Devolving palliative care in Kenya

Author: Aquinas Nyakundi

29 April 2013
  • Professor Emile Rwamasibiro, Chair of the Rwanda Medical and Dental Council (RMDC) addressing delegates
Professor Emile Rwamasibiro, Chair of the Rwanda Medical and Dental Council (RMDC) addressing delegates

As Kenya moves to a devolved system of governance, community health care workers would play an integral part in health care delivery, including palliative care.

Community health care workers should have health literacy for better health care delivery in the devolved system of governance in Kenya.

This was the message from the Chair of Rwanda Medical and Dental Council (RMDC) Professor Emile Rwamasibiro while addressing delegates at the Kenya Medical Association (KMA) 41stAnnual Scientific Conference & Annual General meeting.

Held at Lukenya in Machakos, the main theme of this year’s conference was; ‘Healthcare Delivery in a Devolved Government System’

In Rwanda, Prof. Rwamasibiro said that one man and two women are elected in every village and trained in management of focused health issues.

“These men and women are the ones who facilitate outreach and sensitization activities and are rewarded on performance since their role is not a full time payable job. They are enthusiastic as they are elected by locals and given high status in the village.” He said.

Through such an approach, the RMDC chair said most health issues have been tackled making people in the village know more than their city counterparts.

“Do not fear to embrace innovation strategies and choose developmental models that work for you.” Prof. Rwamasibiro advised.

The Permanent Secretary in the Ministry of Medical Services M/s. Mary Ngari said that the constitution stipulates that every person has a right to the highest attainable standard of health, which includes the right to health care services and reproductive health care.

M/s. Ngari said that the ministry has repositioned itself to fulfill this right. She challenged health care workers to be in the forefront in leadership to ensure patients receive high quality services despite devolution adding that it (devolution) is being done with a lot of care.

Palliative care providers and representatives were among the delegates attending the conference where non-communicable diseases and palliative care were given a spot light.

Kenya Hospices and Palliative Care Association (KEHPCA)’s Special Coordinator for Access to Pain Relief and Palliative Care, Dr Esther Muinga addressed delegates on the Integration of Palliative Care into the Kenyan Health Systems.

Dr Muinga said that through the Waterloo project, a time-limited initiative to significantly improve access to palliative care in Malawi and Kenya, 115 health care providers have been trained in end-of-life care in the country.

She said that the aim of the project is to improve the quality of life of patients affected by HIV/AIDS and other life limiting illnesses.

This, she said, is after a research carried out indicated that the need for education was paramount in pain management, sexuality, communication, care for carers, breaking bad news, nutrition and death & bereavement among others.

“As a result of this project, palliative care has been integrated in 11Level 5 Hospitals and additional 30 Level 4 Hospitals are targeted for similar integration this year.” She added.

In addition, Dr Muinga said that there has been significant recognition of palliative care in both ministries of health that have been operational in the previous government as a result of continued advocacy activities.

She sighted challenges in the integration as shortage of staff, lack of space within hospitals for palliative care units, lack of interest in palliative care from those chosen for training and deployment of trained staff to other areas.

This year, Dr Muinga said that there are steps being undertaken to further palliative care in Kenya which include;

  • Inclusion of pharmacists in palliative care
  • Involvement of 30 Level 4 Hospitals in palliative care training
  • Provision of oral morphine as an important analgesic in government hospitals through Kenya Medical Supplies Agency
  • Inclusion of palliative care in underadecuate training.

Mr. Elijah Musau, head of palliative care department at Machakos Level 5 Hospital gave a hospital story on integrating palliative care.

Mr. Musau said he has encountered a case where medical staff were talking about a patient’s illness without knowledge that the patient was overhearing them having not been informed, adding that this is illegal.

He said that introducing the new concept at the facility was hardly embraced by the medical staff who before understanding what palliative care entailed could for example shout at a patient to make their bed and stop pretending.

“Put yourself in the shoes of your patient. If that was your parent, child or relative, could you wish them to be treated the way you are treating the patient?” He asked.

Though given a building earmarked for demolition, Mr. Musau said that through funds from KEHPCA, they managed to refurbish it to a modern unit.

“Before renovation, patients used to wonder if they had been referred there to die.” He said.

He said that there exists effective and inexpensive methods of pain and symptom management, terming the Continuous Medical Education (CME) that has helped in training health care workers in palliative care as an effective tool.

He told delegates that palliative care is provided by an interdisciplinary team of health care providers and that it can be started anywhere.

Addressing a concern raised by a section of the delegates that having stand alone units would lead to stigma associated to separation from usual health care, Mr. Musau said that palliative care providers most times offer services within wards and the separate units create a conducive environment for counseling and sharing with family members, a service that cannot be offered in the wards.

“It also helps us to attend to patients referred from other centers, who are not admitted in the hospital.” He added.

On challenges of establishing a palliative care unit in a Level 5 Hospital, Senior Nursing Officer M/s. Lydia Warui from Nyeri Provincial General Hospital (PGH) said that cultural barriers limit their service provision.

She said that home based care is not well accepted among some communities who insist that a patient should stay in hospital.

“Chronic illnesses are associated with curses and discussion of end-of-life issues is not appreciated by some people.” She said.

M/s. Warui said that prescription issues remain a challenge as nurses who are mostly in charge of palliative care units are not allowed to prescribe morphine, adding that there is hope as KEHPCA works to put in place protocols and palliative care guidelines.

She surprised many when she projected a picture of unused toilets on the screen, saying that it was the place allocated for Nyeri Palliative Care Unit which they later managed to renovate to habitable standards.

Stella Kubania presented a case of Meru Level 5 Hospital with regard to palliative care in a Government Health Institution.

M/s. Kubania said that the palliative care unit has a capacity of 311 beds with a total of about a thousand admissions and 2900 outpatients.

She said that the hospital has purchased 100grams of morphine this year which would help the unit in management of patient pain.

“We occupy a two-roomed premise that has a kitchen and a restroom where we converted the kitchen chimney to be a strong room for morphine storage.” M/s. Kubania said.

According to the senior nursing officer, the opening of the unit has enabled most patients to be enrolled for the services offered at the unit and their quality of life has greatly improved.

“Patients who would have otherwise gone home without care have been enrolled and followed up in the unit and morphine consumption in the hospital has gone up.” She said.

Her wish is for the government to offer cancer treatment and provide palliative care drugs to promote palliative care in all corners of the country.

Mediamax Network Limited corporate affairs officer M/s. Nyatichi Nyasani said that the media has been known to give priority to sensational stories and little airtime for health features.

“The media tends to focus on negative stories since they consider such stories to be newsworthy yet medical stories can sway opinion.” M/s. Nyasani said.

She said that in the devolved government, the media needs to review the success of governors in the provision of health services and bring such successes to the limelight.

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