.

Richard Harding, PhD is a board member of IAHPC and Senior Lecturer in the Department of Palliative Care, Policy and Rehabilitation at King's College London School of Medicine.

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