Dr Andrew, you’ve been awarded a special commendation by the EAPC for your research. Could you tell me how you fell about that?
This award means a lot to me, because as an early career researcher in palliative care in a developing country, with a lot of limitations, this recognition of the work I’m doing, in spite of the constraints, goes a long way to motivating me to want to do more.
What is the focus of your research?
Primarily, I am a psychiatrist and a physician. For some years now, my focus with regards to research has been to look at the interface between mental health and palliative care.
Palliative care is evolving in Nigeria, and issues with regard to mental health often impede the quality of care that patients receive. I’ve tried to look at the burden of psychiatric morbidity among people who have palliative care needs, and this cuts across a number of patient populations: people with cancer, people with chronic illnesses like organ failure, end-stage renal failure, as well as the older population.
It is important to know that from some of the outcomes of my research, we’ve identified the fact that co-morbidity of emotional illness among this population often impairs good outcomes, as well as quality of life. People often present late with cancer, so there are a lot of issues with regard to accessing health care and the identification of the problem early enough. What we are trying to do now is to look at how we can improve public health awareness with regards to uptake of palliative care. We want to make sure that people have access to it and they have the best quality of access, as the outcome is likely going to be better if they access care early enough.
The other thing that we are trying to do is to look at how we can interface outcomes of research with care, using evidence from research to improve clinical care. Also, it’s not that we don’t have a structured national policy for palliative care, but with more effort and research, we hope that we will be able to convince the stakeholders, the politicians, funders and others who are involved in designing services, to improve focus on palliative care. So there are so many things we feel that improvement of research in these aspects will help us to achieve.
I’m delighted that the work that we are doing is being recognised. I’m going back home with a new energy to want to do more and to want to put Nigeria and Africa on the map of best practices because that is the aim; that the kind of services that we are rendering in palliative care is comparable to what is obtainable in other parts of the world.
Could you talk about both the challenges and the opportunities of doing research in palliative care in Nigeria and also in Africa generally?
Palliative care is evolving. The clinical services are not as structured as those in an ‘advanced’ country, and the services are not equitably distributed. Also, the services are located in the centres, around big institutions. In other words, most of the people in the rural areas find it difficult to access services.
The national health insurance has a poor coverage. Only about 9% of the population are covered. The scope of the health insurance is not comprehensive enough to take into consideration all that is needed in palliative care. Most of the time, people pay out of pocket, so that provides a lot of opportunity and a lot of gap with regards to what is available, and how easy it is for people to access. And if they access it, how can we sustain their treatments after institutional care? So, in terms of services, there is a lot of opportunity with regards to evolving services that will be able to provide services for people around the country.
Also, it is important to link up with other services if possible, and to integrate services into the existing health care system. Such that whatever people have, whether they are able to access healthcare at the primary level, the secondary level, because that is the level of stratification with regard to the services, or at the tertiary level, they can have the opportunity for them to have access to quality palliative care.
I feel that also provides opportunity for research, because as services are developed, this allows for better research. Currently, the research culture in palliative care in Nigeria is poor with regards to the amount of research we are doing. Most of the research we are doing now is personally funded; there are no major funds to drive them, so they are either institutionally funded or personally funded. Also, it is interesting to know that, in spite of our limitation, international bodies like EAPC, have given this recognition.
You spoke about going back with a renewed energy. What will be your next steps when you get back home?
This conference has been an eye-opener. It has provided me the opportunity to be exposed to best practices in spite of the fact that some of the practices may not be fully or completely replicable in my own situation. I’ve learned a lot that I feel that going back home I hope I will be able to reform our guidelines with regards to palliative care in my institution.
I also intend that when I get back home, I’m going to organise some seminars among colleagues and some other people that are involved in palliative care, to disseminate some of the findings from this conference and also to reach out to them to be involved in some of this international activity. I’ve also benefitted from the networking opportunities; I’ve interacted with a lot of people from different countries, with a lot of different interests. I hope to build on such networks to enhance my research.
This conference has also provided me the opportunity to see areas where I can develop myself with regard to training. Overall, the idea is, with this improvement in knowledge with regards to clinical service, with this new energy for research, I hope to translate all these things into better care of my patients, and their family caregivers. Ultimately I hope that within the next few years, we will be able to have enough evidence based on empirical data and research that we’ve done to influence the policy makers. If we have evidence from research that is locally-based it is more likely that we will be able to persuade the policymakers to drive national policy guidelines to guide palliative care and also to allow systematic integration of palliative care into the different strata of the health care system.
I feel that if that can be done, the volume of research that will come out of Africa is going to improve and it is like a virtuous circle: research will increase, clinical services are going to be based on evidence from this research, that will improve, the patient will benefit, their caregiver will be better off, policies will be available, and everyone will be happy. So it’s going to be a win-win situation.
I look forward to Copenhagen in 2015, or maybe the next one, to have better news with regards to my experience. If I’m going to be presenting an abstract, it will be to tell my European colleagues the improvement I’ve noticed, starting from now with regards to my practice, my research. From attending these seminars, I’ve noticed some clear areas for improvement, so hopefully when I get back home, some of the protocol that I’ve written, that I’m working on with regard to research, will be influenced by some of the things I have picked up at the conference.
There are also some areas which have not been researched, for instance: some issues with regard to quality outcomes, which was one of the primary sessions today, I hope to focus on that. So you are not just providing services, you are looking at the quality of the outcomes for patients. Currently in Nigeria we are not doing much of that, we are providing services, but we have not taken time to look at the quality of the outcome. And this is a major issue: Are the patients and their caregivers getting what they are supposed to get? And if they are not, what are the problems? And – once we find the problems – how can we resolve them? These are the things that I hope to take further as I go back home.
I’m grateful to the EAPC for this special award. It has impacted my career in many ways: first of all, this conference has given me the opportunity to be better exposed, and to better interact with the experts in this field. Some of them I know from reading their work in journals, so it is emotional to see them at this conference. Secondly is that the recognition itself is psychologically constructive, that the work I’ve done is appreciated. They’ve also given me the privilege of subscription to European Journal of Palliative Care for one year, which is a lot of resources in terms of literature, so for me it is a huge opportunity that has been given to me, a huge opportunity… and for this I’m very grateful.
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