Space, staffing and lack of drugs are major challenges facing the integration of palliative care in health system in Kenya.

Most palliative care units have reported that only one officer is dedicated to offer services at the unit leading to burn out following an increased number of patients in need of palliative care.

This was revealed during a stakeholders meeting of 11 government hospitals that have integrated palliative care. The meeting was convened by Kenya Hospices and Palliative Care Association (KEHPCA). Over the last 2 years, KEHPCA has been working with government hospitals to integrate palliative care.

The Nursing Officer from Embu Level 5 Hospital M/s. Judy Mutune said that they only have one full time nurse with another working part time.

“We have a small room with a computer we received from KEHPCA but we need more space to attend to the patients.” M/s. Mutune said.

She said that they have a room to operate from and one additional staff operates on a part-time basis.

We work in conjunction with the hospital pharmacist to give pain management drugs, including morphine, after prescription from the unit.

Since we started in 2009, we have managed to see over 500 patients and assisted several families with bereavement support and disclosure.

She said that 20 staff from the hospital have been trained courtesy of KEHPCA and they are practicing palliative care in the wards where they are placed.

M/s. Anne Muthoni from Thika Palliative Care Unit said that when the first reconstituted morphine got finished she was stranded though morphine powder was available.

“The hospital pharmacist has since been trained by KEHPCA, my worries are now over and the hospital staff appreciates palliative care.” She said.

The head of the oncology clinic at Coast Provincial General Hospital (PGH) Dr Esther Getambu recommended that palliative care units should have an oncology clinic at least once a month.

“Sending patients to Nairobi for oncology services will only get them an appointment for another date which is expensive leading to most patients opting to stay at home due to financial challenges.” Dr Getambu said.

She said that at the coast, they have set aside a room for patients to be seen by an oncologist every month. The Oncologist has to travel from Nairobi, approximately 500 KMs to see patients once a month

Dr Getambu challenged hospital medical superintendents to treat palliative care units as other departments within their hospitals.

“Why are you not giving them a building if the only care to give to some patients is palliative care? A Palliative Care Unit (PCU) should be the largest department in a hospital.” She said.

She urged those attending to patients at the units to link up with oncologists elsewhere to reduce the burden on the few government oncologists in the county.

“With internet connection you can Skype with oncologists anywhere in the world. Donors can help PCUs link up with universities abroad where they can get help from their oncology departments and this will help us move forward in palliative care as a country.” She said.

She added that there is an urgent need for scholarships for radio-oncologists as the government looks forward to have five radiotherapy centers in five regions across the country.

Dr Getambu said that the Coast PGH works hand in hand with Coast Hospice where they refer patients and their staff has been trained.

Dr Patrick Mburugu from Garissa PGH said they started a pediatric palliative care unit and decorated it to create a childlike ambience with the help of Hospice Care Kenya.

“We have about 65 children on call most of whom are HIV positive while others have cancer.” He said.

Dr Mburugu said that fundraising is important in palliative care but is a challenge even across the world. “There is need to train palliative care staff on grant writing so that they can boost their fundraising initiatives.”

“Our set up is in a Muslim community and when patients get very sick, relatives request for homecare. Set up of homecare is intended though security will limit us to areas around the town.” He said.

He said that there is a misconception of palliative care being for cancer patients only as well as a profession for nurses.

“Palliative care can be handled by senior professionals including professors. All we need is creating time and be dedicated to palliative care.” He said.

Machakos Level 5 Hospital Palliative Care coordinator Mr Elijah Musau said they are challenged with space to hold daycare services.

“The access way to the unit has no pavement and this is a challenge to patients with wheel chairs.” Mr. Musau said.

He added that in their effort to strengthen palliative care out of the unit, they have received funding from Hospice Care Kenya to purchase a vehicle for home based care.

Head of Evaluation at The Evidence Centre Dr Debra de Silva from the United Kingdom said once the hospitals that have integrated palliative care become centers of excellence, other units would visit for mentorship and placement.

“Pass your skills more often to others who are joining the palliative care field to make this program sustainable and own it in the long run.” She said.

Dr Silva urged those involved in training to give feedback on what would work well and what would not work from their observations to help curb challenges and streamline the palliative care training and mentorship program.

Commending the stakeholders during the meeting, Kenya Hospices and Palliative Care Association (KEHPCA)’s Executive Director Dr Zipporah Ali said that the journey to integrate palliative care in the various government hospitals has been made easier by the willingness of the officers and staff in these hospitals.

“The African Ministers of Health in the recently concluded African Union meeting in Addis Ababa unanimously agreed to improve access to strong pain medications and to drastically increase their availability for patients.

Dr Ali said that there was a recommendation that member-states integrate palliative care into national strategies to combat non-communicable diseases.

“The progress Kenya has made puts our health system in a better position to champion palliative care and offer its services to the patients at all levels of care.” She said.

She said that the soon to be introduced palliative care course at the Kenya Medical Training College (KMTC) will boost this integration as medical doctors, nurses, clinicians and other health care practitioners will join the health system while having knowledge in palliative care.

“As we enter stage two of the integration, we want to focus on making this hospitals centers of excellence to act as mentor units and provide room for clinical placement of the soon to be students of palliative care.” Dr Ali said.

Dr Joe Kanja from Meru level 5 Hospital said there has been great improvement in attitude of pain management giving an example of many patients used to rant in pain in the wards, a scenario that has significantly reduced since set up of a unit within the hospital that has seen their chronic pain managed.

“There has been a lot of awareness creation through the District Health Office where sensitization in schools and churches has been ongoing leading to more people understanding that being diagnosed with cancer is not the end of life and that they can come to such units as early as at diagnosis.” Dr Kanja said.

He said that the counseling component has been good and they want to take it to the next level saying that they intend to start psychosocial support groups where patients can share and encourage one another.

“We should think of going hi-tech by having a palliative are software to ease our paperwork and make reporting easier.” Dr Kanja added.

The cost of morphine was highlighted by Mary Lwanga from Kisii Level 5 hospital saying that patients lacking funds are taken through the hospital waiver system.