The conference is an ideal platform to come together with global experts, medical professionals and government policy makers to share these achievements and shape the future of palliative care services in Kenya through the theme ‘Strengthening Health Systems by Integrating Palliative Care’.

We invite you to join us to this exciting event to exchange ideas, advance knowledge & skills and contribute to the fast developing nature of care for individuals and their families living with a life threatening illness  and the challenges faced by the health system, as cancer and other non communicable diseases are being diagnosed more frequently.

For more information visit the conference website.

A total of 226 health care professionals have undergone the 5 days training and more than 75% of those trained have undertaken three day placements at designated hospices. These hospices have worked with KEHPCA to facilitate the trainings, mentorship and support supervision for the health care workers in the 11 hospitals.

The following provincial and Level Five hospitals have been trained: Garissa; Nakuru; Kakamega; Nyeri; Embu; New Nyanza Kisumu; Coast; Kisii;  Machakos; Thika and Meru

In order for the project to be successful, other activities to increase awareness  on palliative care and pain management were  conducted at the same time that the training were going on. These included, targeting doctors through the regional KMA (Kenya Medical Association) bodies for CMEs on palliative care and pain management and also sensitizing the hospital staff on palliative care and the need for them to support the palliative care units within their hospitals by appropriate patient referrals

The objectives of these trainings were to educate participants on the principals of palliative care; how to communicate with patients and family members; pain and symptom management; ethical issues in palliative care; how to support bereaved families deal with the loss of their loved ones, end of life care and how to have a monitoring and evaluation program that is successful.  At the end of the five day training participants were given a chance to do placement in hospices close to them. The Clinical placements provided trainees an opportunity to conduct a full assessment of a patient; assess and manage their pain and other symptoms;  counsel a patient / family members’; tell the patient their diagnosis; support bereaved family members and also get an opportunity to visit a patient at home.

The majority of those trained have expressed a lot of interest in palliative care and most hospitals have started to integrate the services. They have continued to express appreciation to KEHPCA and the supporters of the project for a rare opportunity offered to them, which has enabled them to become better carers in their areas of operation. Heavy workload and under staffing in most departments in the government hospitals was raised as a major challenge to integration of palliative care services. At KEHPCA, , the project took a lot of commitment, involvement, efforts and therefore all the needed mobilization needs to be done to ensure accessibility of palliative care services in all the government hospitals.

The successful training for health care professionals in 11 Government hospitals under this project has made a great milestone for Kenya, a step that is providing a bench mark to the efforts of integrating palliative care services in the Government hospitals.

A participant from one of hospitals felt remorseful and said the following words after the training, “Oh my God! How I have been insensitive to the needs of patients suffering from life threatening illnesses! Whenever I saw a treatment sheet written morphine, I took no concern because to me the patient was dying anyway! I will now go back to the hospital a converted carer.”

Board elections were conducted and one new board member, Dr. Ether Munyoro Cege was elected to be on the new board. The board members are: Dr. Brigid Sirengo (Chair); Dr. Christine Kisia –WHO (Hon Secretary); Mr. Faustin Mgendi of Coast Hospice (Honorary Treasurer); Mr. Paul Asige of Eldoret Hospice; Mr. Stephen Gitonga of Maua Methodist Hospital: Mrs. Roselyne Opindi of Kenyatta National Hospital Radio-Oncology, Mrs. Saraphina Gichohi of Nyeri Hospice; Mr. Peter Bunde-Legal Adviser and Dr. Ether Munyoro of Kenyatta National Hospital Palliative Care Unit.

The Catholic Relief Services (CRS) is supporting the Kenya Prisons Health Services capacity building in different aspects of holistic HIV care and management.  One area of focus is the integration of palliative care services provision to patients and family members facing problems associated with life threatening illnesses.  On 23^rd to 27^th April 2012, a variety of health care professionals from the Kenya Prisons Services participated in a week long ‘Introduction to Palliative Care’ course facilitated by KEHPCA in conjunction with Nairobi Hospice, Kenyatta National Hospital PCU and other private practitioners.  The participants came from the following 20 institutions in the prisons health department:

The course emphasised care of the whole person, laying emphasis on all aspects of care including physical, psychosocial, spiritual and emotional aspects of care, not only to the patient but also to family members/carers and the community.  Most trainees expressed that the training was a great eye opener to them and the majority committed to change the attitudes of caring for the sick in prisons.  One participant said that the training acted as a mirror through which she observed herself and was now sure of areas that needed change and improvement as she went back to care for prisoners with palliative care needs.  Trainees were made to acknowledge that prisoners too deserve the best health care as any other Kenyan, palliative care and pain management should be provided as a basic right.

On top of this Dr Mburugu has also established a comprehensive child friendly palliative care room, decorated in bright colours with a TV set, toys and a variety of childhood games and is in the process of creating a child friendly play room in the paediatric ward.  As a paediatrician, Dr Mburugu understands the importance of a child’s surroundings in the development of their social, emotional and intellectual abilities through play, interaction and sensory stimulation, and that a child with a life limiting illness is no different in these needs from other children.

