88% of the world’s population have no access to palliative care (source: Global Atlas of Palliative Care). This sobering fact led the board of the Irish Hospice Foundation to agree that, while we are primarily an Irish-focused organisation, our constitution commits “to fostering relationships with those working in the fields of hospice, palliative and end-of-life care” including the provision of funds and grants for the development of hospice, palliative and end-of-life and bereavement care. Africa has the highest per capita need, so we chose this as our area of focus. This July our Chair, Jean Callanan who was visiting Uganda in a personal capacity, offered to take the opportunity to visit those projects being funded by IHF. Jean has written three blogs about her experiences, and we are sharing the second one today.
“We are training the future leaders of palliative care in Africa and internationally,” said Dr Eddie Mwebesa, Clinical Director at Hospice Africa Uganda in Kampala, Uganda, as he introduced me to students who have received scholarships from Irish Hospice Foundation. “These students have been chosen because of their ability to become leaders in palliative care in their own countries, across Africa and globally.”
IHF is funding scholarships over three years for students from Uganda and other African countries to attend courses run by Hospice Africa Uganda (HAU) and its Institute of Hospice and Palliative Care in Africa (IHPCA). I was there to meet the 11 students who were completing the annual International Program – an initiating program with two components, three months online and a three-week hands-on module where they are involved in patient care, home visits and learn about the very practical side of palliative care.
The 11 students were drawn from Sierra Leone, Nigeria, Ethiopia, Cameroon, Togo and Uganda. Their professional backgrounds were varied: Doctors, Nurses, Pharmacists, and a Ministry of Health Official. What they shared was a passion for improving palliative care in their own countries and across Africa. 42 students completed the online three months, but only 11 of these were able to visit Kampala for the in-person module – largely due to cost. Which is where IHF comes in. We funded the course for five of these eleven students.
Let me introduce you to some of the students to whom we have given scholarships:
Akobodu Babatunde Abhulmajeed
Akobodu Babatunde Abhulmajeed is a doctor who heads up family medicine in Lagos University Hospital, Nigeria’s biggest hospital. He is also a lecturer in Lagos University. Babatunde is passionate about supporting the development of palliative care, particularly geriatric palliative care, and has just made a formal proposal to Lagos University for a module on palliative care to be included in the Lagos University medical curriculum. Babatunde hopes to be made a consultant next year, and to use this position to help to promote the palliative care ethos in the hospital.
When I met Senafit Gebread from Ethiopia her passion and energy was palpable. She is a pharmacist (whose Master’s thesis was on the formulation of opium) and 12 years ago was an Ethiopian government regulator. In this role she worked closely with medics and authorities to understand how, working within the existing regulations, oral liquid morphine could be made more widely available for palliative care. Senafit made a massive difference then, and access to oral liquid morphine improved considerably in Ethiopia. This is very important as oral liquid morphine is the most effective drug for serious pain, and it is affordable and easy to administer. The WHO calls it “a gold standard for pain relief”.
Twelve years on though, due to a series of events too complicated to go into here, access to morphine is again very constricted in Ethiopia. Stefanit, now a business consultant with her own business, has taken on the cause and has, with other likeminded people set up the “Pain and Palliative Care Organisation” and is actively lobbying the Ethiopian government to put in place a plan for subsidized production of oral liquid morphine in the country. Senafit told me how this course had given her the opportunity to learn more, particularly about hands-on palliative care which would not have been a part of her formation. Most importantly it had given her an international network of fellow students who can support her in her championing access to morphine.
Ivan Kalyango is a young medic who is doing clinical placement in HAU as part of his BSc in Palliative Care funded by IHF. He explained how his salary of 555,000 Ugandan Shillings (about €130) a month did not allow for him to fund his own studies, and that it was only thanks to the IHF sponsorship that he could follow his passion for palliative care – he hopes in the future to be able to do a PhD in Palliative care.
We talked about what is his medical colleagues thought about his choice of studies. “They wonder why I am studying to be able to help people who are going to die, rather than working to find cures,” he told me. This I discovered is not an unusual response to palliative care in Africa, indeed many funding organisations. Both internationally and within Africa, organisations limit their funding to finding cures, explicitly ruling out investment in palliative care.
Alitalia Stella is a nurse midwife in the hospital in Hoima, a small city in the western region of Uganda. The hospital already has one nurse trained in palliative care but Stella hopes that now there will be two of them that they will be better able to champion the principles and practices of palliative care within the hospital. Hoima is one of the two locations outside Kampala where HAU have hospices (the other is Mbarara). Stella’s training and time spent with the HAU team will mean a closer connection between the two organizations with patients leaving Stella’s hospital being referred to HAU for home care support.
The International Program is only one of the courses that IHF is supporting. We are also funding scholarships for a range of courses including Bachelors of Science, diplomas, postgraduate diplomas and masters, run by the Institute of Hospice and Palliative care in Africa, some of which are in association with Uganda’s Makerere University (one of Africa’s top 10 universities).
Dr Anne Merriman, the 88-year-old founder of HAU and IHPCA, is working tirelessly to change this and to champion palliative care in Uganda and across Africa. As she told the students when I was there, “In the past you have been trained how to cure… Now you are also going to learn how to care.”
Dr Anne Merriman with a patient in day care at Hospice Africa Uganda. (Photo credit: Niall O’Sullivan)
This is the second in a series of three blogs by Jean Callanan, Chair of Irish Hospice Foundation, about her experiences on her recent trip to Uganda and visit to Hospice Africa Uganda.
You can learn more about the work of Hospice Africa Uganda and support their work here.
This article was originally shared by the Irish Hospice Foundation on 14 August 2023. To see the original post follow this link.