Burundi is a landlocked country in the African Great Lakes region of southeast Africa, bordered by Tanzania in the East and South, Rwanda in the North and the Democratic Republic of Congo in the West.
The country has been devastated by many civil wars since independence from 1972 to 2005. This partially explains its poor economic situation: Burundi is listed among the five poorest countries in the world: GNI per capita is just $280 (2013) while life expectancy is just 54 years (2012).
Despite a long armed conflict that paralyzed development including public health system, the country has made significant progress in health sector field such as reducing maternal and child mortality, decrease HIV/AIDS prevalence, and malaria mortality.
Palliative care though is not seen in most health settings and is not yet included in the health strategy plan of the Burundian Ministry of Health.
Cancer is also a real threat in developing countries where its prevalence and burden are rising alarmingly. According to Julio Frenk, Dean of the Harvard School of Public Health, 55 percent of new cancer cases arise in developing nations—a figure that could reach 60 percent by 2020 and 70 percent by 2050.
According to the most recent World Health Organization (WHO) estimates, in 2004 there were 7.4 million cancer deaths worldwide, representing around 13 percent of total deaths. More than 70 percent of those deaths occurred in low- and middle-income countries. In Burundi, the estimated number of new cancer cases in Burundi for the year 2008 was 5860.
In environments with limited resources; palliative care is the principal axis of response.
The WHO defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual;
The concept of palliative care is based on a human rights approach and its integration in public health systems would improve the quality of life of patients and their families facing life-limiting illness.
Burundi Ministry of Health has delayed to develop appropriate services adapted to patients’ needs and Burundi still lags behind compared to other East African Community countries where significant progresses has been made.We are facing many challenges regards the support of the program in the Burundian health system:
- Lack of personnel skilled and trained in Palliative care
- No chemotherapy and/or radiation
- Palliative care not included in education programme for medical and nursing students
- Lack of pain treatment, with approximately 0% coverage of deaths in pain with treatment
The current consumption of opioid analgesics needed to meet the minimum demand from deaths due to HIV or cancer is widely negligible and almost inexistent.
Freedom from pain is a human right. It is important for the Ministry of Health to understand that patients continue to die without appropriate support. We need to change our own and other’s attitude. I had different conversations with patients diagnosed with cancer and other life threatening diseases who said they would prefer to die than continue to live with untreated, severe pain.
All partners and stakeholders should consider and think about the ways to deliver these patients from suffering unreasonably. The only way to achieve this is to integrate palliative care in the Burundian public health system using the WHO model of health system: Policy, Education, Implementation and drug availability remain the key.
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