Setting up the Paediatric Palliative Care Unit, was not without its problems, there was inadequate infrastructure, insufficient human resource for health, lack of finances and staff burnout.  In order to overcome this, Dr Mburugu worked in partnership with the support of the hospital administration and the Medical Superintendant to identify ways of overcoming these issues, and with the help of KEHPCA, APHIA PLUS and Hospice Care Kenya came up with a complete solution of utilizing the integrated model of service delivery which enabled staff to multi task to deliver a range of incorporated services, access grant funding and provided 25 staff members with additional training to enable them to become more fulfilled and involved with the work of the Paediatric Palliative Care Unit.

The unit is now fully operational and delivering services to 79 children living with HIV/AIDS and/or Cancer.

Part of the success of the unit is the adoption of specific admission, follow up and referral forms, along with training on palliative care to other medical professionals within the hospital which has built up trust and encouraged more hospital staff to refer for the specialist support the Paediatric Palliative Care Unit supplies.  Dr Mburugu noted that ‘Some practitioners are afraid of palliative care.  Practitioners naturally want to enable people to live.  KEHPCA is playing an important role in supporting practitioners to be equipped to provide the best possible service to terminally ill patients.’ Because of increased awareness of palliative care and of the new unit, more and more children are being referred and are accessing holistic child friendly support for patient, parents and siblings.

On top of the success of the establishment of the new facilities, Dr Mburugu exhibited a poster presentation at the 13th Kenya Paediatric Association conference. The presentation generated much interest among paediatricians from East Africa who were in attendance and it was realised that the paediatric palliative care programme was implementable and can be duplicated in other centres all over the country.

The presentation generated a good discussion and a way forward for advancing palliative care in Kenya; issues of having a palliative care policy; a palliative care bill and guidelines were discussed. Dr. Ogaja was requested to work with the various responsible departments to ensure that morphine syrup is included on the standard medicine order form for government hospitals, as well as work with KEMSA to ensure that KEMSA stocks and distributes morphine syrup to government hospitals. This is key because, while morphine syrup is on Kenya’s Essential Medicine List, it is not available in majority of government of hospitals. The Ministry of Health promised to second a Ministry of Health Medical Officer to work with KEHPCA as the GAPRI (Global Access to Pain Relief Initiative) Fellow. This Officer will be the link person between KEHPCA and the Ministry to ensure availability, accessibility and affordability of pain relieving drugs in government hospitals. The Head of Departments’ meeting was chaired by The Director of Administration, Ambassador Felistas V. Khayumbi, who acknowledged the work that KEHPCA does and promised to work with her team to improve the situation of palliative care in Kenya.

KEHPCA wishes to acknowledge the support from the Ministry of Health on advancing pain relief and palliative care in Kenya. I wish to acknowledge the positive support from the Director of Medical Services, Dr. Francis Kimani. I also wish to acknowledge the support from Dr. William Maina, Head of Non Communicable Diseases (NCDs) and Dr. Patrick Waihenya, Program Officer in the NCDs department who have been very supportive all along. Dr. Elizabeth Ogaja and Dr, Izaq Odongo have stood by us throughout and strongly believe that palliative care should be an integral part of a successful health care system.

By Dr. Zipporah Ali

When I arrived at Nairobi Hospice, situated in Kenyatta National Hospital, I was greeted by a range of bubbly delegates, as the room filled up we shared our stories of why we were attending.  Some were from other Hospices (Eldoret and Coast), others had been personally touched by caring for someone with a life limiting illness, and some worked for NGO’s (Lady Hope Wellness Institute, Hope 4 Cancer Kids and Wahopnel Disability) and wanted to increase their skills to enable for them to carry out their role more effectively.  For me, it is my first time working in the palliative care sector in Kenya and I wanted to know more about the realities of care for people living with a life limiting illness.

The course soon started, I was pleased to find that the course was interactive, attention grabbing, and suited to everyone’s needs – a tough task considering the diversity of the group.  The tutors were exceptionally good at explaining medical aspects of palliative care in a jargon free way.  The sessions ranged from the practical aspects of caring for someone, e.g. how to use a bed pan, changing a bed with an individual in it, feeding etc.  For me, a person with no medical background or experience in caring for a person’s physical needs with a long term illness, I found this eye opening and an essential part of caring for someone that everyone should know.  I discovered the importance of mouth care, how to clean the mouths of people in various stages of responsiveness, and how to prevent bedsores and even how to clean a wound.  However, I was keen to learn more about the holistic aspects of palliative care….I did not need to wait long.

We moved on to the importance of communication and how to break bad news. I wondered to myself ‘how is it possible to tell someone and their family the worst possible news in a positive way?’ Jescah, the Nursing Officer and Training Coordinator illustrated the techniques that the staff at Nairobi Hospice use, and while the news is still life changing, it can be conveyed in a kind, sensitive manner that makes the news easier to digest, without withholding vital information, making the experience all the more bearable for both the individual and the family in coming to terms with the illness and the way they deal with it from then on.

Amongst other topics, the course covered symptom and pain management; the benefits of food, nutrition and physical exercise in boosting the immune system and maintaining wellbeing; exploring our personal attitudes to death; preparing individuals and their families for death & dying and how to help others cope in times of bereavement.

