In 2010 KEHPCA began implementation of an important new stream of work to introduce Kenyan Hospices and Palliative Care Centres to the provision of legal support for patients, with support from the Open Society Initiative for East Africa.

Several cultural groups in Kenya claim customary inheritance practices that favour males over females and policy debates regarding the property and inheritance rights of women in cohabitating unions (unregistered and often customary marriages) continue to divide the public, politicians, and religious and other civil society groups. Inheritance disputes are commonly arbitrated by local leaders and corruption is a major risk to the assurance of fair hearings.

Central to inheritance protection is how disputes are resolved. Providing improved access to legal protection of rights will greatly support palliative care patients. The KEHPCA programme will enable more patients to be aware of their legal rights and demanding them, more health care professionals working in hospices to be aware of the legal rights of their patients, and more lawyers to be mobilized to provide pro bono legal support to the hospices.

Initial research was undertaken with three hospices to identify areas of need, and a workshop held to share and discuss the findings of a subsequent report conducted by Husika Trust in conjunction with KEHPCA, with Kenyan hospices, palliative care units and some lawyers in July 2009. Following this, KEHPCA has worked with an initial group of 28 hospices and palliative care centres*, who attended a sensitization training in Nairobi from 22-23 November 2010.

The sensitization training introduced the concept of providing legal support to patients, and four lawyers joined the hospices to explore and discuss ways of empowering patients to:
-know their human and legal rights
-understand how the Kenyan Court system works
– understand the power of attorney
– understand how to make a will

The objectives of the workshop included addressing laws relating to Human Rights for persons with life-limiting illnesses and schedule training needs for hospice professionals; identifying and addressing specific issues for persons under palliative care; identifying policy issues for follow up; discussing the development of legal tools for palliative care in Kenya – focusing on simple and user-friendly materials for use by hospices in educating their patients e.g a sample will, sale agreements, land/property transfers, succession documents, affidavits, power of attorney, etc; and reviewing resource materials on human rights in palliative care.

Following this sensitization training, Nyeri Hospice has successfully introduced monthly legal aid clinics for patients. Links have been established with four pro-bono lawyers, who are strongly supportive and provide free advice and services. The lawyers participating are also supporting the hospice trained health care professionals to be providers of basic legal guidance themselves during patient consultations, during home visits, and during hospice daycare sessions, and to understand and promote their patients’ human and legal rights.

Nyeri Hospice share how one patient has benefited from legal support whilst receiving hospice treatment:

Mr. John (not his real name) with HIV and cancer of the oesophagus has been under the Nyeri hospice care since February 2011. He is a widower with five sons and one married daughter. The second born son passed on and left a wife and five small children. In the process of counseling the hospice learned that he had not written a will and neither divided his properties to the heirs. He was booked for the legal aid clinic, where he sat with a lawyer offering pro bono services and legal aid to Nyeri Hospice. Following the session with the lawyer, Mr. John convened a family meeting, wrote a will, gave power of attorney to one of the sons in agreement with others and planned for the subdivision of his land. He has now started attending land board, divided all his properties and handed over documents to the sons. He recently reported how he has been helped by the legal aid clinic and is now at peace with self, children and God. He is a happy man now and openly says if he dies, he will not leave behind conflict in his family, a thing happening often in many Kenyan communities.

In order to support and further raise awareness to health care workers at KEHPCA member institutions, patients, family members and the general public, KEHPCA has developed and published several brochures with information about patient legal rights. They include;

• Guidelines on how to make a Will – incorporating a sample will
• What is Power of Attorney? – explaining how to choose an agent who can make decisions on behalf of the person who is unwell.
• Know your palliative care rights – Outlining the patients’ rights charter, and rights and responsibilities of health care professionals.

These publications are all available for download on the KEHPCA website.

Looking forward, during towards the end of 2011, KEHPCA will hold a second training session, to sensitize paralegal personnel from other regions in Kenya on palliative care so they are able offer legal advice to hospices and palliative care units within their regions. KEHPCA will also be working with four more hospices to integrate legal aspects of palliative care into their programs.

* The hospices participating include: Busia Palliative Care Unit, Chogoria Palliative Care Unit, Coast Hospice, Eldoret Hospice, Embu Mbeere Hospice, Kakamega Hospice, Kijabe PCU, Kikuyu PCU, Kisumu Hospice, Laikipia PCU, Litein PCU, Machakos PCU, Maua Methodist PCU, Meru Hospice, Murang’a Hospice, Nyahururu Hospice, Nyeri Hospice, Shepherds of Life, Siaya Hospice, Tenwek PCU, Thika Hospice, Thigio Hospice, VIAGENCO, Webuye Hospice, Nakuru Hospice, Baraka Medical Centre, KNH PCU, Nairobi Hospice.