Two reports of interest concerning palliative care in Sub-Saharan Africa.
The first report is highlighted by a press release from King’s College , UK which sets the stage for the problems facing this region overwhelmed by patients with HIV/AIDS; the second is a comment by workers in the region who deal with these problems on a day-to-day basis. Both full text reports are available online from The Lancet –see the details below.
1) A Press Release from King’s College , UK
"Africa needs improved palliative care for HIV/AIDS With an estimated 26 million people living with HIV in Sub-Saharan Africa and over 2 million deaths relating to the disease every year the need for palliative care in the region is great. Researchers from King's College London have assessed the current availability of care and revealed that the care burden primarily falls on family members and local communities, who are 'often inadequately trained in clinical skills and lack access to essential drugs."…
Professor Irene Higginson and Dr Richard Harding, who published the results of their review in the latest edition of The Lancet, stress that in order to provide feasible, accessible and effective models of palliative care in Africa , questions on how the models of care used in developing countries can be adapted to the different setting must be resolved…
The South African government has already recognised how valuable traditional healers could be as a bridge between patients in the community and more formal palliative care initiatives. These healers are often the first port of call for patients with both cancer and HIV/AIDS, and it seems that patients who visit them are more likely to stick to pain-relief medications. However, offering training to these healers alone is unlikely to be sufficient to satisfy the massive need for palliative care…
According the researchers, one way of improving the situation would be to expand provision of simple protocols for basic palliative care procedures to volunteer carers. Some organisations, such as the World Health Organization, have already begun to do this. Greater numbers of community volunteers, such as those at Hospice Africa Uganda, could also be trained to identify and refer patients who would benefit from palliative care services, as stigma can prevent patients with HIV disease from referring themselves to hospices…
A major problem for care givers in Africa is the poor access to essential drugs, with only a third of the population able to obtain these. In addition, there is a high mortality rate among trained health care professionals, with one in four hospital healthcare workers in Malawi being lost to AIDS and TB every ten years.
A further issue is that anti-HIV drugs, or highly-active antiretroviral therapy (HAART), are associated with a range of distressing side effects, which mean that palliative care is required even as HAART is rolled out across Africa .
According to Dr Harding, 'a common misconception is that HAART replaces the need for palliative care. However, despite the therapy, pain continues - and the psychological and spiritual needs of people with HIV persist. Effective HAART programs require palliative care to ensure adherence to the therapy to maximise clinical benefit and reduce the potential for the emergence of resistant strains.'
Currently, few palliative care services in Africa have integrated with HAART provision, although some examples of palliative care alongside anti-HIV treatment are emerging, enabling patients to maximise the quality of their life and their death.”
“This press release is based on the following article:
“Palliative Care in Sub-Saharan Africa ”
Richard Harding, Irene J Higginson
The Lancet, 4 June 2005; Volume 365: pages 1971-77”
The full text of this review may be viewed on The Lancet online Web site which requires a free registration at URL: http://www.thelancet.com/home click on review after logging into the past issue of 4 June 2005.
2) "Palliative care in Africa: an appraisal"
by Dr. Anne Merriman and Manjit Kaur of Hospice Africa, Uganda. This report is in the same issue as above (The Lancet, 4 June 2005 ; Volume 365), but must be viewed under the section termed Comment.