Reducing the Burden of Pain and Suffering: Developing Palliative Care in Low and Middle Income Countries. Palliative Care Side Event at the World Health Assembly May 2012

At the recent World Health Assembly (May 2012) held in Geneva, the Ministry of Public Health and Sanitation –Ministry of Health Kenya, in collaboration with the Department of Health and Human Services of the United States of America, the Ministry of Health of the Republic of Panama and the Department of Health and Aging of Australia held a side event to emphasis on the importance of reducing the burden of pain in low and middle income countries by developing palliative care in these countries.

Kenya was able to show case the current developments in the country on integrating palliative care services into the health care system. For the last two years the Ministry of Health in Kenya has been working with Kenya Hospices and Palliative Care Association (KEHPCA) to integrate palliative care services into services provided by government hospitals; as well as mission and private hospitals. The Director of Medical Services, Dr. Francis Kimani, read out Hon Beth Mugo’s message, which emphasized on the importance of having palliative care as part of the services offered by health institutions through integrations.  Other invited quests were: the Hon Minster of Health of Uganda- Hon Dr. Christine Ondoa, a physician who has worked in palliative care in Uganda. Hon Dr. Ondoa shared the Ugandan experience of integration and nurses who have undergone extensive training in palliative care and pharmacology prescribing opioid analgesics. Dr. Rajagopal, director WHO CC Trivandrum Institute of Palliative Sciences also spoke on taking pain relief and palliative into the comminty. Other speakers were Dr Da Cost, Palliative Care Advisor to the Ministry of Health of Panama who shared on Panama’s experience with integration of palliative care into Primary Health Care Services. Dr. Cecil Wilson, President elect of the World Medical Association also spoke on the critical role of the medical community in ensuring availability of palliative care, while WHO representative emphasized the role of countries to ensure that palliative care is integrated at all levels of care. Dr. Jim Cleary, Director of International Pain Policy Study Groups addressed the issue of lack of opioids analgesic (morphine) in developing counties.  The side event was moderated by Ambassador Jimmy Kolker, Principal Director, Global Health Office-United States Department of Health and Human Services

Previously, palliative care was only available in hospices in the country, which are few and far between. Government hospitals were unable to provide these patients with services as staff  had not received training to do so and the right medications like morphine for the management of moderate to severe pain  were not available. This meant that patients would either die at home, often in great suffering, without proper medical support, or had to travel long distances to access care at hospices.

In an effort to make sure more patients can access palliative care, KEHPCA is working in collaboration with the Ministry of Health to integrate palliative care services in government hospitals.  This project has started off with 11 level five and provincial hospitals. This involved the training of 20 health care professionals in each of the 11 hospitals to form a core team that is initiating the services. The long term plan is that once palliative care services at these hospitals are established, work will continue to ensure palliative care services will, with time, trickle down to lower levels of care, eventually ensuring that palliative care is available at all levels of care and accessible to patients wherever they are.

Over the last two years, Kenya Hospices and Palliative Care Association has focused on advocating for the integration of palliative care in medical and nursing curricula. In 2010, the Nursing Council of Kenya added 45 units of palliative care into the core curriculum for the BSN training, while Moi Teaching and Referral Hospital, the second largest training institution for medical doctors in Kenya, added three weeks of palliative care and chronic diseases to its program. Kenya Medical Training Institution has added 12 more hours and is in the process of starting a post graduate diploma course in palliative care.

In 2011, the Ministry of Health launched the first National Cancer Control Strategy in Kenya. It focuses not only on prevention, early detection and treatment, but also on palliative care. Currently KEHPCA and the Ministry of Health in collaboration with relevant stake holders are in the process of developing palliative care guidelines.

It is important that health care providers recognize that, where possible, they should aim to cure disease but where not possible they have a responsibility to patients to relieve their pain and suffering. Hippocrates, the father of modern medicine once said that health care professional should aim to cure sometimes; to treat (relieve) often and to comfort always.

While we will work as hard as we can on preventive and curative care for Non communicable diseases (NCDs) and communicable diseases (CDs), the reality is that many patients will not survive cancer, HIV, TB or other life-threatening illnesses. We should therefore not just focus on preventing avoidable deaths but also on preventing avoidable suffering. In our national policies and in our international discussions palliative care should be a core component within a continuum of care for NCDs and CDs. Palliative care is a necessity in the response, not a luxury – both for the people living with the conditions and the health system as a whole. Indeed, palliative care can play a key role in patient & community education about cancer and other illnesses. As such, it can help deliver prevention messaging to families and encourage early detection and treatment.

KEHPCA would like to thank Open Society Foundations for funding the side event. Special thanks go to Mary Callaway- Project Director, International Palliative Care Initiative and Diederik Lohman- Senior Researcher with the Health and Human Rights Division at Human Rights Watch; Anastasia Osundwa of the Kenya UN Mission in Geneva, Dr Sammy Mahugu-Head/ International Health Relations Department (IHR),Ministry of Public Health and Sanitation, Dr. William K. Maina, OGW, MB.Ch B., MIPH Senior Deputy Director of Medical Services/Chief Medical Specialist Division of Noncommunicable Diseases, Ministry of Public Health and Sanitation and Honorable Tom Mboya Ambassador of the Republic of Kenya Geneva

“You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die.” ~ Dame Cicely Saunders -founder of modern hospice movement

By Dr. Zipporah Ali – Executive Director KEHPCA