International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide

International Association for Hospice & Palliative Care

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"Promoting Hospice and Palliative Care Worldwide"

 

2004; Volume 5, No 9, September

 

IAHPC Regional Report - South Africa

Deborah Norval, MD
(South Africa)

Index:

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Message from the Chair
& Executive Director:

Dr. Bruera
& Liliana De Lima


Article of the Month:
Dr. Ripamonti

Book Reviews:
Dr. Woodruff

Travelling Fellowship Reports:
Ghana

Regional News:
Africa
Uganda
UK

A Day's work:
Mobile Hospice Mbarara

Focus on IAHPC Board Member:
Dr Daniela Mosoiu

Hospice & Children:
Help the Hospices

Webmaster's Corner:
Anne Laidlaw

Editor's Notes:
Dr. Farr

Palliative Care in the Developing World: Principles and Practice

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Report on the Inauguration of the First African Palliative Care Association (APCA).

Annual General Meeting held in Arusha, Tanzania June 2-5, 2004
Deborah Norval, MD (South Africa)

In his opening speech the Hon. Deputy Minister of Health, Dr. Hussein Mwinyi gave his government's public support to the African initiative to seek solutions to address the care of the dying. He also gave the assurance to the Tanzanian people that their government would support the Tanzanian palliative care association in its efforts to develop policies around education and care for the terminally ill in Tanzania.

With such an auspicious opening the first annual general meeting and conference in Arusha Tanzania was in full swing. The theme of the conference, promoting understanding and sharing is a vision that was embraced by all delegates.

The father of WHO's pain control stepladder, Dr. Jan Stjernsward, encapsulated the spirit of the historical event by quoting the following - "THERE IS ALWAYS SOMETHING NEW OUT OF AFRICA"

As a South African I suddenly became aware of the importance of Africa taking its rightful place in history. As our young people are dying around us, Africa needs to find its own solutions for its problems. We Africans must, in the words of St Francis of Assisi - "Start doing the necessary, you will then start to do the possible and suddenly you would be doing the impossible". From our humble beginnings we have accomplished so much already, that the rest of the world can learn from us. Dr. Anne Merriman from Uganda stated that Africa is facing an epidemic of death. She further stated that life is taken for granted when it is not yet threatened; when it is threatened it is as fragile and delicate as an egg and is dependent on whose hands it is in.

Palliative care allows the lives of the vulnerable to be in the hands of a caring government, health care professionals and communities. It becomes affordable, assessable holistic care that is care spearheaded by government and thus forms part of the government's overall strategy for health care.

How far do we still have to go to achieve this goal? The World Health Organisation sates that affordable palliative care is in the grasp of even third world countries and it hinges on the following. Policy and commitment by government, education in palliative care for all levels of health care providers and access to pain medication, especially the ever-illusive morphine.

The following illustrates the advances countries have made to develop palliative care in their respective countries.

Uganda and Zimbabwe include palliative care as part of the national curriculum for doctors and nurses. Uganda has had the law changed to allow nurses to prescribe morphine provided that they are trained in palliative care. Similarly, South Africa includes palliative care as part of the national policy of health care. They have developed an integrated home base care programme that makes palliative care accessible and affordable for most South Africans. Uganda and South Africa have world class training programmes that can be adapted for all African countries. Botswana and South Africa have started the roll out of ARV's in all its provinces. Zimbabwe, despite all its problems, still manages to provide care. Unfortunately affordable morphine is becoming harder to obtain. It does not help that their own government denies the problem. Namibia brought its government representative to the conference to obtain information on how to start a national programme for itself.

We were humbled and inspired by countries like Rwanda, Mocambique, Ethiopia, Cameroon, Abidjan and Swaziland - where little or no care exists; where poverty is the overriding factor of existence and the sustainability of poverty - alleviation - projects supersedes health care programmes. The absence of the Northern African countries poses a major challenge to the African Palliative Care Association. It is imperative that we bring them on board as part of the initiative to plan and develop all of Africa.

Standards of care in clinical, governance, management-development and education, as well as funding, will be the focus of all policy development. Luckily most of these have been and are being fine-tuned in South Africa and can be adapted to most countries. It is the hope of APCA that by bringing the expertise together of all countries, affordable accessible palliative care will become a reality for all Africans. To this end all participating countries have committed themselves fully. In the words of the newly elected president Kath Delfilippi, quoting president Nelson Mandela - "IF WE WORK TOGETHER WE CAN BUILD THE AFRICA OF OUR DREAMS". To this end we as Africans pledge our support to ACPA. May your gods be with you.

By the end we had shared our common vision of palliative care for all. We have learnt from others and know that advocacy becomes the responsibility of each and every person who has seen a single person die in needless pain or live with the effects of HIV/AIDS. Finally it is our responsibility to care for Africa's suffering millions. GOD BLESS AFRICA.