From a personal resolution to public action – providing palliative care in Senegal

Categories: Care.

The Institute is the main centre in Senegal for people suffering from cancer. It was created in 1964 and has a 25 bed capacity, a radiotherapy unit, a chemotherapy unit and a surgery service. It receives an average of three thousand patients each year.

Senegal is located in West Africa and has a population of fourteen million based on the most recent (2014) statistics. The population is mostly Muslim, with a small number of Christians. It is a multicultural place where tolerance and respect between communities is the norm.

The Juliot Curie Institute receives a large number of people every day seeking care for cancer. Referrals come from regional and teaching hospitals for diagnosis, surgery, chemotherapy and radiotherapy. A high percentage of these patients arrive at hospital with advanced or metastatic cancer.

My friend and former medical school roommate was diagnosed in 2012 with cancer of the hypopharynx. She was med-evacuated to France while the disease had already reached an advanced stage. She passed away there after months of palliative care. However, she died without getting to say goodbye to her two young children.

This experience was the trigger that made me realise the importance of taking care of patients with life-limiting illness as well as their loved ones.

I was inspired after the death of my friend to focus my professional career on improving the quality of life of patients with life-limiting illnesses and their families. To honor her memory I vowed to do my best to provide palliative care to patients in order to relieve their pain and suffering

The concept of palliative care was integrated in the Institute in November 2014 after my training in palliative care for Francophone countries with Hospice Africa in Kampala, Uganda. With the support of the head of the department, we organised two courses on palliative care and pain management.

The Senegalese Ministry of Health appointed me to set up the program, with the goal to improve the quality of life of the numerous people with cancer we take care of every day in the different departments of the Institute. 

The courses brought about a significant attitude change for health providers regarding pain medication prescribing patterns. There were also numerous anecdotal reports of high satisfaction rates amongst patients and their families.

After six months of my presence at the Institute, 282 outpatients had received palliative care services, pain was controlled in 80% of patients and awareness of palliative care was increased.

Palliative care is not yet available to the departments of Neurology, Infectious diseases, Cardiology, Internal Medicine unit or the Geriatrics center. Awareness has to be increased. A questionnaire has been developed by the Department of Health in November 2015 for an ongoing needs assessment. The pediatric oncology unit also offers palliative care services for patients in need.

I was able to review the WHO Resolution on Palliative Care and share it with my peers in Senegal after I attended a workshop at the Dublin Palliative Care Colloquium, with the support of IAHPC and All Ireland Hospice of Hospice and Palliative Care.

In my opinion, in Senegal we first need to develop a National policy and Strategic Plan on Palliative Care which would be integrated at all levels of the Senegalese Public health system.

We also need to do human capacity building by educating health providers and the community about the concept of palliative care. In the future, a palliative care curriculum should be developed to train future medical doctors, nurses, and social workers on how to integrate the holistic approach to patient care.

Lastly, the availability and accessibility of opioids as essential medicines from the National Pharmacy at the Ministry of Health should be an imperative priority of the government in order to avoid stock outages. We need also to develop a research program in palliative care.

I am grateful to the head of the oncology department for his advocacy for the integration and expansion of palliative care services throughout the Institute as well as his continued encouragement of the involvement of the other oncologists.

I personally keep on advocating for the integration of a palliative care curriculum in the medical school in order to instil interest early on in our young practitioners. I have convinced an oncologist from Mali who is completing his residency in Dakar to take the Uganda palliative course in May 2015. In addition, I convinced a colleague from our department to represent the Palliative Care Unit at the International Francophone Congress in Tunisia.

I would like to acknowledge specially Prof. Phillip Larkin, for inviting me to attend the October colloquium and for the opportunity to meet and discuss with experts in palliative care at the Dublin Colloquium.