Palliative care is an essential component of affordable and effective cancer care. Pain and symptom control, coupled with counseling and spiritual care, enables patients to die with dignity, preventing a painful and distressing death. However, research has shown that 79% of the global morphine supply is used by only 6 countries (USA, Canada, France, Germany, Australia and Britain). In Africa, there are also restrictions on the prescription of morphine because of fears about addiction. There is thus relatively little use of oral morphine in Africa. Without access to palliation, most cancer patients in Africa die in considerable pain. AfrOx hopes that working with partners in a process of education, awareness raising and destigmatization, with due attention paid to cultural sensitivity, will presage the more widespread introduction of palliative care.
Palliative Care Lectures, January 2009
Dr. Samira Iskander-Gabra from the UK gave lectures and compiled a preliminary needs assessment on palliative care in Ghana on behalf of AfrOx. Dr Gabra spent a month in Ghana. She gave lectures at the Korle-Bu nursing school in Accra, and the hour-long lecture was attended by 50 students. She also travelled to Tema, 40 kilometres west of Accra to a private nursing school. Here she lectured to the 2nd and final year students on introduction to palliative care. This subject was new to the students who showed keen interest on being taught more on this subject. She met the academic officer Mr Obossey and discussed the advantages of teaching palliative principles at a pre-graduate level. The school has requested that they would include the teaching of palliative care in the curriculum. Dr Gabra also spoke at clinical meetings in the Radiotherapy and Haematology departments Korle Bu Teaching Hospital and the clinical meeting of the pharmacists. The chief clinical pharmacist Mrs Nkansah at Korle Bu requested a similar talk for the pharmacists with emphasis on palliative drugs for pain. Around 60 pharmacists attended this session covering the reason for palliative care, the importance of multidisciplinary efforts, the role pharmacists could play in palliative care and the logical approach to treatment of pain.
Dr Gabra advised that informing equipping and encouraging those working medical staff on the front line will result in a demand by professionals and patients, that cannot be ignored by the policy makers. She recommended that the best way to start would be by gathering around all those who are likeminded, get them interested and engaged to establish a small manageable local service at the hospital. To start building on these recommendations, Dr Gabra returned to Ghana on behalf of AfrOx to conduct a detailed needs assessment and to run a series of palliative care training workshops in October 2009. For more information about Dr Gabra's second visit to Ghana, see below.
Palliative Care Training Workshops, October 2009
In October 2009, Dr Samira Iskander-Gabra returned to Ghana to run a series of training workshops and lectures on palliative care for AfrOx in Ghana. The workshops were designed around the syllabus from the Help the Hospices palliative care toolkit, which has been specifically to equip, empower and encourage health workers in resource-limited settings to integrate palliative care into their work and their communities.
The subjects covered included: the definition of palliative care; palliative care in low-resource settings; assessment of pain and other symptoms and advocacy. Each group of participants was asked to hand back their answers to certain questions, to allow assessment for further training. At the end of each session each participant was given a copy of the Toolkit and a CD and was asked to hand back their completed evaluation forms.
The first workshop was in the Radiotherapy Dep. In Korle-Bu hospital. Doctors, clinical psychologists, a clinical physicist, nurses from the Oncology department and members from the Cancer Society of Ghana attended the first workshop.
The second workshop was held at the children's block at the Korle Bu Teaching hospital and was attended by a number of doctors, community pharmacists and many nurses from a polyclinic outside the hospital, dealing with patients with HIV and tuberculosis. From this workshop Dr Gabra learned that whilst there was good support for HIV and tuberculosis patients who receive counselling, treatment, food and clothes, no one however, knew of any kind of support for people with cancer. Following this workshop, Dr Gabra was invited to give a lecture to the staff at the next clinical meeting in the paediatric unit by Dr Lorna Brenner the consultant paediatrician.
A third half-day workshop was arranged for 58 final year students of the Public Health School. All the students had a background of general nursing or midwifery before joining the school. On their graduation they will be given senior posts in community health centres. Many of them felt they will be able to apply palliative care principles in their areas of work and use their position to tell others about it; and some asked for follow-on training on palliative care. At the end of the session
Dr Gabra met Mrs Sarah Mildred Addo, the principal of the school and presented her with a copy of the Toolkit and a CD. This workshop was valuable in identifying an important group who are willing to receive training in palliative care
Dr Gabra also visited the nursing college at Ghana University in East Legon. Dr Ernestina Donkor, the dean of the college was given a copy of the Toolkit and a CD. 56 people, tutors and students from different years, attended Dr Gabra's lecture. The dean said she would welcome further input in the future.
Dr Gabra also attended at the clinical meeting in the Children's Block at Karle-Bu. 26 doctors and nurses were present for the talk on definition of palliative care among them was Dr Ofori-Teta the senior clinical psychologist who promised to send more of her students to attend the final workshop.
The fourth and final workshop was at Korlu-Bu, in the radiotherapy department. Largely pharmacists, few nurses and clinical psychologist students attended it and there was a discussion on the availability and cost of palliative care drugs.
In addition to leading workshops and giving lectures during this visit Dr Gabra, in partnership with the experts in Ghana, conducted a detailed needs assessment on palliative care. AfrOx is now in the process of designing a palliative care programme to address these needs and intends to collaborate with international, regional and local organizations in Ghana on this programme.
To download a free copy of the Help the Hospices palliative care toolkit, please click here.