World Hospice Day

October 6th 2007 is a day to highlight issues of hospice and palliative care worldwide. There will be many many events across the globe, with details on http://www.worldday.org/ This year the theme is 'Across the ages - children to older people', and raises issues of access to care. A new report also highlights the scandal that many many people have not even basic pain control. Called 'Access to pain relief - an essential human right', it can be downloaded via this weblink. http://www.worldday.org/documents/access_to_pain_relief.pdf Many messages of support have been received such as this statement by the Irish rock star and campaigner Bono, "In the poorest countries, where so many people are fighting for their lives, the conditions of death don’t get much of a look in. But how we care for the sick and dying is surely a litmus test of our humanity. Just as we fight for equality in life, we should fight for equality in death.”

Let me give you a flavour of the problem. A colleague in Africa shared last year the tragedy of caring for patients when there is no access to analgesia. A young woman with severe pain due to her progressive breast cancer asked over and again for help. Her doctor had very little to offer and eventually had to admit this to her. She thanked him and went home to take her own life. We can only guess at the despair and suffering that goes unacknowledged and unsupported. Yet we have seen in Uganda, Kerala and many other countries that pain relief can be made affordable and available. (see the picture of oral morphine in Hospice Africa Uganda and Abdul Aziz, a patient in Kerala whose pain was controlled with oral morphine) A few months ago I had the privilege of spending time in India with journalists from the New York Times; Donald G McNeil Jr and Ruth Frensom, who were researching the issue of lack of access to morphine. The 2 articles appeared on the front page of the New York Times Sept 10th and 11th. Please read them by accessing the links below; and make sure you watch the audio-visual. It is such an excellent overview entitled 'Drugs banned; many of the world's poor suffer in pain.'

http://www.nytimes.com/2007/09/10/health/10pain.html?_r=1&oref=slogin
http://www.nytimes.com/2007/09/11/health/11pain.html

Finally, here is Charles. He works as a clinical medical officer in Sierra Leone where there is a palliative care service called Shepherd's Hospice. Charles and his team face huge problems; including no oral morphine, lack of electricity, prohibitively expensive fuel and a ratio of 1 doctor to 54,000 people.

Let us do all we can to raise the awareness of these issues and to support Charles and many like him who are seeking to overcome the challenges and ensure care is available to all who are in need.

Nairobi and Malawi

September 2007 saw more than 400 delegates from over 30 countries gather in Nairobi, Kenya for the 2nd conference of the African Palliative Care Association (APCA). It was an exciting few days with delegates from such different countries having a chance to learn, share and plan. The energy and commitment shone through - but also the huge challenges facing those trying to ensure palliative care reaches those who need it most. The 'giants' of African palliative care were acknowledged and thanked (see left). East and South Africa have seen the greatest palliative care developments but there were delegates from West Africa and the francophone countries that were beginning to see changes. The delegation from Rwanda (see left) took time to plan together with a very proud Grace (front wearing white) who is about to graduate with a Diploma in Palliative care from Nairobi/Oxford Brooks; the first nurse to do so in Rwanda. Across the continent morphine availability and accessibility remain major barriers; as do other resources and training.

I then made the journey to Malawi with my 2 colleagues Prof Scott Murray and Dr Dorothy Logie. We were facilitating a Master trainer's course in the capital Blantyre; and supported by funding from the Scottish Executive. The course had been jointly arranged by the Palliative Care Association of Malawi (PCAM) and the Ministry of Health and sought to train the leaders in Malawi to teachers and trainers. It was a challenging week but inspiring and rewarding to work with such committed participants. They represented the key people who will take the palliative care agenda forward in Malawi - and very encouragingly, included senior participants and facilitators from the Ministry of Health. This government support will be crucial. We were also joined by Fatia Kiyange from APCA as a co-facilitator which again represents wider African support.

Malawi faces many challenges with significant HIV/AIDS prevalence, high maternal mortality, scarce resources, few doctors and a low GDP. Despite these challenges there is much being done in palliative care. There is an agreed manual for training and plans to include palliative care across the health sectors, including home based care. Making sure this training makes a difference in the villages and hospitals remains a challenges but we wish our colleagues well in Malawi as they seek to address these needs. It is a beautiful country - and the place where the idea for Cairdeas was born. You can see me under the baobab tree where the first Cairdeas vision was drawn up; maybe even the same tree that David Livingstone sat under! Lastly, sunset over the Shire River to the sound of hippos.