IAHPC Hospice and Palliative Care Newsletter

Palliative care is a relatively new specialty and still unheard of in many parts of the world especially Africa. In Uganda the modern aspects of palliative care became a reality in 1993 at the time when Hospice Africa Uganda was born.
The objectives of Hospice Africa Uganda in 1993 and to-date are:

To provide a palliative care service to patients and their families.
To carry out education programmes in palliative medicine, so that this form of care can be available to all patients in need.
To encourage palliative care for other African countries

The Cancer Society of Ghana is spearheading the initiation of Palliative Care in Ghana for both cancer and AIDS patients. The society arranged and organized for an introductory palliative care course in an attempt to identify those that could be trained as trainers.

The society contacted St. Helena Hospice, Colchester UK, as well as Hospice Africa Uganda to help arrange and run this course. The course was arranged in such a way that it is based on what is achievable and practical in an African setting. This African experience was to be provided by Hospice Africa Uganda.

Funding was obtained from the International Hospice and Palliative Care Association (IHPCA) for Terry Magee from UK, as well as Dr. Henry Ddungu and Ms Berna Basemera from Uganda. Hospice Africa UK funded Dr. Jack G.M. Jagwe, a senior advisor on Policy, drugs and advocacy at Hospice Africa Uganda.

The program leader was Terry Magee, Director of Education at St. Helena Hospice UK, who together with Hospice Africa Uganda made the program and training handbook for the participants.

The course was initially arranged to take two weeks with the first week being an introduction to palliative care and then training of trainers, during the second week. However, this was not possible. It remained a one week introduction to palliative care course.

The team from Uganda arrived on May the 8th 2004 and had a one day rest before the course began. The team from UK landed very early in the morning of the day the course commenced. They were of course tired though they did not suffer from jet-lag – England is at the same longitude (Greenwich) as Accra.

The Opening ceremony took place at the Ghana International Trade Fair in the afternoon of Monday the 10th. It was attended by many dignitaries including executive members of the Ghana Cancer society, government representatives and all the course participants. It was a very colourful occasion.

The Keynote address was given by Dr. Ken Sagoe, Director of Human resources, Ghana Health Services. He emphasized government’s position towards palliative care in Ghana and their (Government) willingness to incorporate it into policy and advocacy.

Professor F.T. Sai, Chairman, Ghana AIDS Commission and former examiner at the Institute of Public Health – Makerere University (Uganda), emphasized the importance of cancer prevention, early detection and pain and symptom management.

The opening ceremony was on the headlines for the evening news on TV3 – a private TV company in Accra with a very wide coverage.

A total of 96 participants registered for the course. Of these only 17% were males. 64% were nurses. Two doctors attended during the first few days. Thirty participants were students. These students would qualify to be nurses, but are not taken by government for training. They are identified and provided with special caring skills so that they can help out in the various communities, including hospitals in caring for patients.

The training began on Tuesday 11th May 2004 with the first lecture given by Dr. Henry Ddungu, on the Hospice Concept. It was made clear that even with minimal funding one can care for a dying patient in need of palliative care, as long as there was commitment. Examples of locally available remedies that have been tried and found to be working were given and emphasized.

Terry Magee is a very experienced teacher! She gave among others a wonderful practical session on the physiology of pain and all were left convinced.

Dr Jack Jagwe discussed the laws governing use of Narcotics as well as ‘Myths and Fears’ on use of morphine to such a degree that all the fears they (participants) had waned away.

Berna and John took the group through spirituality in the hospice context and the discussion groups never wanted to stop! It was such a good experience for the groups discussing various issues and sharing the various experiences.

Grief and bereavement in Ghana was another interesting topic. The group agreed to divide into the different ethnic groups – the Gas, the Akans, the Ewes, the Dogombas and Mamprusis, and the Dagarees and Sissalas (Northern). Each of these groups gave their cultural beliefs towards grief and bereavement. It was so amazing to realize that even in the same country, different groups have differing cultures and beliefs when it comes to death and dying. It emphasized the importance of cultural considerations – Cultural Pain – and palliative Care.

The trainees were a very enthusiastic group that was involved in-group work, asking and answering questions, sharing their cultural differences and many other important things.

The course ended well and it was explained to participants how they were to write a reflective diary to be submitted to the Cancer Society of Ghana before they could receive their certificates in June 2004. They were all ready and willing to do this and to-date, many have received their certificates.

During the course of the training we had a meeting with the executive of the cancer society of Ghana on the future possibilities following this initial training. It was suggested that the society would identify a few people who had grasped the concept, for further training as trainers of trainers. It was also suggested that a few nurses and a doctor be identified for a clinical placement in Uganda so that they gain practical experience in palliative care.

As far as availability of oral morphine was concerned, this did not seem a very big problem because the department of health is already aware and willing to support the importation of oral morphine into the country. However we will see how this goodwill develops! It was however, emphasized that potential prescribers need to be sensitized on the use of morphine.

Lack of trained personnel in palliative care
Oral morphine, an essential drug for management of pain in cancer and AIDS, is not readily available in Ghana.
The senior doctors, like in many other parts of Africa may be unwilling to change their ideas about use of morphine.
We had almost no doctors present for this training, yet they are very important as far as understanding the use of morphine. It may not be easy for them (doctors) to understand the concept unless they do attend such a course.
The people from Central and Northern Ghana, including Kumasi, were not given a chance to participate in this training. They contacted the Ghana Cancer Society and requested a similar course.

All in all it was a very good experience for both the Ghana group and the facilitators from UK and Uganda.

The training team was presented with very beautiful gifts from both the participants and the Cancer Society of Ghana to show their appreciation for the knowledge and skills they gained during the one week training.

	International Association for Hospice & Palliative Care
	Promoting Hospice & Palliative Care Worldwide