Reports

2013; Volume 14, No 2, February

Reports

Traveling Fellow’s Report – Kenya

I had the privilege to attend the 3rd National Palliative Care Conference in Kenya as an IAHPC Traveling Fellow, to contribute as a faculty member and to learn about the challenges of delivering palliative care in Eastern Africa.

I gave two plenary presentations, the first on new results about palliative care development worldwide including Kenya from the forthcoming “Global Atlas of Palliative Care at the End-of-Life”, and the second highlighted the results of an international demonstration research project on Decent Care Values in Palliative Care Services conducted in Nairobi.

In addition, I conducted two workshops on communication skills in palliative care and how to write an abstract for conference presentation.
Prior to the conference a group of us visited Thiga Hospice outside Nairobi. This is a wonderful community based program run by the Daughters of Charity. They have a 9-bed inpatient residential hospice for patients that are unable to be cared for at home. In addition to palliative care, they have many programs for the community including a kindergarten class, a school for disabled children, a library and study center, and a sewing skill-training center.

Following the conference, Dr. Jim Cleary and I made presentations at Cancer Care Kenya which is a cancer treatment center. Jim’s presentation was focused on palliative care in oncology and I spoke on psychosocial issues in cancer care to an audience of clinicians, patients, and volunteers. We had planned to visit Thika hospital where I was to present on integration of palliative care into a hospital, however there was a physician strike that day so I could not present.

We visited the state Pharmacy and Poisons Board to discuss the low consumption of morphine in the country and to encourage them to make sure that the morphine use was not discouraged. The new pharmacy officer assured us that the board was committed to expanding the medical use of morphine for pain relief.

Finally, I spent time with Dr Zippy Ali at the Kenya Hospices and Palliative Care Association office (KEHPCA). We looked at mortality data in the WHO/WPCA Global Atlas to estimate by province the need for palliative care in Kenya. Kenya lacks good national mortality data. Kenya is making great progress in palliative care development in cooperation with the government. KEHPCA was invited to begin establishing palliative care services at all eleven regional level 5 hospitals. They have made good progress and are now ready to expand to over 30 additional district hospitals. The challenge they face is to ensure that community based palliative care is available in the communities where these medical centers are based.

I am continuing to work with Zippy and her team at KEHPCA on the challenges they face. Kenya is one of the bright spots in Africa with respect to palliative care development. There is a willingness to develop palliative care and there is a shift to centralize political power at the county level which holds promise that palliative care can develop from the ground up and the top down.

Stephen R Connor, PhD
Sr Fellow to the Worldwide Palliative Care Alliance
International Palliative Care Consultant
Open Society Foundations- New York
Altarum Institute - Washington DC
Research Director Capital Caring - Falls Church, VA
Cell: 703-980-8737 Email: sconnor@icloud.com

 

Traveling Scholar’s Report - Uganda

REPORT ON THE ADVANCED RESEARCH COURSE IN PALLIATIVE CARE
NOVEMBER 2012

Thanks to a traveling scholarship provided by the International Association for Hospice and Palliative Care and the Dianna, Princess of Wales Memorial Fund (DPWMF), I was able to attend the advanced research course in palliative care in Kampala, Uganda.

The Makerere University Palliative Care Unit in partnership with the University of Edinburgh, the Institute of Palliative care in Africa and Hospice Africa Uganda sponsored this course.
Participants were from African countries and experts in palliative care research were from Uganda and the UK. I was the only participant form Rwanda.

The schedule was full of interesting subjects pertinent to conducting research and included things such as asking the right questions, managing the data and making sense of it.
Journal clubs were included in the schedule everyday starting on the second day. During the journal clubs, we were able to benefit from the great resources provided by IAHPC to its members in the form of online access to the palliative care journals and the CINAHL database.

During the course, we learnt more about generating a research question, choosing the methodology and analyzing the data. At the end of the 1st week, each participant generated a draft research question and proposal.

During the 2nd week we presented our draft research proposals to the facilitators (experts) and attended Journal clubs. A research network on palliative care was created.

Next we learned a great deal about writing a paper (structuring it, presenting results and a discussion, tips on how to get published, and academic writing, etc.). During this week, an individual’s draft research proposal was reviewed by an expert.

Conclusion
After completing this course, I am now focused on my first research project and question -- what are the palliative care needs in Kibagabaga District Hospital?

I extend many thanks to IAHPC and DPWMF for enabling me to take this course.

Kind Regards,

Dr MUGENI REGINE
Palliative Care Physician
Kibagabaga District hospital
Rwanda

IAHPC’s Scholarship Support for a Diploma in Higher Education in Palliative Care -
Sponsored by Nairobi Hospice and Oxford Brookes University

Palliative care in my country is not fully integrated into the healthcare system. In my opinion, this may be due to lack of sensitization and resistance to change in some health institutions. Healthcare institutions in remote regions lack trained personnel so that the majority of the professionals don’t understand what palliative care is and consequently are unable to adequately diagnose and manage pain in their patients. Myths and taboos also play a great role -- thus the ignorance.

Communities in my country need to be exposed to a sensitization programme about the importance of verbalizing pain which will allow adequate care to be given to them without resistance. During my training, I realized that many healthcare professionals, and even patients, fear using morphine since it’s regarded as a killer drug especially when used on patients suffering from cancer in their last stages of life. It is important to explain to my colleagues the mode of action of opioid drugs which may allay some of the confusion and anxiety over their use.

Many pharmacies in the country do not stock opioid drugs since they are known as “dangerous” drugs that should only be stocked by the country’s major hospitals under lock. Since most professionals aren’t sure of how to use them, the opioids useful life expires and patients who need them don’t get them. By educating and empowering the professionals and the government officials about the rational and effective use of these agents it is possible that they could be made available at an affordable price to ease patients’ symptoms.

During the conference, I also learned that home based care is vital. This enables patients to be adequately followed by the palliative care team in their homes, which ensures that their needs are met since the entire family is involved. Most patients don’t receive these services because of geographical barriers to a palliative care team.

In some communities, language is also a barrier leading to communication breakdown; most patients end up without healthcare altogether. As stated by one of the presenters during the conference, utilizing interpreters could save many patients from a lack of care.

Finances are another challenge. I think partnering with other organisations to provide the care and training might help promote the use of palliative care services by more institutions.

As a palliative care professional, it is my sincere wish that putting forth a great effort, my colleagues and I can change the image of palliative care in my country.

I wish to thank the IAHPC and the Diana, Princess of Wales Memorial Fund for the providing this scholarship for my diploma studies.

Mildred Agnes Waka, RN
KENYATTA NATIONAL HOSPITAL
NAIROBI

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