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Palliative Care in Ethiopia Barbro Norrström MD, Senior Consultant in Oncology

The INCTR First Symposium on Pediatric & Adolescent oncology Addis Ababa, Ethiopia January 18 – 21 2011. Palliative Care in Ethiopia Barbro Norrström MD, Senior Consultant in Oncology Diploma in Palliative Medicine

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Palliative Care in Ethiopia Barbro Norrström MD, Senior Consultant in Oncology

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  1. The INCTR First Symposium on Pediatric & Adolescent oncology Addis Ababa, Ethiopia January 18 – 21 2011 Palliative Care in Ethiopia Barbro Norrström MD, Senior Consultant in Oncology Diploma in Palliative Medicine ASIH Långbro Park, (Advanced Palliative Home & Hospice Care Stockholm, Sweden) 21st of January 2011

  2. Characteristics ; Ethiopia • Ethiopia; 10th largest country in Africa • Population ranges 81-85 milj • Life expectancy/average; 53 years • Low income country • Mortality rate; children up to 5 years;164/ 1000 children • Physicians < 5/100,000 inhabitants • GNP/person;320 dollars ( 2005)

  3. Ethiopia continued: • 1 clinic of oncology and 1 clinic of internal medicine with hematology at Black Lion University Hospital • 4 oncologists 1 hematologist ( no pediatric oncologists) • Plans for cancer registry • ECA( Ethiopian Cancer Assoc) ; 120,500 adult patients/year recieve a cancer diagnosis • Late stages, cx, breast, headneck, upper GI, liver, hematological • Scarse access to palliative care

  4. Palliative Care in Ethiopia • 11,5 million people are calculated to die of cancer in 2030 • Majority of these deaths will occur in low & middle income countries • These countries have only about 5% of the world´s resources • In Ethiopia 120 500 adults are diagnosed with cancer yearly

  5. Late diagnosis = palliative situation • Mainly advanced stage disease • Lack of awareness -Illiteracy • 85 % of the population in remote areas • Lack of qualified health professionals in remote areas • No knowledge about treatment possibilites • No social security = costly to patient & family • Afraid of cancer being diagnosed

  6. Organisations promoting palliative care in Africa • ACPA ; African Palliative Care Association • Hospice Africa; Uganda • FHSSA; Foundation for Hospices in Sub-Saharan Africa • IAEA- PACT programmes • UICC affiliates • ESMO; Developing Countries Taskforce (DCTF) • ASCO & EAPC

  7. African Palliative Care Association APCA´s Vision :Everyone living in Africa with a life-limiting illness will have access to quality palliative care that is delivered in an affordable and culturally appropriate manner. • APCA´s mission is to promote and support affordable and culturally appropriate palliative care throughout Africa. • APCA believes that palliative care is a right for all those in need within Africa. that this care should be given in a culturally appropriate and sensitive manner and that the quality of the care is important. • /http://www.apca.org.ug/

  8. Hospice Africa • Supporting palliative care in Ethiopia, Malawi, Sudan,Sierra Leone, Nigeria, Cameroon, Rwanda and previously in Tanzania and Kenya • Big emphasis in training and support for development of palliative care in Africa • ”Hands on training” • Anne Merriman, head of Hospice Africa • www.hospiceafrica.or.ug

  9. FHSSA • Founded in 1999 • Began as the Foundation for Hospices in Sub-Saharan Africa. Is an affiliate of the U.S.-based, National Hospice and Palliative Care Organization, headquartered in Alexandria, Virginia. • Mission is building partnerships to enhance compassionate care in Africa.   • FHSSA has funded Hospice Ethiopia since 5 years back.

  10. Ethiopian pall care initiatives • Hospice Ethiopia • Ye Mathiwos Wondu Ye Ethiopian Cancer Society • The Ethio-Norvegian shelter ( mainly a shelter) • INCTR initiative in pediatric cancer • ENAHPA initiative, TASK FORCE

  11. Advanced pall home care in Stockholm

  12. Hospice Ethiopia • Works in cooperation with • Tikur Anbessa (Black Lion) University Hospital • St Paul Hospital • Mission is to collaborate & work to improve QoL of patients with critical conditions and their families, by advancing hospice & palliative care programmes, education, research and favorable services

  13. Hospice Ethiopia TsigeradaYisfaWessen January 2011

  14. Hospice Ethiopia: • established in 2003. • located in, Yeka sub-city, Woreda 9, Addis Ababa. • Secured legal certificate bearing the number 0082.

