Introducing Children’s Palliative Care in Rwanda

Categories: Education.

Three facilitators hailing from South Africa and Uganda have just returned from a week in Rwanda where they trained a total of 19 healthcare workers in the ICPCN’s comprehensive Introduction to Children’s Palliative Care course.  The trainers were David Kavuma and Dr Jane Nakawesi from Uganda and ICPCN’s Busi Nkosi from South Africa.  The three trainers were assisted by the three paediatricians on the course who were instrumental in interpreting the training into French. The training took place at the Hilltop Hotel in Kigali, the capital of Rwanda.

The training was funded through the THET Multi-country partnership project “Strengthening and integrating Palliative Care into national health systems through a public health primary care approach in 4 African countries to contribute to meeting the targets of MDG goal 6” which commenced in 2012. The project is being run through partnerships between the University of Edinburgh, the African Palliative Care Association, Makerere University, National Palliative Care Associations and in-country organisations. To find out more about this project, you can visit the website at http://integratepc.org

The training
The 19 health care workers who were trained included 3 paediatricians, 3 general practitioners, 1 social worker, 1 nutritionist and 11 nurses. They were there representing three Rwandan hospitals. Most of the participants spoke French and Kiyurwanda and therefore training had to be done through interpretation. The participants were very keen to learn and expressed great eagerness to implement what they have learned. This enthusiasm resulted in one of their requests being a session on the setting up a children’s palliative care service. 

A child in great pain
On the  morning of 12 December we spent some very constructive time at the University Teaching Hospital as part of the clinical attachment required by the course. At the hospital we came across a distressing situation with a young patient – an 11 year old boy who had osteosarcoma of the left knee. It was very bad and he was going to theatre for amputation of the left leg that day. The boy was in great pain despite receiving pain medication continuously through a pump. We discovered that they did not have morphine to give him as it has been out of stock in the country for more than 3 months.  We advised the students on the course to use this case to motivate the authorities to buy more morphine as they reported that the country stock is very limited.

Monitoring and support
All the participants wrote a pre-test and post-test on the same questions and the results of the post test were impressive.  APCA will be monitoring the implementation of skills and knowledge learnt on the course over the next 6 months. Participants were given forms/templates for that purpose. We will also continue to support them, especially with information. It was encouraging to discover that they have adequate support from their government which has developed a comprehensive policy and a five year strategic plan.