Health Ministry Creates Palliative Care Strategy

| May 15, 2015

The Ministry of Health has embarked on creation of a comprehensive National Palliative Care Strategy (NPCS) to remedy all the deficiencies in meeting the holistic needs of the chronically and terminally ill patients and their families.

A Palliative care specialist at Princess Marina Hospital, Dr Babe Gaolebale, said this when giving an overview of palliative care (PC) in Botswana at the Holly Cross Hospice’s first annual charity ball recently.

The strategy, Dr Gaolebale said, covered all elements required for the provision of effective Palliative Care at all levels of the health care system from tertiary to hospitals to community level.

From it, she added that a pocket size pain management guideline had been produced and disseminated all over Botswana to be able to manage pain, named: “RAGA DITLHABI.”

Accompanying it, she said morphine was also being made available and accessible to patients.

However, she expressed concern that morphine was not widely available and accessible although it managed pain.

In 1995, Dr Gaolebale said Botswana introduced the Community Home Based Care (CHBC) programme to provide care and support services to patients living with HIVAIDS and terminal illness.

Despite the admirable intention to make available at community level much needed PC, she said it was not possible to offer much beyond basic support to such patients, provided primarily by community and family caregivers with guidance from the home-based care coordinators in local clinics.

Therefore, to remedy deficiencies, she said the Ministry of Health came up with a comprehensive NPCS, which was completed in 2014 and was now at its implementation stage.

Dr Gaolebale indicated that the increasing numbers of cancer diagnosis yearly, which is now at 1700, had changed the PC service delivery in Botswana, solely directed by the NPCS.

She also said the goal of the PC was to improve the quality of life for both the patient and the families facing the problem associated with life-threatening illness.

That, she said was done through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems-physical, psychosocial and spiritual.

Palliative Care, Dr Gaolebale said was a specialty that can also be described as offering care beyond cure or adding life to days, not just days to life, adding “never saying there is nothing we can do, but rather there is always something to do.”

Care offered under PC provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process.

It also intends neither to hasten nor postpone death, integrates the psychological and spiritual aspects of patient care and offers a support system to help patients live as actively as possible until death.

Additionally, PC also offers a support system to help the family cope during the patient’s illness and in their own bereavement.

It uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated and enhances quality of life and may also positively influence the course of illness.

Further, Dr Gaolabale said Palliative Care was applicable early in the course of illness, in conjunction with other therapies that were intended to prolong life, such as chemotherapy or radiation therapy and included those investigations needed to better understand and manage distressing clinical complications.

The service, she said was available to different groups of patients with life-threatening diseases like cancer, HIVAIDS, end stage diabetes, renal failure and other chronic disease at end of life. She added that support was also offered to patients with physical, psychological, social or spiritual distress, as result of the treatment they were seeking or receiving or not getting any further treatment.

Furthermore, she said PC could be offered either in hospitals, at home and at centres.

She indicated that currently in Botswana, the service was offered in hospitals especially major referral ones adding “although still at infancy stage, where only cancer patients benefit.”

“We will hope that as the specialty continues to grow, the service will be available to all patients requiring the service. It is also available through CHBC teams, NGOs and hospices,” she added.

Like any other service, she said PC had its own challenges, adding that the increasing numbers of cancer cases had put an extra burden on the limited skilled personnel that offered the service, especially in hospitals.

Despite extra help and support in the community, by volunteers- through the CHBC and NGOs, she said lack of funding to support them had also put pressure on the already skeletal service that the community tried to offer.

The other challenge, she said was the lack of inpatient hospices or even step-down homes or centres to reduce the burden of overcrowding in hospitals, especially in the North as all the three hospices were situated in the Southern region of Botswana.

So far, she noted that some of the achievements for provision of PC in Botswana, was that in 2014, a Botswana Hospice Palliative Care Association was launched- even though it was still at its infancy stage.

The association, she said would participate in the implementation process of the NPCS and play a vital role in aocating for research and constant improvement and access to care through its continuing support for the government programme.

She also noted that the association would have the opportunity to facilitate training in PC and act as a liaison and coordinating agency between government and other entities in the NGO sector, such as hospices, Cancer Association and training institutions.

“It will be strengthened in its activities through its relationships and interactions with partner organisations and international and regional bodies, such as APCA,” she said.

Source : BOPA

Source : Botswana Daily News

Category: Medical/Health Care

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