Hospice Africa Uganda - Clinical Department

1. Cancer is on the increase in all African countries.

With the conquering of infectious diseases by improved sanitation and the recent arrival of AIDS with its associated cancers, the causes of death are now changing. In those countries without disasters of war or famine, cancer is the first or second cause of death. Unfortunately less than 10% of resources committed to cancer control are available to patients in the developing world where the biggest increase in cancer is taking place.

Thus patients seek medical care with already advanced cancers and with severe consequences of pain, symptoms and gross disfigurement. Most are sent home from conventional medical establishments and clinics with a few simple analgesics at the most, as there is nothing left to be done for them. This leads to untold suffering for the patient and family.

2. AIDS

AIDS has brought an epidemic of death and increased the urgency for palliative care services not only in hospitals but in the community and reaching to village level where up to 57% of the population may never see a health professional. Palliative care must reach these people through training of health and non health professionals who live in the villages.

25-50% of patients with HIV/AIDS have severe pain. AIDS has brought a great increase in cancers and Kaposias sarcoma is now the highest occurring cancer in Uganda. There is much attention given to the procurement of ARVs for Africa at present. However this will not mean there is no need for palliative care for all, even those who are rich or powerful enough to access them will need palliative care when their time comes. Presently hospice networks with ARV centres, so that those who may benefit, can be treated if possible.

Hospice offers control of pain and symptoms during critical illness and end of life. This is combined with a holistic approach to the patient and family where the patient is the focus. This form of care is now a speciality called "Palliative Care". It allows the patient to die in the place most suitable to them and their family. This is usually in their own home, so most modern Hospices have a large home care service.

THE WORK OF HOSPICE UGANDA

We do not have an in patient facility. We work with patients and families in their own homes and in hospitals where we are asked to see them. Research and experience have shown that most patients want to die at home . In Uganda, our own experience has shown that patient and families can share this time together in a meaningful way, when pain and symptoms are controlled and they are at peace. The family are supported in the knowledge that they can call on Hospice for any problems that may arise.

On referral, we visit the patient at home or in hospital within 24 hours. The patients are followed up at home if they live within 20 kms of a Hospice. Those who live outside this catchment area have their pain and symptoms controlled before returning to their homes, from which they report back periodically. However with the training of health professionals throughout the country, some are managed closer to home by palliative care trained nurses, clinical officers or doctors.

Patients are referred from health professionals, trained community vigilantes and some are self-referred. New patients or their relatives are requested to fill in our referral form through their present Doctor or the Doctor who made the diagnosis. This is important for the professional care to be tailored to the needs of each patient. However in the villages, the palliative care team will have to diagnose and treat without referrals for those who never see a doctor.

As we now extend this care to the villages, we, and those we are training, need to be able to diagnose terminal illness and to treat with the principles of palliative care without high tech diagnostic facilities.