Is hospital based palliative care more beneficial than home based care?

This was the argument put forward by Eunyoung Choi, the Associate Field Director of Palliative Care Program at AMPATH Oncology Institute in Kenya, during KEHPCA’s 3rd Kenya National Palliative Care Conference.

Choi said it is in hospitals that most severely ill patients are attended to, facilitating the ease in provision of palliative care.

“Palliative care can start early for inpatients as they are on a daily check-up routine, a scenario not common with out-patients” Choi said.

“There is a correct disease trajectory which aids in decision making on when to put a patient on palliative care easy.” She added.

To realize full benefit from the hospital based palliative care, Choi said accurate prognostication has to be done for correct monitoring of the patients illness.

This, she said, can only be possible where there are qualified health practitioners who are readily available at hospitals.

Recommendations
Choi recommended good communication skills through training to the health care providers to facilitate better contact between the medical staff and the patient.

“Counseling is crucial in palliative care and all medical practitioners need proper training to carry out this requirement perfectly,” the Associate Field Director said.

She said that a better engagement between the medical staff and the patient will bring out the patient’s wishes to the care plan.

The use of palliative care champions is a plus in integrating this venture in the hospitals as this will encourage more support for the program as most people have not embraced it due to lack of palliative care awareness.

This, she said, includes identifying interested staff and training them in palliative care for a long term benefit as unwilling individuals will derail such beneficial programs.

She advised those willing to begin in-patient palliative care to begin small and grow rather than waiting for big things that may never materialize.

Areas of focus

Research is a basic method to establish what is hindering palliative care intake among health practitioners and policy makers and in an effort to find a solution. There is need for team building to ease the tension between health practitioners and patients and break the communication barriers to facilitate information flow,  Choi said.

She added that availability of health care practitioners is important for the success of hospital based palliative care despite the challenge of work overload at hospital facilities.

AMPATH Oncology Palliative Care Program is focused in introducing Palliative Care services including monthly daycare and a 24hour palliative care hotline that is aimed at reducing the cost of a patient in hospital or traveling to a hospice.

KICOSHEP – KENYA; Shaping Patient Life
Kibera Community Self-Help Program – Kenya (KICOSHEP) has a bed capacity of seven for an inpatient respite center. They strive in expression of decent care values in achieving human flourishing, quality of life and dignity.

Founded in a sparse clinic at the shanty settlement of Kibera in 1991 has grown to be among the leading home care palliative care givers in the second largest slum in Africa.

In a her presentation during the 3rd National Palliative care conference in Nairobi’s Sarova Panafric Hotel, the Executive Director, KICOSHEP, Rev. Anne Owiti, said they have been able to realize increased survival of patients with life limiting illnesses.

Rev. Owiti said that they have realized increased use of morphine followed by a decrease in pain scores among the patients that the facility serves.This has been made possible following the training and support supervision by the National association, KEHPCA.

“We have had an increase in the number of cancer admissions that has led to increased survival among those whom we attend to.” She said.

KICOSHEP has raised its hospital partnerships from one to eight hospitals in an effort to effectively manage and provide synergy in pain management.

The organization has a primary school serving about 500 students in Kibera, majority of whom are orphans due to HIV/AIDS.

Alongside family planning, pre-natal care and PMTCT services including an emergency childbirth facility, it offers extensive counseling services to the patients as well.

Awards
KICOSHEP’s effort has bore fruits for their efforts in the struggle against the HIV/AIDS pandemic among the locals.

In May 2003, KICOSHEP was recognized by the Firelight Foundation and Youth Philanthropy Worldwide for their participation in the Youths Together Against HIV/AIDS Program. KICOSHEP received a certificate of appreciation for their partnership in the health fair organized by the US Embassy in March 2003

In April 2002, KICOSHEP was recognized for their outstanding contribution towards youth leadership and awarded the Youth Leadership for Development Initiative.

With all these awards, the organization aims to offer Decent Care and Palliative care that is founded on value of human agency and self determination.

KICOSHEP has introduced the use of memory books by patients faced with life limiting illnesses as a way of leaving a legacy that can help those left after the patient’s departure.

Lack of enough health care givers to participate in Palliative Care and access to morphine remain a challenge to the organization.

International Palliative Care Consultant Dr. Stephen R. Connor acknowledged that Decent Care complements Palliative Care

Dr. Connor added that it was an opportunity for the World Health Organization (WHO) to conceptualize better ways of offering health care.

It is in this spirit that KICOSHEP initiated a program to offer knowledge on income generating activities to sustain its course of Decent Care.

 

 

By Nyakundi Aquinas – Journalist – KEHPCA