Regional Reports
Palliative care in the National Cancer Control Program
in Hungary
In September 2005 the government of Hungary announced the National Cancer Control Program (NCCP) as part of the National Development Plan. Quality of life improvement and social and professional collaboration for fighting cancer were indicated as the main aims. Another aim is to provide a complete oncological approach to balanced patient care. With this purpose in mind, the guidelines and recommendations of the World Health Organization’s (WHO) program were followed in the new National Cancer Control Programmes.
In order to develop the program which was prepared by the Ministry of Health, the Hungarian Hospice-Palliative Association (HHPA) offered to construct the chapter on hospice/palliative care and also the recommendations/aims section since these were not present in the first plan of NCCP. Very useful relationships were formed between the Association and the Ministry’s Department of Health Policy during the years in which the Palliative Professional Guidelines (2002) and the Palliative Minimum Conditions (2004) were constructed and while organizing joint conferences (2001; 2005).
The HHPA developed chapters on palliative care and the fist version was submitted for social-professional debate in November 2005. The HHPA represented itself at debates within the Professional Colleges and the member organizations, from these it was able to collect further additions and proposals.
The final National Cancer Control Program was introduced on the 3rd February 2006 in the National Institute of Oncology in the presence of the Prime Minister and the WHO’s representative (Dr. Cecilia Sepulveda).
Palliative Care is included in the chapters of the Progress report.
As part of the Action Plan:
OBJECTIVE 13: CREATING A COUNTRYWIDE HOSPICE NETWORK IN ORDER TO IMPROVE THE QUALITY OF LIFE OF CANCER PATIENTS
Tasks:
1. To establish, by the year 2010, at least one hospice inpatient centre by region, and operating as part of the health insurance system.
2. To achieve countrywide coverage of hospice care delivered within home care services in 3 stages (in counties, towns and their surroundings, in the whole country).
3. To provide for the professional representation and presence in education and training of hospice and palliative care, and to integrate it into education and continuing education.
Dr. Katalin Hegedus PhD
President of the Hungarian Hospice-Palliative Association
1089 Budapest , Orczy ut 6.
Tel./Fax: +36-1-215-0938
e-mail: [email protected]
Website: www.hospice.hu
ADVOCACY FOR AVAILABILITY OF OPIOIDS IN NIGERIA
In Nigeria , opioid analgesics are on the essential drug list and have been in use for many decades. However, due to frequent changes in the government, lack of proper accountability, misconceptions about opioids, fear of abuse and inefficient bureaucratic procedures, the country was without strong opioid analgesics for over four years. The strong opioid that has been consistently available is pentanzone! I attended the World Congress of the International Association for the Study of Pain (IASP) in 1996 and by 1998 I inaugurated the Society for the Study of Pain, Nigeria (SSPN). Our active advocacy for opioid availability commenced with this inauguration, followed by letters of appeal and visits to key officials of the Federal Ministry of Health. They included the Ministers of Health, Directors of Pharmacy and the Director of the National Agency for Food and Drug Control (NAFDAC). One of the letters to the pharmacy was from David Joranson ( University of Wisconsin , USA ).
The annual conferences of SSPN had special features on the importance of opioid analgesics for the management of severe pain. Featured articles were published in Nigerian newspapers and the electronic media by key opinion leaders in the country. The Nigerian Society of Anaesthetists and Palliative Care Initiative group were involved in advocacy. On December 1 st 2001 NAFDAC informed SSPN about the availability of a supply of opioids that had been poorly distributed for use in the health facilities. Because of this, a lot of the supply had already expired in the government stores by September 2004. The machinery for continuous procurement was not put in place. We intensified our advocacy efforts at getting another continuous supply of opioids for severe pain and we developed a workshop in Ibadan in collaboration with Hospice Africa, Uganda. This had wide media coverage and resulted in dissemination of a communiqué. The lecture and interview on palliative care and opioid use by Anne Merriman was broadcast live on national television.
The advocacy efforts (including visits) finally had the support of the current dynamic director of the National drug regulatory body (NAFDAC) Prof. Dora Akunyili. An authorization to import was issued to the Ministry of Health in May 2005 and a supplier was appointed by the Ministry of Health. The supply of opioids (pethidine, morphine, fentanyl, dihydrocodein injection; pethidine tablets and morphine sulphate powder) finally arrived in the country in January 2006. We have sent letters of appreciation to the Honourable Minister of Health, Director, NAFDAC with suggestions for training/retraining of doctors, nurses and pharmacists on safe use and handling of opioids. Also, mentioned were issues of sustainability of the supply, effective distribution, monitoring and prevention of complications and abuse.
Olaitan Soyannwo
Immediate Past President, SSPN
Member IASP Council
Member, Board, African Palliative Care Association
Ndola , Zambia
The Dominican Sisters of Ndola are members of LARC a Link Association for the relief of children. In the past, we have been chiefly engaged in education and health. Since 1996, we have been involved in caring for homeless, orphaned, abused and abandoned children.
In 2000, we established the Twapia Transient Home in Ndola . The home caters at present to 63 children from 4 to 15 years. It became very difficult to adequately cope for healthy as well seriously ill children especially the very young ones in need of constant care and attention. Consequently, an alternative accommodation was needed for HIV/AIDS and TB infected children.
