Esther Clift’s African Blog Series, part 3: 'Palliative care'

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the third part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

The scourge of AIDS in the 1990s led to the introduction of palliative care as both a medical speciality in symptom management and a community initiative to support people at the end of their lives to live at home with their loved ones. Communities identified and trained community carers to offer practical support for activities of daily needs. Some palliative care facilities were developed, particularly in Uganda where AIDS was rife, and the government and NGOs were particularly proactive in both prevention measures and care, as both centres of training and excellence, as well as hospice care. Two of these are Mildmay International and Hospice Africa Uganda (HAU), founded in 1993. From HAU the Institute of Hospice Care in Africa (IHPCA) was founded, offering training programmes in both English and French to reach ‘Le Monde Francophone’, offering a BSc in Palliative Care to over 100 students all over Africa. These are delivered as 5-week blocks on an annual basis to develop and extend skills for palliative care clinicians- medics, nurses and pharmacists.

However the picture of the patients admitted to the caseload is changing. Far fewer people living with HIV and AIDSs (PWA) are reaching palliative stages, due in most part to the availability of Anti retrovirals (ARVs). There is a significant increase in the number of people dying with terminal cancer diagnoses, and a noticeable number of people receiving palliative care who are living with frailty. Symptom management is with pharmacology (Oramorph is now readily available for palliative care), but also massage and aromatherapy are well-accepted treatment modalities.

The model of care for HAU has never been admission to specialist units and the main centre in Kampala still has no beds.  A World Assembly resolution in May 2014 saw an integration of palliative care into the health system in Uganda. The focus is on Home Based Care, and the training of community facilitators to monitor and manage patients at home, and seek more specialist help when required. The palliative specialists also consult for patients who are in acute beds in any of the hospitals in the vicinity. April 2014- June 2015 saw 4,632 people cared for through the service.

It strikes me that we have a huge amount to learn from this model as we look for a more sustainable NHS!