Dr. Ornella Sainterant is a family physician in Port au Prince, Haiti. In October 2015, she traveled to Kampala, Uganda, as an IAHPC Traveling Scholar to attend the 14th Palliative Care Initiators’ Course held by Hospice Africa Uganda.
Haiti is a resource-limited country that faces many healthcare challenges. The emerging prevalence of cancer and chronic diseases, added to an already overwhelmed health system that struggles to manage infectious diseases such as HIV, means that the need for palliative care becomes increasingly important every day. The needs that I have observed in my country include the lack of training in palliative care, the stigma around end-of-life care, the inadequate provision of palliative care in hospitals and the fact that palliative care is still relatively unknown in Haiti. Yet, despite the need, there is still no initiative to incorporate palliative care into hospital services, nor are there any national policies.
As a family physician, I see many patients with HIV as well as those who suffer from chronic diseases and cancers. I trained in various topics across a range of specialties during my residency but received only one week of training in palliative care. This training, although not a part of residency curriculum in Haiti, was provided because the medical director of our residency had pushed for a more holistic training. I felt that a week of training was still insufficient because I had seen the need for palliative care throughout my six years of medical practice, yet the resources to learn about palliative care did not exist. It became obvious that there was a need for more training when I began working in the oncology department at one of the national teaching hospitals in the country. I decided to speak with the hospital management to explore the possibility of training.
During the search for training programs, I was put in touch with a colleague who suggested a training program in Uganda. He felt that the setting would be culturally and contextually similar to my own, and that the program in Uganda would have more experience in palliative care than we have here in Haiti. He also believed it would be a place in which to network and meet future collaborators.
I was offered a place on the 14th Palliative Care Initiators’ Course at Hospice Africa Uganda and was awarded an IAHPC Traveling Scholarship enabling me to attend the course. It was a five-week course where I learned about how to provide quality care to end-of-life and chronic disease patients. I also learned how to manage patients who choose to be at home, in hospital, or in a hospice care center. During the last week of the course we had a “Training for trainers in palliative care” course.
The Palliative Care Initiators’ Course has been helpful in several ways. First, it taught me how to improve the care and support I offer to my patients and their families at the teaching hospitals where I work. Second, it helped me to become more aware of what others are experiencing in the field and how they manage the care they give. These experiences have helped me to alter the care I give by shifting my approach in how I communicate with my patients, discuss end of life decisions, and train and mentor others in my profession. It was also insightful and comforting to hear that regardless of the fact that Haiti is quite a distance from Uganda and other countries in Africa we have similar stories and are facing similar challenges.
Since my training, palliative care has been integrated as a regular rotation into the family medicine residency program and we hope it will be integrated into other specialties as well. I’ve also seen patients in the outpatient clinic more often and palliative care patients have been added to the home visit schedule. We have created a palliative care advocacy group at my hospital. Currently, the group is working to integrate palliative care into the inpatient services. I am also advocating for a palliative care fellowship at the hospital. I hope that the work we do at the hospital will expand to other hospitals in the region, which would allow us to do more advocacy work at the Ministry of Health and at medical schools in Haiti.
I am thankful for the experience of attending the course at Hospice Africa Uganda and I look forward to seeing the long-term impact of my newly acquired knowledge of palliative care on medical education in Haiti and also on my career.
“... regardless of the fact that Haiti is quite a distance from Uganda and other countries in Africa we have similar stories and are facing similar challenges.”
To find out more about IAHPC’s Traveling Scholarships and other opportunities, please visit our website.
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