Each year, the IAHPC awards several grants to people who are working in palliative care in low- and middle-income countries enabling them to attend education and training events where their oral or poster presentation has been accepted. In May, we were delighted to provide grants enabling 11 people to attend the 14th World Congress of the European Association for Palliative Care, held in Copenhagen, Denmark, on 8-10 May.
In this edition, we are delighted to publish contributions from three of our traveling scholars from Africa that give an insight into palliative care in their countries and how their participation at the congress may influence their work. More contributions will be published next month.
Dr Mohamed Ahmed Hablas is from Tanta, Egypt. Here, he explains some of the background to his work in palliative care and comments how the congress may help him take forward his work.
“…meeting with people from Egypt at the congress will allow a chance to communicate with them and this will create a link between us to serve palliative care in Egypt.”
The need for palliative care in middle- and low-resource countries, including Egypt, is clear. The Gharbia Cancer Society (GCS) is a non-profit, non-governmental hospital, located in Tanta, the capital of the Gharbia governorate in the mid-Nile Delta. The Society provides acute care to patients with cancer including surgery, chemotherapy and radiotherapy. A review of nine-year data of the Gharbia population-based cancer registry from 1999 to 2007 revealed 3,480 cancer cases a year, with Age Standardized Rate (ASR) of 161.7/100,000 for males and 120.8/100.000 for females.
About 70% of patients present in advanced stages (III and IV), with liver cancer being the most frequent cancer in males and breast cancer in females. The GCS started a comprehensive palliative care service in April 2011 with a 10-bed inpatient unit and an outpatient clinic that operates six days a week. All equipment was provided by public donation. The main challenge was opioid availability as the Egyptian law limits the dose prescribed to patients. The program succeeded in convincing local health authorities to increase the recommended opioid dose and to allow more physicians to prescribe opioids for cancer pain.
Through collaboration with the National Cancer Institute, Bethesda, Maryland, and the San Diego Hospice and the Institute for Palliative Medicine and Middle East Cancer Consortium, we developed a fellowship training program for a medical oncologist in palliative medicine and an end-of-life care training course for nurses. The major challenges for the program were inadequate public and health professional awareness of palliative care services and the lack of vehicles and funding to cover home visits. The initial results of the program warrant allocating more resources to cover a large number of trainees and instituting a home visits program.
Attending the 14th EAPC World Congress allowed me to meet many doctors from different countries, to network and to discuss opportunities for future collaboration. I even met people from Egypt, where palliative care is still not recognized, and this led to our exchanging experiences and considering how we might manage to solve some of the problems we face in our country. We discussed the possibility of establishing an Egyptian Society for Palliative Care to spread the knowledge of palliative care in Egypt.
Josephine Muya, Administrative Assistant, Kenya Hospices and Palliative Care Association (KEHPCA), Nairobi, Kenya. Part of Josephine’s role is to coordinate local conferences for KEHPCA and she found the EAPC World Congress a source of inspiration.
“The congress had a wide range of abstract and poster presentations as well as plenary sessions which gave in-depth insights into various palliative care issues.”
Traveling to Denmark to attend the 14th EAPC World Congress was a lifetime experience for me. The congress, which had a wide range of abstract and poster presentations, was a true learning experience. Of special importance to me were the presentations on breathlessness and end-stage chronic obstructive pulmonary disease, and also topics that highlighted the roles of carers in end-of-life care.
Around 2,800 delegates from 80 countries attended the congress. The well-coordinated congress was an eye opener for me because in my role as administrative assistant of KEHPCA I’m on the frontline when it comes to organizing local palliative care conferences in my country. The presence of exhibitors at the congress was essential as this gave delegates the opportunity to learn from other spheres of palliative care.
Thank you IAHPC for awarding me the traveling scholarship.
Dr Peace Bagasha, Physician and Clinical Lecturer, Makerere Palliative Care Unit, Mulago Hospital, Kampala, Uganda, presented a poster on the palliative care education needs of senior doctors in Mulago Hospital. Here, she describes the background to her poster and what she gained from attending the congress.
“… my first ever high-level palliative care gathering. I was inspired by the various presentations especially on experiencing the degrees of achievement in palliative care service provision … and the benefits to caregivers, both medical and non-medical, and patients.”
Palliative care was first introduced in Uganda in 1993. Twenty-three years down the road a lot has been achieved but there’s still a lot to do. The biggest driving force has been the great political will but despite this we still face an uphill task to change attitudes and beliefs because of the deeply ingrained cultural and social beliefs concerning end of life in all dimensions, i.e. caregivers, patients and medical practitioners.
The palliative care community in Uganda is very passionate about the work that we do. We are starting to observe shifts in attitude; for example, senior doctors, on observing the integration of holistic care by junior doctors, asked to be included in palliative care training programs. When we surveyed senior doctors’ education needs we found that they had difficulty in communicating with families and patients about end-of-life related issues and so most patients consequently have no advance care plans.
The EAPC World Congress helped me to appreciate that these challenges are not unique to Uganda but cut across most regions and can be overcome by implementing a multitude of approaches. I now understand the value of utilizing quality indicator tools and motivating staff to collect this information regularly. Carrying out economic evaluations of the impact of palliative care would go a long way in enhancing policy formation and lobbying for increased support for palliative care services and I want to do this in our own institution.
I am very grateful to the IAHPC for having given me this grand opportunity. I feel very empowered and motivated to create and implement changes and provide the best palliative care service possible.
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