One of the highlights was to see the hospice being used at day care – a peer support group for those living with a life limiting illness.  It was inspiring to see how each supported each other and came together to share experiences but also have a good time together in good company.

As the course went on, more of the group told their stories of how they have been touched by losing a loved one, how they cared for them and the support that was or was not available from other sources at the time.  The realities of how many people are providing palliative care in their own homes began to emerge, and the need for more people to access support while providing informal palliative care became clear.  This course provided the essential skills to deliver such care, as well as providing coping mechanisms for carers.  I highly recommend this course to anyone who is from a non health care professional background with an interest in palliative care, I learnt far more than I ever thought, met a great group of people and am better placed to carry out my role at KEHPCA as an advocate for palliative care.

By Gemma James

KELIN, KEHPCA, WOFAK, KANCO and MSF took to the streets outside Nakumat Prestige Matatu Stand on Ngong Road wearing masks.  It wasn’t long before bystanders approached asking inquisitively ‘why are you wearing masks?’ Some looked afraid, walking away quickly covering their mouths, while others stopped and stared.  The group soon won the some of the public over, by talking with them about TB, how it is spread, how to get tested, and why wearing the mask protects from the spread of TB, and soon more and more people were wearing the masks.

From there, the group took a number of matatus to Kenyatta National Hospital, all the way giving out masks and raising awareness.  At KNH, people queued to take the opportunity to be tested for TB.

By Gemma James

We arrived just as the team were busily taking notes and preparing to begin the afternoon session with Dr Weru, and were told that within the team of 20, all hospital departments were represented. Dr Weru began with the World Health Organisation (WHO) Pain Ladder, and talked this through with the team, exploring how they currently assess patients in pain in their daily practise. The different types of pain medication available were explored, within Steps 1 non opioids and adjuvants for mild pain, Step 2 weak opioids for moderate pain, and step 3 strong opioids for severe pain.  When asked which step the team thought would cause more side effects to a patient’s health if taken on a long term basis, the majority of the team responded with ‘Step 3 – morphine’; however Dr Weru explained this was a common misconception, that Morphine was perfectly safe to administer as a primary pain relieving drug over a period of time (and that the only common side effect is constipation), and that actually the Step 1 non opioid drugs were more harmful if taken on a long term basis. This was met with much surprise from the team.

The team participated in a lively session as Dr Weru threw many questions open to the floor, and explained that the team need to ‘continuously assess pain and modify medication regimes appropriately’. The team were then split into groups and given case studies of fictional patients to discuss and decide how they would manage their pain and breakthrough pain. As the teams worked we spoke to Nurse Esther, present from Nyeri Hospice, who is acting as Thika Hospital’s twin hospice. Nurse Esther explained ‘There are so many things they are learning about palliative care that they didn’t know before. They are seeing palliative care to be a new concept, and this to be a good training that will help them to give care. After this training they will come to Nyeri Hospice for three days clinical placement, and then we will make a plan to undertake regular ward visits with them at the hospital’.

Esther Nyeri Hospice Nurse

The groups discussed their case studies together, and then moved on to conclude the session discussing paediatric palliative pain management. As the afternoon session concluded, we were able to speak with some of the trainees. Ruth, a Theatre Nurse at Thika Level 5 Hospital, told us ‘It has been very educative so far. It has made me look back on my practise, and remember the times I have worked with patients in severe pain and felt unsure of how to manage it. We all need to be able to deal with pain assessment and management, and I have learnt much that I will be able to take back to work’. We also spoke to Lucy, a Nursing Officer in the Medical Ward who explained ‘the training is good, quite demanding. You need a big heart to go through this. We are talking about inspiring hope in patients who are likely to be feeling hopeless. As a nurse, you might carry their situations and burnout. We are learning in great detail how to go about implementing palliative care, and to make a real difference in changing the lives of the affected’.

Lucy Nursing Officer Medical Ward

As we were leaving, Chris, a Nurse in the hospital’s emergency unit told us ‘Morphine is available at Thika Hospital, but is not being prescribed – I actually didn’t realise it could be used to the affect that Dr Weru has explained today. From now on I will concentrate on pain – and I will tell all my colleagues’.

By Julia Strong

The programme began implementing activities in September 2011. Within 5 months, groups of health care professionals selected from different disciplines within eight of the eleven hospitals have under gone the one week course successfully.

KEHPCA was targeted to train 20 delegates per session but has exceeded expectations. In March, 68 delegates instead of 60 were trained. This shows the increasing popularity and demand for training in palliative care and pain management in Kenya.

The one week training courses have been followed by three day placements at designated partner hospices which, jointly, with KEHPCA, facilitate the training, mentorship and support supervision for the health care professionals. The feedback received from the majority of the participants is that the training has been a great eye opener, generating opportunities to strengthen and initiate care and support to the many patients suffering from life threatening conditions as well as the family members.

Furthermore, a number of those trained have expressed an interest in pursuing palliative care at a higher level and have started approaching KEHPCA to link them or offer scholarships for their study, compounding the desire for increased knowledge in palliative care.