Geriatric palliative care unit Ain Shams University, an Egyptian palliative Care Unit journey.

Palliative care in Egypt remains an unmet need and comes with its set of challenges – by Dr Elham Raouf

Lack of awareness about end-of-life care among professionals and non-professionals undermines its impact both on individual and institutional levels.

 Cultural factors influence patients’ behavior, many are reluctant to participate in end-of-life discussions. Bad news disclosure is often met with negative reactions.

  Many physicians underestimate symptom burden towards end of life and neglect psychological, spiritual, or social needs. Barriers to receive opioids remain a major challenge for Egyptian patients.

  Apart from few scattered services, palliative care settings in the country are scarce and do not accommodate for the growing need.

  As Geriatricians in one of the top University hospitals in the country and a tertiary center for referral, the Ahmad Shawky Geriatric Hospital, we encounter a growing number of patients with life limiting illnesses.

According to our hospital data in the last five years, more than 20% of our patients presented with advanced stages of terminal illnesses such as cancer, organ failure and neurodegenerative diseases, most of them struggled to find structured palliative care services.

    Therefore, to accommodate this growing need, steps were taken to initiate a structured Geriatric Palliative Care service.

   The Geriatric Palliative Unit and Clinic in Ahmad Shawky Geriatric Hospital were launched in August 2022 as the first and only palliative care services in Ain Shams University hospitals. More services were included since then.

Young residents with some members of the team

   A member of our skilled nursing team

   World Palliative Care Day celebration.

 

Our medical services today include:

– An acute in-patient unit for acute conditions necessitating short hospital stay with a capacity of 12 beds.

– An outpatient clinic twice weekly for new cases and follow up services.

– An In-hospital consultation team for patients in other departments in Ain Shams University hospitals

– A telemedicine clinic for post discharge follow-up twice weekly

All these services are provided by a multidisciplinary team of geriatricians trained in palliative care, a palliative care and pain board certified consultant, consultant oncologists, a clinical pharmacist, a psychologist, a social worker, skilled nurses, and a dietitian.

  The multidisciplinary team manages different physical symptoms including pain, shortness of breath, delirium, oncological emergencies, and others.  Screening, counselling, and management of psychological and social distress among our patients is an integral aspect of our care.

We have in this period worked with over 600 patients and families with cancer and different types of neurodegenerative diseases.

To ensure continuity of the service we established an easy referral pathway for patients from different departments of Ain Shams University hospitals as well as outpatients. Any patient in need can easily access our services.

 Through our hospital social media, and in campus events, rate of referral is growing.

Our goals:

– Establishing a center of excellence for geriatric palliative care

– Integrating palliative care education for undergraduates and fresh graduates

-Raising awareness about end-of-life care in the community.

– Collaborating with national and international service providers for research, raising awareness and providing continuity of care.

   We work hard to collaborate and connect with the global network of palliative care.

 

Elham Raouf, MD, MRCP UK – elhamraouf@med.asu.edu.eg

Lecturer of Geriatric Medicine and Gerontology

Director and co-Founder of Geriatric Palliative Care Unit

June 2024