A study conducted by UNICEF, on Assessment of the Need for Palliative Care for Children in 2013 in Kenya, Zimbabwe and South Africa indicates that very few children with palliative care needs get the necessary support. In Kenya less than 1% of children with palliative care needs accessed the services.
To address this gap KEHPCA has trained several health care workers from different hospitals on paediatric palliative care and is conducting Continuous Medical Education (CME) targeting health care workers working in various paediatric departments. KEHPCA’s program team conducted a CME at Coast Provincial General Hospital focusing on concepts and pain management in children. “Morphine is very safe in children and has been included in the Basic Paediatric Protocols 2016, let us use it for management of moderate to severe pain in children,” said Dr. Kinyanjui, Director of programs, KEHPCA.
Kenya Hospices and Palliative Care Association (KEHPCA), the umbrella body for palliative care services has been supporting integration of these services in various parts of the country in line with the associations’ vision; Quality Palliative care for all in Kenya. Palliative care is a human right and should be accessible to all patients and families. The association has set plans to visit various regions in order to advocate for integration and scaling up services. KEHPCA programs’ team visited various sites in Coast including the Coast Hospice, Coast General Hospital, Malindi Sub-County Hospital and Kilifi County referral Hospital on the week of 7th March 2016, where they interacted with palliative care providers and hospital administrators.
Malindi Sub-County Hospital has an established palliative care center with one nurse who is fully deployed to work at the unit. She receives support from other team members including a clinical pharmacist, Dr. Aisha, who helps in reconstituting oral morphine solution. “Initially I only used to help them reconstitute morphine but slowly I have come to appreciate that palliative care patients require more support and team work” said the nurse.
The palliative care unit serves approximately 30 patients per month and has been instrumental in data collection especially for non communicable diseases. “Recently, we have noticed changes on cancer trends. Initially we used to attend to many cervical cancer patients but now this has changed to breast cancer which is affecting even men and very young girls. We have shared this information with relevant authorities so that further surveys and research can be carried out to establish the reasons behind these observations and also address the underlying problems. Our assumption is that some cultural issues like early marriage could be a contributing factor” Dr. Aisha added.
Staff shortage is a big challenge in various counties in Kenya. In Malindi the patient: nurse ratio is very high in some instances one nurse managing over 60 patients, this has led to burn out and low staff motivation. “I have over 60 patients in my ward, some of these patients require palliative care but it is not possible to attend fully to all when alone” said one of the palliative care nurses from Malindi sub-county hospital.
KEHPCA team had a meeting with the hospital nursing officer in charge and hospital administrator who agreed to support the palliative care team in different areas including staffing, creating awareness within and outside the hospital. The KEHPCA team was delighted that the unit was active and providing care to patients and families “Recently we received a call from Kenyatta National Hospital regarding a patient who was being discharged, lives in Malindi and requires follow up by palliative care team. If these services did not exist, this patient would have to travel for long distance to get the necessary support.” Said Komora – palliative care nurse, Malindi.
KEHPCA team together with the Coast Hospice Program manager, Eric Amisi also visited Kilifi County Referral Hospital where they met a nurse who has been trained and mentored by coast hospice and proving palliative care services on part time basis. The hospital administration has already identified a room within the outpatient department proposed for use in the provision of palliative care services. “We are in the process of reorganizing her duties so that some days she is free to attend to palliative care patients. Once we receive more staff, we will fully release her” said theActing Nursing Officer in charge.
In addition, KEHPCA team conducted needs assessment on legal aspects in palliative care. The findings indicated that there is a huge gap among hospice patients. The survey recommended incorporation of legal aspects in the provision of holistic care in these areas: Will writing, power of attorney, patients’ empowerment on health and human rights among others. KEHPCA is working closely with 5 hospices in Kenya to integrate these services. This project will be scaled to other facilities in future. The associations’ program team participated in a legal clinic facilitated by Mr. Joseph, a pro bono advocate of the High court, at Coast Hospice. The topic of the day was on power of attorney. Patients who attended the legal clinic participated fully by asking questions and appreciated the information given.
KEHPCA has also been working closely with KMA to sensitize its members on palliative care and pain management. Kenya Medical Association (KMA) is a voluntary membership organization open to all medical and dental practitioners registered in the Republic of Kenya. Currently the association has over 2,000 members countrywide. Doctors play a critical role on the integration of palliative care and due to their busy schedules in the hospitals majority don’t participate in the regular continuous medical education sessions (CMEs) within the hospitals. For this reason, KEHPCA has been utilizing KMA sessions to reach out to them. KMA has branches in major towns like Mombasa among others. KEHPCA programs’ team in collaboration with Coast KMA branch organized a CME dinner where they discussed concepts of chronic pain and use of morphine in management of severe pain. The session was well attended and very interactive. Those present acknowledged the need to demystify some of the myths regarding morphine and other opioids. “ We have so many patients under our care presenting with severe pain. Sometimes, we are not equipped to manage them” said one of the participant.
This reflected the need for the public and health care workers to be educated on the need for palliative care. “KEHPCA should organize more sessions and roll them over the entire country, all doctors need to be trained on proper pain management,” Said the KMA Coast division chairman, Dr. Yossa