Ndola Central Hospital is located in the Copperbelt Province of Zambia with catchment population of more than 400,000 people. The hospital also receives referrals from three other provinces in the northern region: Lwampula, Northern and North Western. The palliative care team at the hospital is made up of multidisciplinary cadres of health care workers including nurses, doctors, social workers, clinical psychologist and pharmacists. There is however a core team that oversee most operations.
Palliative care in Ndola Central Hospital began as early as 2009 through the contribution of the Government of Zambia, PEPFAR through the Twinning Project, Princess Diana Trust Fund, True Colours Trust and other stakeholders, working through the Palliative Care Alliance Zambia (PCAZ). One recent supporter is the 3-year Tropical Health Education Trust (THET) partnership project*.
Through the THET project, APCA recently conducted a two day support supervision visit on 19th and 20th February 2015 and participated in two sensitization meetings. During a courtesy visit to the hospital’s administration, Dr Malawo Dande, the Senior Medical Superintendent was enthusiastic about the contribution of palliative care in improving the quality of life of patients. He acknowledged that most patients in need of palliative care were based at home and in the community; and commended the hospital’s palliative care program, which although was hospital based, was equally an active player in community programmes. It was thus essential to streamline this continuity of care from the hospital to community through strengthening linkages between the Hospital and the communities through the District Health Office Clinics. There are already positive steps as the Ministry of Health has promised to support Citekelo hospice provide some respite care for patients with chronic condition discharged through the hospital.
“The ability of a group of people to do remarkable things hinges on how well those people pull together as a team.” ― Simon Sinek, Leaders Eat Last
The sensitizations were held in two health centers: Chipokota Mayamba and Chipulukusu health centers, which serve a combined population of about 100,000 people. Team work, resilience and innovation was evident as the palliative care team struggled to set up the sensitization meetings, including handling logistics, teaching and offering supportive roles. Content of the sensitization included introduction to the concept palliative care and the role of communities’ workers and volunteers in palliative care. During these fora the challenges and needs of the volunteers were discussed, with suggestions on ways to curb these challenges. Key challenges included balancing the high demand for services with limited resources. Responding to these challenges, Mr. Burwell Mulenga, an active member of the palliative care team advised: ‘Many people need palliative care but due to high workload and limited resources, we need to triage and prioritize who really needs their interventions and delegate or teach families to care.’
An emerging issue challenging the palliative care approach was on striking a balance between therapeutic touch and health protection/prevention against hepatitis, Ebola and other contagious and infectious diseases. Another key observation was that even at the health center level, the prevalence of Non Communicable Disease (NCDs) was increasing. For instance, in one of the clinics , the prevalence of Hypertension moved from position 10 in 2012 to 7 in 2013, and in 2014 it moved up to top 5 in the list.
The THET collaboration features prominently in the journey of success for Ndola palliative care development. For instance, three nurses from the palliative care team were supported through the THET project to begin the degree course in palliative care from the Institute of Palliative Medicine in Africa, based in Uganda and attend clinical placement to Makerere University Palliative Care Unit. Through this exposure to Uganda model and advocacy, the palliative care team were motivated to strengthen the palliative care unit functions, which now provides consultation to patients from different departments that need palliative care. Currently, when she walks into the hospital wards, it is usual for Mrs. Betty Njunju, a senior nursing administrator to hear comments from patients ‘we are here Mam; that medicine you recommended has really helped’
Common challenges still exist common to many national institutions as regards to fitting or retrieving palliative care data in the system HMIS. This is expected especially since palliative care services are part of integrated care.
Collaboration, teamwork and partnership: these are popular buzzwords describing the key to success of the palliative care program at Ndola Central Hospital. By the end of the two day visit and joining the two sensitizations, I am assured that with such a dedicated team, there is a bright future ahead for patients in need of palliative care in the Northern Region of Zambia.
*Note: The 3-year Tropical Health Education Trust (THET) partnership project that run for three years from April 2012- March 2015 is funded through the Department for International Health (DFID) through the University of Edinburgh (UoE), which provides overall oversight. The project aimed at strengthening and integrating palliative care through a public and primary health care approach to contribute to meeting the targets of MDG Goal 6.’ The project was implemented in four countries (Kenya, Rwanda, Uganda and Zambia), with three hospitals selected from each country. The in Zambia the overall project implementation is coordinated and overseen by the Palliative Care Alliance Zambia (PCAZ) in collaboration with the African Palliative Care Association (APCA), with support from Makerere University Palliative Care Unit.
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