The 70 km drive from Kampala to Gombe District hospital in Butambala in Uganda welcomes a typical village town graced by Banana plantations, virgin bushes with climbing trees and an ongoing rural road construction. Gombe District Hospital is one of the Hospitals that has benefitted from a 3-year Tropical Health Educational Trust (THET) multi-partnership project funded by Department for International Development (DFID) since April 2012 and delivered through the University of Edinburgh (UoE) in the UK and the African Palliative Care Association in Africa. The hospital was selected for capacity building support as it was centrally placed, with a large rural catchment population.
The THET project aimed at strengthening and integrating palliative care through a public and primary health care approach to contribute to meeting the targets of Millennium Development Goal 6 (Combat HIV/AIDS, malaria and other diseases). It was expected that interventions after the three years would lead to Ministry of Health recognition of palliative care in national health plans (Advocacy), palliative care (PC) approaches and services integrated into the local hospital, district health systems in each country ensuring better and earlier service access (service delivery);Adequate number of generalists and specialists able to provide palliative care within the identified hospital networks (staff capacity) and strengthened public-private partnerships and active mentorship programmes across the focus countries and the UK.
On 28th January 2015, the African Palliative Care Association (APCA), Makerere Palliative Care Unit and the Palliative Care Association of Uganda (the core team managing the project), joined stakeholders from the Gombe District Health management team and the health care workers from Gombe District Hospital into a reflection on the outcome of the THET project over the last 3 years, including sharing achievements and discussing a sustainability plan. The meeting was attended by over 80 participants including village health teams, religious leaders, health care workers from Gombe District Hospital and Health Centres in the district, community and hospital counsellors, representatives from the ministry of health and district political leaders.
Gombe District Hospital demonstrated milestones in palliative care integration as a result of the project. Prior to project implementation, there was no organised palliative care services, and in 2015 the work of the palliative care team has attracted other health care workers to be involved in linkages to identify patients needing PC and making a referral to the PC team. The hospital has now extended PC services to patients from within hospital and those near the facility, provided bereavement care; and support supervision visits to health workers in health centers to deal with complex palliative care problems. The team also contributes to the Media programmes on local radio station (Radio Buwama) and has developed a PC Newsletter with future plans to publish regularly.
Feedback from the District Health Officer and testimonies from the health care workers and a beneficiary patient confirmed the success stories from THET project interventions. One of the nursing sisters in the palliative care team, Sister Florence gave a testimony on how her own mother who had cancer was cared for by Gombe PC team and the services she received including truth telling, holistic pain management and end of life and bereavement care. She appreciated the importance of personalised care and part of her testimony is given in the quote:
‘She was given therapeutic touches…She died finally but I and the family were at peace and the family has continued to send appreciation to the PC team in Gombe hospital. I also realise that it is not only money that motivates people to help others but the peace that the patient obtains is a key motivation’
A patient who had been diagnosed with late stage cervical cancer and received care from the hospital commended the patience, creativity and support of the palliative care team members; ‘Dr. Mbugga has allowed me to disturb him all the time and my survival depends on him – I can stand and even sit, which I was not able to do. He has been very creative about my life which is why I am still surviving.’ She also commended her home carers for their dedication and commitment that encouraged her to keep on living life the best she can.
Some of the factors accounting for the success are: training of hospital staff on PC and providing opportunities for continuous development including the attendance of local and international PC conferences; running a regular PC clinic every Wednesday and Thursday of the week; extending support to lower level health facilities; weekly ward rounds and visiting patients at home. Local and international mentorship by experts instilled confidence among health care workers. Collaborating with political leaders in the district and advocating together with communities has also been a major contributor to programme success. Monthly meetings were also held on palliative care resulting into monthly reports.
Despite the achievements, the delivery of palliative care services to all those in need in the district still faces some challenges. There is inadequate facilitation of team activities especially for home visiting to follow-up patients at home, referral between facilities and community volunteers is still weak due to poor infrastructure and communication. The palliative care team is also still working out ways to integrate spiritual care within their work. There is also a need for some palliative care specialist skills in the hospital.
The issue of sustaining palliative care services in the hospital and the district was discussed. Advocacy towards attitude change through the training of more health care workers, community sensitisations, working through the hospital administration and aiming at including palliative care activities like home visits in the hospital budget were recommended as further interventions. The need for specialist palliative care skills, the training of spiritual leaders and encouraging them to join the hospital palliative care team and community volunteers as well as mobilizing funding for home visits and outreaches were also identified as areas of priority. District political leaders encouraged the hospital palliative care leadership and management to advocate for funding of palliative care activities at the district level by submitting a proposal to the district council.
The Principal Nursing Officer to the Ministry of Health, Mrs. Akumu Christine Sifuna applauded the hospital for the development and assured them that the Ministry of Health was ready to support sustainability of the services. She urged Gombe District Hospital to endeavour to be one of the established centers providing quality palliative care and encouraged the health care professionals who received mentorship to initiate the best practices acquired in their context.
The African Palliative Care Association and all its partners in the THET project (UoE, Palliative Care Association of Uganda and Makerere Palliative Care Unit in Uganda) are very proud of Gombe District Hospital. We see it as a model that can be adapted by other district hospitals in Uganda and other African countries.
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