Dr. John Weru is a Senior Instructor and Consultant in Palliative Medicine at Aga Khan University Hospital, Nairobi, Kenya. He is a co-chair of the steering committee charged with setting up palliative care services in the East African region.
The big burden of life-limiting illnesses and the associated physical and psychosocial distresses experienced by patients and families, demonstrate the urgent need for access and availability of palliative care in the healthcare system in Africa. Three years ago, when I joined the Aga Khan University Hospital, Nairobi (AKUH, N), palliative care services were virtually non-existent and there was no job description or designation for a palliative care professional. Despite my vast experience in the field spanning more than 10 years, I had to join the system as a senior house officer in charge of oncology services. Two reasons informed my decision to accept this situation and position:
When I was confirmed in my position as a senior house officer, I immediately started lobbying for the setting up of palliative care services in the institution, which entailed discussing its importance with the management while talking about it with fellow clinicians. Despite many challenges, one year down the line I was allowed to start a service while still undertaking my employment duties. This gave me more confidence to ‘up the advocacy game’ by offering CMEs & CNEs (Continuing Medical and Nursing Education) training within the institution. At the same time, I started running two outpatient palliative care clinics a week and daily inpatient consults. Guidelines, protocols and referral criteria were developed, accepted by the institute and circulated.
One year later, the service had grown to the extent of requiring all my time and I was now fully released to offer palliative care services to patients and families in need. At the same time, I got a faculty appointment as a Senior Instructor in Palliative Medicine. Now I could officially introduce a palliative care module and teach students on palliative care. Recognizing the importance and the need for palliative care throughout the Aga Khan Health Services (AKHS), a palliative care workshop was held in June 2015 with participants from Pakistan, Afghanistan, Tajikistan, Tanzania and Kenya. The main agenda was to develop a framework to set up palliative care services in the various institutions and countries. AKUHN was recognized as the institution with an operational service, and protocols and a good baseline foundation to grow palliative care services.
The biggest challenge was access to the services for all patients and families in need because of paucity of knowledge and skills about palliative care. However, it was clear that AKHS was ready and willing to support integration of palliative care into the existing healthcare program in the entire network.
Within the East African region, a Palliative Care Steering Committee (PCSC) was formed and I was selected as the co-chair to spearhead the development of palliative care in the region. Members of the committee then identified champions in the various institutions. I developed a proposal, which has been adopted by the steering committee as a guide to developing palliative care services. The priorities identified are:
Within these priorities are specific objectives, which each institution has identified as urgent needs. With the institutional support and backing from the leaders of the entire Aga Khan healthcare network, these objectives can be met and implementation of the most urgent is already under way.
In conclusion, the journey has started on the right footing. The biggest challenge is to keep the tempo high, to train others, to develop infrastructures, to have fully fledged palliative care teams in all the institutions, and to get palliative care services firmly entrenched in the entire healthcare network. If I could dare to dream five years ago, now is the time to implement the dream and the goodwill is there.
Dr. John Weru's emails: [email protected] and [email protected]
The Aga Khan Hospitals are a network of international hospitals based in Dar es Salaam, Mumbai, Kisumu, Mombasa, Nairobi and Pakistan. The Hospitals are managed by the Aga Khan Health Services, one of the most comprehensive non-profit healthcare systems in the developing world.
As a non-governmental organization (NGO) in formal relations with the World Health Organization (WHO), we are invited to send representatives to the regional committee meetings. We like to take advantage of our large network of members throughout the world and invite them to attend these meetings representing IAHPC. This has several advantages: first, it enables the IAHPC members to meet and build relations with the health authorities and it also ensures that palliative care topics are raised and discussed. In this role, in September, IAHPC members Dr. Rita Kabašinskien? and Dr. Marija Inesa Poniškaitien? attended the 65th session of the WHO Regional Committee for Europe in Vilnius, Lithuania, representing IAHPC.
Dr. Rita Kabašinskien? MPH, physician and director at Kaunas Nursing Hospital, Lithuania, and Dr. Marija Inesa Poniškaitien? PhD, physician at the hospital, have both worked in palliative care for many years. Here, they share a few key milestones in the development of palliative care in Lithuania and describe the WHO meeting in Vilnius.
The biggest human desire on earth is to love and be loved. Palliative care helps to implement this achievement at the end of life for patients with incurable diseases. Palliative care steps are slowly but surely developing in Lithuania.
Kaunas Nursing Hospital was founded in 1993 and palliative care services were included in the original license. Dame Cicely Saunders, the founder of St. Christopher’s Hospice in London, visited our hospital in1996 and we have continued to keep in touch with St. Christopher’s. We also have a twinning link with St. John’s Hospice in London, UK, which was initiated by the former CEO, Mike Coward.
The Lithuanian Palliative Medicine Association was established in 1995. We have gained a lot of experience in Poland, the Czech Republic, Hungary and other countries. We have also received significant support from the UK: ‘The Tiltas Trust’ and the British-Lithuanian Society (Wendy Hove), Macmillan Cancer Support and from Northern Ireland.
In 2007, the Lithuanian Ministry of Health authorised the provision of palliative care to patients. Unlike other countries, patients in a coma are included so the length of stay in a palliative care service is unlimited. Palliative care services are provided in different forms: inpatient, outpatient, at home and day care. The core team members are a doctor, nurse and social worker with staff of other disciplines involved where necessary. In 2015, the Ministry of Health included patients with dementia and Alzheimer's disease in the list of patients eligible for palliative care.
Currently, there is one hospice, 51 palliative care inpatient units and 21 home care services in Lithuania. Vilnius Hospice was opened in 2012. Good psychosocial support for cancer patients and their relatives is provided by St. Francis Oncology Center in Klaip?da. Voluntary Services have been created in Kaunas and Alytus.
On 14-17 September, we participated in the 65th session of the World Health Organization (WHO) Regional Committee for Europe in Vilnius, Lithuania as representatives of IAHPC. It was a great opportunity for us to look round this immense organization and to see how it works in the region. H.R.H. the Crown Princess Mary of Denmark, and the WHO Regional Director for Europe. Dr. Zsuzsanna Jakab, opened the session, recognizing intersectoral action as the overarching theme. The President of Lithuania, Dalia Grybauskait?, welcomed more than 300 delegates.
The Regional Director gave a report on the work of WHO in the European Region, emphasizing how it works in outbreaks and emergencies with health and humanitarian consequences. Dr Jakab also gave an overview of the global governance reforms. In response to the growing numbers of refugees and migrants arriving in the European Region, WHO supports countries by offering medical supplies, assessing national preparedness to assist people in need, training the personnel at points of entry in public health and migration matters, and providing information materials. The priorities of health systems strengthening were presented, as well as approved strategies of new physical activity, tobacco control and an action plan to curb tuberculosis. The Health 2020 policy framework has given us a way forward to meet challenges, offering a unique foundation on which to coordinate activities.
Thanks to IAHPC we had the chance to take part in this great international event, to learn more about the wide-ranging experiences offered in this session, and to talk to people from our Ministry of Health about the palliative care situation in Lithuania.
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