Walking the Talk; RFM Hospital Integrating Palliative Care Services in eSwatini

Categories: Care, Category, Featured, and Leadership.

The Raleigh Fitkin Memorial (RFM) Hospital is a 350-bed facility located in the densely populated region of Manzini in eSwatini and serving an aggregate population of about 350,000. The hospital is part of the eSwatini Nazarene Health Institution (ENHI), together with 20 Nazarene Community Clinics dotted across the 4 regions of eSwatini (formerly Swaziland). The clinics also serve about 250 000 people, bringing combined reach of the mission facilities to 40-50% of the country’s population, thus making ENHI a major player in the health sector of the country.

Initially, palliative care services at the RFM Hospital were focusing only on end-of-life care. However, following the call by the Ministry of Health of eSwatini to expand palliative care to include treatment, care, support and follow up for all patients facing any life-limiting condition, as well as support for their family, the RFM Hospital undertook several steps to integrate palliative care services into the hospital’s systems.

Management Commitment to Palliative Care Integration

Hospital management appointed a PC Steering Committee whose main task was to ensure full integration of palliative care services in the facility through awareness creation, development of Standard Operating Procedures and establishment of a fully functional care unit within the hospital. These were envisaged to facilitate seamless follow up of clients with life-threatening and life-limiting conditions and their families.

The hospital also allocated a building of good size specifically for palliative care and pain management that include 6 rooms , 1 kitchen, 2 toilets, and a spacious waiting area to accommodate about 100 clients.

Local & International Partnerships for PC Integration

The RFM Hospital palliative care team received training and capacity building through a number of partnerships and collaborations.

  1. Two RFM Hospital palliative care team members went on clinical placements at Good Shepherd Hospital and Mbabane Government Hospital, both of which are tertiary Hospitals like RFM Hospital, but had already started palliative integration care and home-based care services provision.
  2. With the help of the Ministry of Health of eSwatini in collaboration with the American Cancer Society, 70 doctors, nurses and pharmacists received training in Pain Management.
  3. ESwatini Nazarene Health Institution’s capacity to improve the integration and uptake of palliative care services at RFM was enhanced significantly through technical and financial support received from the Open Society Initiative for Southern Africa (OSISA) and the African Palliative Care Association (APCA) in collaboration with eSwatini Ministry of Health. Below are some of the outcomes of the support from OSISA and APCA:
  • Seven-day training for 41 doctors, nurses, pharmacists, social workers, and counselors in palliative care (5 days off site training and 2 days clinical placement at Hope House and eSwatini Hospice at Home facility.
  • Clinical placement of 1 medical officer ,2 nurses and the national palliative care coordinator (MOH)at Queen Elizabeth Central Hospital in Malawi to learn how palliative care services can be integrated in a hospital setting.
  • Two learning exchanges and experience sharing meetings with other facilities providing palliative and home-based care services in the country.
  • PC sensitization meetings with the senior hospital management.
  • Palliative care and pain management services sensitisation sessions with about 360 health care workers in the hospital.

4. The hospital received further support to furnish the facility (office chairs, office desks and visitors chairs) from the American Cancer Society (ACS) and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF).

PC training for health professionals in eSwatini

 

Success factors for PC integration

Several factors account for the successful integration of Palliative Care services into the RFM Hospital’s system;

Success factor What has worked well
 

Senior Management involvement & support

PC being considered in next budget, with scope to scale up PC services to 20 clinics.
Well-established unit with dedicated staff  

1 doctor, 1 nurse, 1 receptionist and 1 cleaner providing services that include pain relief, symptoms control, psychosocial support, spiritual support, clinical meetings and ward rounds.

Ward palliative care focal persons (palliative care ambassadors)  

Focal persons (in every unit or department) identify patients with palliative care needs in his or her respective unit / department and initiates the 1st care before consulting palliative care team or   discharging  the client  via the palliative care unit for continuum of care

 

Excellent referral systems with community-based facilities for continued care & support for clients

Bed-ridden and home-based clients are referred to 2 facilities that do home visits and admissions in all the 4 regions.
Involvement and support from Ministry of Health  

The unit receives mentorship and supervision from the Ministry of Health of  eSwatini palliative care program

Collaboration with the pharmacy department with good supply of painkillers more especially morphine liquid and tablets  

One pharmacist thanked the palliative care team stating that patients needing and accessing morphine at RFM Hospital have multiplied by up to 3 times since the PC services were established. She sees clients who used to cry in pain now come to refill their morphine with a smile. She also testifies that some years back  morphine used to expire in the pharmacy shelves though there were patients in need.

PC integration in pre-service training institutions  

Following the integration of the palliative care program in training institution curriculum ,the unit now receives students for clinical placement. So far 3 student nurses from University of eSwatini and 6 social work students from eSwatini Christian University have been attached to the unit.

 

The need of palliative care in Africa, and in particular in eSwatini is enormous as shown by the prevalence of  HIV & AIDS, cancer related and non communicable diseases.

Sensitisation and training of health professionals is key to PC integration

Read more about the Raleigh Fitkin Memorial Hospital on http://www.snhiswaziland.com/pages/index.php