2 nd KEHPCA Palliative Care Conference 4 th to 5 th November 2010 Sharing the Care. Dr. Zipporah Ali National Coordinator KEHPCA

Transcription

1 Yesterday, Today and Tomorrow 2 nd KEHPCA Palliative Care Conference 4 th to 5 th November 2010 Sharing the Care Methodist Guest House and Conference Center Dr. Zipporah Ali National Coordinator KEHPCA

2 Scaling up services Education and Training Integrating palliative care Opioids availability Research Collaboration and partnerships The future of palliative care in Kenya

3 Reflections 1988 Nancy was a single parent with cervical cancer. She was dying in pain, suffering, not knowing what was killing her. She did not know where to turn to for help. She was not the only one. There are still many like her, with no where to turn to.but This can change, if we share the responsibility of reducing pain and suffering.

4 Reflections 1988 Ruth Wooldridge and Jane Moore Knew they had to do something for Nancy and others like her. Jane More Ruth Wooldridge

5 Jane Moore as I gave all day and all night to it. I worked very hard. We used to meet up with Ed Kasili at literally 6am in the morning whilst he was on his way driving past the Karen dukas near where I lived on his way to work at KNH. If I had not got to meet him then I would never have got the many forms signed and had a quick chat before we both started our busy days. (Jane Moore) Ruth and I used to meet and we still joke about it!! We did all our work meeting and doing the meetings on the roadside. We had no office or anything until we took over a very small 9 x9 foot hut in the grounds of KNH. Ed used to leave his home where we went many times in Ngong Hills home at am Ruth and I came across in our work some tragic cases. I was working for and nursing Mike Wood he stated AMREF whilst I was also doing my nurse registration (KRN) at Langata clinic and in KHN. Ruth was nurse volunteering in Kawangware. We were crying and comparing one day at a lunch how heart breaking it was to se so many patients in terrible pain and whatever other very distressing symptoms I

6 could not bare to witness the pain we were seeing with patients with very advanced cancer in Kenya. Ruth had the idea to run a conference and we got 88 people: medics, physicians, nurses religious leaders, doctors etc etc. it was now incredible to think they came ; they did not know what it was and there were no per diems!! One of those present was a now dear friend of ours, Dr John Omany now a leader in Palliative care in this country UK. One of my patients was Dr Mike Wood (who began AMREF in 1962!! It was then the Flying Doctor nearly 50 years ago) Mike aged 62 was my patient with nephrotic carcinoma. He was in terrible pain. He said to me three days before he died in his home in Karen "Jane the best thing in the world is to be out of pain' I knew he was in terrible pain and I got some friends to bring some medication from UK (Yes two bottles came in in someone s hand luggage from London!!)

7 Professor Edward Kasili a pioneer and recipient of palliative care Prof. Edward Kasili

8 1990 Nairobi Hospice was started as the 1 st hospice in Kenya

9 A journey of a thousand miles begins with a single step Eldoret Hospice Nyeri Hospice Coast Hospice Kisumu Hospice Meru Hospice

10 Kakamega Hospice Nakuru Hospice Laikipia Pal. Care Center Embu-Mberee Hospice

11 PCU in Mission Hospitals/ Government hospitals Chogoria PCU Muranga PCU KNH PCU

12 Hospices and Palliative Care Units in Kenya

13 Training and Education One week certificate trainings Nairobi Hospice KNH-PCU Nyeri Hospice Kisumu Hospice Meru Hospice KEHPCA (CPD) Diploma Course 18 months Diploma in Higher Education Nairobi Hospice in conjunction with Oxford Brookes University Masters in Palliative Care (MPC) University of Dundee-Masters

14 Training on use of Opioids for doctors Heads of Departments KNH A young Proud Doctor Doctors training

15 Training of ToTs from Medical, Nursing, Dental, Clinical Officers and Pharmacy Schools across Kenya (Integrating pc into HCPs curricula)

16 CMEs -Introduction to palliative care CMEs on pain management CMEs on Principals and Concepts of palliative care CMEs on Breaking bad news, Communication g, and Ethical Issues on EOLC

17 Advocacy

18 Public Awareness

19 Advocacy. Ten Government hospitals (provincial and level el 5) to integrate palliative care National Cancer Control Strategy that includes palliative care and pain management A commitment by both Ministries of Health Integrating PC into Health care professionals Curricula More drug companies to import opioids KEMSA to supply government hospitals with opioids The Government Standard order form for drugs to include morphine syrup and other opioids No taxation on morphine powder EML ( Essential Medicine list) includes opioids and other drugs for palliative care

20 Integrating Palliative Care in Government Hospitals

21 Kenya Essential medicine List

22 Research A new development APCA /KEHPCA Quality of Life for the Terminally Ill Cancer Patients t in Kenya: An Assessment of the Deficit and Need for Palliative Care Dr. Z. Ali, Dr. E Munyoro, Dr. R. Gakunga) Impact of Fungating gwounds on the Quality of Life of Cancer Patients - Joyce Marete MPC Students research (Dundee University)

23 Empowering patients to make decisions and demand for their rights Project on legal aspects of palliative care Right to palliative care Right to pain medication Right to make decisions about property Succession plans for children Writing wills Place of burial

24 What are palliative care rights? Palliative care embraces human rights that are already recognized in national laws, international human rights documents, and other consensus statements. Palliative care rights include the right to: Pain relief Symptom control for physical and psychological l symptoms Essential drugs for palliative care Spiritual and bereavement care Family-centered care Care by trained palliative care professionals Receive home-based care when dying and to die at home if desired Treatment of disease and to have treatment withheld or withdrawn Information about diagnosis, i prognosis, and palliative i care services Name a health care proxy for decision making Not be discriminated against in the provision of care because of age, gender, national status, or means of infection. Open Society Institute and Equitas

25 Partnerships and Collaboration Over 30 hospices and PCU Community Based Organizations Mission Hospitals Private Hospitals NGO s Government hospitals Donor Funding: Diana Princes of Wales Memorial Fund, Open Society Institute, African Palliative Care Association, True Colours Trust, Hospice Care Kenya, Catholic Relief Service, CDC, PEPFAR, AIDS Relief,..

26 Challenges Kenya does NOT have a national palliative care policy A national pain Management policy Hospitals have not adopted appropriate pain assessment tools/ Pain management tools Hospitals understaffed Have not included PC in their budgets Do not have trained teams Some do not have a room to allocate to a PC team Hospital budgets reduced to almost half of previous Despite all these, the idea is well received and all feel they need it to happen immediately!

27 TheFutureofPalliativeCare inkenya Palliative care and pain policies/ guidelines in place PC is integrated in HCPs Curricula PC integrated into health care services at all levels (community to tertiary levels) Recognized as a specialty (Offered at degree level) Pediatric PC and PC for Older people embraced and practiced PC for other life threatening illnesses Adequate ToTs for PC Research Centers equipped with relevant educational materials

28 In Conclusion Change will not come if we wait for some other person or some other time. We are the ones we ve been waiting for. We are the change that we seek Barack Obama (Speech 5 th Feb 2008) You must be the change you wish to see in the world Mahatma Gandhi

29 Thank you