Dr. M. Jane Bates, a palliative care physician from Malawi in Southern Africa, received a Traveling Scholarship to attend the Indian Association for Palliative Care conference (IAPCON), held in Hyderabad in February. Here, Dr Bates shares what she learnt at the conference and what she can adapt to an African setting.
Malawi (where I have been practicing as a palliative care physician for the past 13 years) is a small densely populated country in Southern Africa. Palliative care started here just over 10 years ago. With support and collaboration between government, donors, the national association and some key provider sites good progress has been recorded. Resources: in terms of diagnostics, drugs and staff numbers are critically low, whilst HIV and continuing population growth threatens to bring the health service to breaking point. Most patients with cancer are diagnosed late when their disease is at a very advanced stage. Traditional beliefs, financial constraints on basic necessities (such as transport to hospital), as well as limited practical training for health workers, are factors that contribute. All health workers, wherever they practice, will regularly meet young and older patients with palliative care needs. The current provision offered by two specialist sites will only ever reach a fraction of those in need.
Foundational for the provision of palliative care are access to pain relief and good communication. At IAPCON we learnt of some of the struggles that India is having with new legislation to make morphine available. In Malawi, we have an easier situation with less bureaucracy. However, even when morphine is available there is still resistance from many health workers who believe morphine to be highly addictive even when given to patients in severe pain with cancer. The conference was a reminder not to grow weary in educating and advocating.
At the conference, excellent presentations from a wide range of practitioners (from clowns who work in hospitals to spiritual leaders doing PhDs) reminded us of the holistic reach of palliative care. There was a good deal of humor shared too. Given different religious and cultural settings we were reminded that suffering itself could have different meanings for the patient and family unit. What was also very clear was that – in all settings – pain and suffering persist and there is enormous unmet need both for adults and children across the globe. Teaching and training are required at all levels and through all means (short courses, long courses, through the media, in the armed forces, through mobile pain schools to name a few). The poster section showcased thought-provoking work as well as providing plenty of ideas for research projects that can be replicated in our local setting.
For those of us involved full time it is sometimes difficult to remember that palliative care is still so new for others. We witnessed how the conference itself was used as a forum for advocacy. Plenary sessions, graced by public celebrities and chairpersons, included senior figures of note from a variety of medical and non-medical backgrounds. Local college students were used as volunteers. This is something we can learn from as we try to establish our own national meetings to showcase and discuss issues relevant to palliative care.
The conference was held in a high quality setting (Novotel) requiring the commitment and dedication of the local conference planning committee, each of whom had their own story of involvement in palliative care. The meeting brought together a fascinating range of experiences and perspectives from India and further afield. All of us who attended left inspired to continue to ‘Influence – Innovate – (and) Integrate’ as we move forward.
Dr. M. Jane Bates, email email@example.comRead more about the IAHPC Traveling Scholarship program