  15. Objectives • Provide a comprehensive, affordable, accessible and culturally suitable palliative care services for cancer and HIV/AIDS patients as well as their families. • Provide palliative care training. • Provide awareness on palliative care

  16. Major Working areas of Hospice Ethiopia: 1 Intensive Palliative care Services 2 Training 3 Awareness creation

  17. Partners • working closely with other partners: • Hospice Africa Uganda, • Black Lion Hospital and ST. Paul Hospital, • Mathiows Wondu Ye-Ethiopia Cancer Society • African Palliative care association, • University of California Santiago Ethiopia, • Foundation of Hospice Sub-Saharan Africa. • True Colour Trust

  18. Programs /Areas of Focus/ Provide psychological, social, economical and spiritual supports Provide food support, Provide medical Support ( Pain and symptom control), Provide training for health professionals and community care givers, Conduct awareness raising program on palliative care,

  19. Programs /Areas of Focus/ cont.. Build the capacity of community leaders, home-based care providers, health workers as well as spiritual leaders, Create working partnership with traditional heelers‘, religious leaders, NGO Facilitate income generating actives for patient families,

  20. Achievements • Provided home based palliative care for 320 bed ridden Cancer and HIV/AIDS patients.

  21. Achievements Before PC Provided pc for 41 cancer & HIV/AIDS patients at Hospice Care center, After PC

  22. Beneficiaries before and after Palliative Care After Before

  23. Achievements Provided palliative care for 3o pediatric cancer patients, Carried out formative assessment on the availability of pain and symptom drug, Provide bereavement care 81 families, Discussion healed with 10 traditional healer in the target area, Provided capacity building training for 250 community member,

  24. Achievements Provided PC training for 44 health professionals, Provided training for 104 volunteers

  25. Current project on Paediatric patients • Project life- 2009-2010 • Partner organization- MWECS, BLH & HE • Achievement: • Supported 60 paediatric cancer patients • 16 have died • 14 left to their region and lost contact • Currently 30 patient on the program

  26. Some of our beneficiaries

  27. Multi country project/APCA/ Project title – mitigating the impact of HIV/AIDS by controlling pain symptom control in 6 African countries : Ethiopia , Malawi, Kenya , Tanzania , Rwanda , Zambia Key activities Training of advocates & of master trainers Base line assessment Training of 20 physicians Stake holder forum /networking

  28. Major challenges Shortage of pain and symptom control drugs, Lack of Fund for designed projects, Lack of finance for : => food support => equipped and increase hospice care centre => palliative care training => increase of the number of needy patients Lack of patient diagnose information who was treated at paediatric ward of TAGSH Strengthening partnership with existing partner organization.

  29. Major challenges cont… • The number of beneficiaries in the project sites were beyond our organization capacity, • The sustainability of the project is uncertain due to lack of fund. • Lack of adequate and clean water. • Current Hospice centre is not accessible as well not adequate to all referred cancer patients. • Patients are suffering with regard to their accommodation in between treatments. • Lack of finance to recruit staffs

  30. Future Plan Continuing collaboration with other partners Create comprehensive support programs Improve the QoL of patients & families Fund raising to strengthening capacity Establishing new hospice centres Expanding services Continuing awareness programs. Provide training in palliative care to health professionals.

  31. Thank you www.hospiceethiopia .com

  32. Mathiwos Wondu YeEthiopia Cancer Society •  Its vision is to play an active role in the International concerted efforts to create a world where Cancer is eliminated as a major life-threatening disease for future generation. • In cooperation with the INCTR

  33. Further pall care support • Prof Dan Hinshaw Ann Arbour University • Email:hinshaw@med.umich.edu • Supported and worked with HE since 2 years • Board member Hospice Africa US • Has formed a Palliative Care Taskforce • Multidisciplinary team leading by St Paul CEO

  34. Dan Hinshaw • Works closely with ENAHPA- Ethiopian North American Health Professionals • Financing the training programme for St Paul´s hospital in february 2011 • A group from the US will be a part of this training

  35. Further resources • Nurse SR Birtukan did palliative care training in Uganda for two years. Graduated by Diploma • Works at dpt of oncology at Tikur Anbessa • Intentions after Diploma to run a hospice or a general clinic • Two of the collegues in oncology at Tikur Anbessa; dr Wondemagegnu & dr Anallem are qualified in PC, diploma courses in South Africa

  36. Palliative care needs • OVERWHELMING • The WHO recommendations of palliative care as a human right are not secured • The possiblities if joining forces, cooperating in capacity building for palliative care in Ethiopia are favourable • Create a national plan and a palliative care association • Associate with APCA

  37. To remember…. • There is no PRIMADONNA in palliative care reminds us Dame Cicely Saunders! • Palliative care has a multiprofessional approach and is based on teamwork

  38. Thank you!!!

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