David Fearon, Medical Director of Cairdeas Sahara, and a PhD student in palliative care at the University of Lancaster, UK, and Alhousseynou Sall, a molecular biologist, and President of Action Sahara pour la Santé, l’Innovation, le Développement et l’Education (ASSIDE), Nouakchott, Mauritania.
Cairdeas Sahara is the first palliative care service in Mauritania, a country with a population of almost four million, situated between the Western Sahara and Senegal in West Africa. Cairdeas Sahara is an affiliation between the Scottish charity, Cairdeas International, the Swiss charity ‘Consulting Training and Support’ and the local association, ‘ASSIDE’. There are four main aspects to our work: research, training, advocacy and care provision.
In 2015, we trained over 45 nurses in the foundations of palliative care using the Worldwide Palliative Care Alliance’s toolkit 1, made five presentations at the third International Francophone Palliative Care Congress in Tunisia and currently have two local part-time nurses visiting patients in their homes four days a week, with telephone support outside of office hours.
It is an interesting challenge to make palliative care as culturally relevant and appropriate as possible in this predominantly Muslim country. In Europe, and to a lesser extent North America, palliative care seems to have embraced the postmodern concept of ‘spirituality’ as the new face for the out-of-date ‘formal religion’. 2 This distinction, however, does not reflect, nor is necessarily helpful, in working with the majority of the world, which still holds firmly to formal religion. One of our research projects is the translation and validation of the African Palliative Care Association’s African Palliative Outcome Scale, 3 into French, Arabic, Hassaniya and Pulaar. This research is an enlightening process, especially concerning one of the ten questions: “Over the past three days have you felt that life was worthwhile?”
Much of the surrounding controversy amongst local healthcare professionals centers on the concept that, in Islam, life is considered as a loaned gift, which God can take back whenever He wishes and its quality should not be questioned. Other commentators felt that the question was asking whether the patient wished to die, a concept with which many struggled: “There is always a desire to live and the religion stops people wishing for death.” (Doctor).
Nurses celebrate completion of the second foundational palliative care course (9-11 June 2015)
In 2016, we wish to explore the extent to which these views are shared by the local palliative population, and whether this question is relevant in a Mauritanian context. At the wider project level, we plan to extend the care provision, train a further 50 nurses, run a training program for Imans in palliative care, and start teaching a palliative care module at the local medical school.
1. Bond C, Lavy V, Wooldridge R (2008), Palliative Care Toolkit: Improving care from the roots up in resource-limited settings. Worldwide Palliative Care Alliance. (Available to download in seven languages from the website of the Worldwide Hospice Palliative Care Alliance. http://www.thewhpca.org/resources/category/palliative-care-toolkits-and-training-manual (Accessed 20 January 2016).
2. Bramadat, P, Coward, H, Stajduhar, KI, (2014) Spirituality in Hospice Palliative Care, SUNY Press.
3. Powell RA, Downing J, Harding R, Mwangi-Powell F & Connor S on behalf of the APCA M&E Group (2007) Development of the APCA African Palliative Outcome Scale. Journal of Pain and Symptom Management, 33: 229-232.
Arabic and French versions of this article are available to download from the IAHPC website:
Our thanks to Ndiaye Alioune for translating the article into Arabic and to Alhousseynou Sall for the French translation.