The Building of the Saint Anthony Children’s Village in Masala was initiated and funded by Caritas, Italy. The running costs for the Home in 2005 were funded by ZOA, Hilton Trust and Global Funding.
In May 2003, the first twenty children were transferred from Twapia to the Village.
So far 278 children have passed through Saint Anthony Children’s Village. 23 boys and 29 girls have succumbed to HIV/AIDS related illnesses. At the end of last year there were 114 children at the village.
Managing Agency: The Dominican Sisters, P.O. Box 70235 , Ndola
ACTIVITIES
Feeding, shelter, healthcare, counseling, education
OBJECTIVES
To provide shelter and basic services for homeless orphaned, abused and HIV/AIDS infected children.
To re-unite as many children as possible with their relatives and continue monitoring and supporting them.
To provide psycho-social counseling
VISION
To provide holistic care in a home setting for HIV/AIDS infected and affected children until alternative and stable arrangements can be made.
To re-unite as many children as possible with their families, or place them into foster homes.
ACHIEVEMENTS
Saint Anthony Children’s Village has assisted 278 children (165 girls and 113 boys) to date. Presently: 26 girls and 24 boys are attending nursery school at the village 15 have moved to the Twapia Transient Home to attend primary school.
CHALLENGES
Children returning to their families
Adjusting to a new environment
To counsel traumatized and abused children
Coping with chronic ill-health, death and dying
To help children to accept and care for mentally and physically handicapped members in the Village
To cope with the ever increasing demand for shelter
LESSONS LEARNED
- To be patient, and allow children to make mistakes and turn them into learning experiences to foster growth and confidence
- Never to force a child to reveal its past until it is ready to open up
- To take time to listen, to comfort, to praise and encourage
PLANS FOR THE FUTURE
To improve existing structures, especially to care more adequately for the disabled and infants.
More and more babies are being admitted due to the mother dying in childbirth or newly born babies are dumped at bus stops, eating places and shopping centres.
Many grandmothers seek admission for their small grandchildren because they are too old, frail and poor or are overburdened with the raising of numerous children from their sons and daughters who have passed away.
A few weeks ago, we received a handicapped child with a sock in her mouth, left by her mother in a sack, covered with long grass. The girl spent the night this way until people discovered her in the early hours of the morning. Some days later the police traced the mother. Listening to her story of abandonment by her husband, and having no means to support herself and her children, the police released her and allowed her to be temporarily accommodated with her children at our village. She has turned out to be a loving carer.
Best wishes of Peace and Joy and God’s blessing on your work.
Sr. Edmunda Meier OP
Click photo to view larger |
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| Sr. Edmunda and all the children at the Saint Anthony Village. |
Africa
PALLIATIVE CARE TRAINING FOR ONCOLOGY NURSES
Dakar , Senegal
15-16 November 2005
“The African Organization for Research and Training in Cancer (AORTIC) held it 5th International Conference in Dakar, Senegal November 14-`17, 2005, under the direction of Dr. Paul Ndom, President. The sessions were attended by 400 persons from many countries in Africa. To bring Palliative Care concepts to the treatment of patients with cancer in Africa, a request was made to the AORTIC Vice Presidents of AORTIC to recommend oncology nurses from their region who would attend a two day workshop, on November 15-16 planned for nurses, in which they could learn more about the theoretical and practical aspects of palliative care in the context of cancer care in which curative treatment could not be undertaken. The faculty consisted of Anglophone and Francophone Palliative Care nurses and physicians who presented lectures and led interactive discussions.
World first: a Nurses’meeting in West Africa
Nurses coming from: South Africa, Cameroon, Senegal, Egypt, Tunisia, Morocco, Mali, Uganda, Tanzania, Burkina Faso
AORTIC's key objectives are to further research relating to cancers prevalent in Africa; support the management of training programs in oncology for health care workers, and to deal with the challenges of creating cancer control and prevention programs, as well as raising public awareness of cancer in Africa…..
Program
The workshops were simultaneously held in French (Sabine Perrier-Bonnet, Director) and in English (Jimmie Holland, Director). These workshops represented the combined efforts of AORTIC, the International Psycho-Oncology Society (IPOS), Alliance Mondiale Contre le Cancer, and the International Network for Cancer Training and Research (INCTR). The workshops were generously supported by the Soros Foundation. The program began with a plenary session of the entire conference, with simultaneous translation, in which the history of palliative care in Africa was presented by Jan Stjernsward, former Director of Cancer at the WHO. Anne Merriman described the successes of Hospice Uganda; pain management was presented by Soyanwe Nigula, from Nigeria; guidelines were given for care by Philippe Poulain, France ……
Conclusion
In summary, the workshops were the result of close cooperation of four organizations, three cancer (AORTIC, INCTR and AMCC) and one psycho-oncology (IPOS) which sought to bring oncology nurses who worked with the oncologists who attended the meeting to become acquainted with and learn from palliative care nurses and physicians to bring the concepts of palliative care closer to the oncology setting where much of the care in Africa is non curative and where greater knowledge of pain and symptom management will improve the care of patients with cancer…..”
The above material is extracted in part from a report we received from International Psycho-Oncology Society/The African Organization for Research and Training in Cancer (AORTIC). To access the entire report click here.
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