UICC World Cancer Congress 2006

Dame Cicely Saunders initiated Modern Hospice Care in 1967.This was later called Palliative Care in Canada by Dr.Balfour Mount, because the word “Hospice”had a bad image in Canada in the 1970's.

Palliative Care in Uganda

Palliative care was introduced to Uganda in 1993 by Dr. Anne Merriman, MBE, FRCP a distinguished phycisian .She commenced her work after the Government of Uganda had granted her permission to initiate this programme. This specialty was introduced for the first time and along with it she insisted that oral morphine be made available and this was also granted by the Ministry of Health.

The service has expanded to two more upcountry centres i.e. Mobile Hospice Mbarara(MHM) and Little Hospice Hoima(LHM).in 1998.Hospice Africa UK supported Hospice Africa Uganda (HAU) to start palliative care in Kampala.

There were three noble objectives at the beginning:

1- To provide a palliative care service to patients and families 2- To carry out education programmes in palliative care, so that this form of can be available to all patients in need. 3- To encourage palliative care for other African countries

TEACHING AND RESEARCH

HAU embarked on recruiting regular Nurse and Clinical Officers and trained them for palliative care. Work started in a defined area of 20km around Kampala, the capital city, by visiting hospitals in the city. Gradually, the number of patients has increased .HAU has also opened up two more centres upcountry for service teaching and research at Mabrara and Hoima. HAU has initiated lectures to 4th Year Medical Students at both Makerere University and Mbarara University of Science and Technology.

This strategic exposure of palliative care to future doctors is producing expected results. Many young doctors are getting interested in the specialty because they see the need for pain management for cancer and AIDS patients.

Lectures are also given in health institutions for nurses, pharmacists and pharmacy technicians. Research has been carried out on needs of people suffering with pain in their homes both in urban and rural areas so as to guide on expansion of services through collaboration with government and other NGO's offering Home-based Care and Support. Because of HIV/AIDS epidemic, Uganda has a large network of support and care network of organizations.

Government Support

Following the WHO-3- Foundation Measures for starting palliative care, HAU has carried out advocacy with policy makers, health officals, various leaders and the community. moved by incorporating palliative care into the 5- year Health Strategic Support Programme 2000-2005.Palliative care is now part of a Health Care package of Essential Clinical Services offered in all public health institutions.

Drug Availability

Government through Ministry of Health and the National Drug Regulatory Authority has imported powdered morphine and have it reconstituted into oral morphine for use by patients who need it for free.Proper guidelines have been worked out by all stakeholders according to the laws on narcotics with relation to procurement, manufacture (making Liquid Morphine), transportation storage and use. These have been widely disseminated to handlers of morphine.

Progress of palliative care in Uganda

Government has expanded the prescribers by authorizing Specialized Palliative Care Nurses and Clinical Officers to prescribe, as of March 2004. With education, sensitization and familiarization on how to use morphine 23 of the 56 districts are now receiving morphine for severe pain. More work is going on to reach out to patients in the remote places where a doctor cannot reach. Uganda has a population of 26 million but the Doctor:.Population ratio is 1:18,000 and in remote areas it is1:50,000.!

Hospice and Palliative Care Association of Uganda

Hospice Africa Uganda has initiated the formation of a Uganda Country Palliative Care Team consisting of Ministry of Health, HAU, WHO, Makerere University Medical School, TASO, Mildmay international and Kitovu Support Care organization [NGO], to guide the direction and set standards and to ensure drug availability for palliative care.

Palliative Care Association of Uganda [PCAU] has been formed to spearhead palliative care work in the country .It has a membership of over 200 interested people .PCAU produces a Bi-annual journal ,holds CME updates quarterly and produces other publications .PCAU brings all players together for networking .

International Collaboration.

HAU working with other palliative care associations in S.Africa, Zimbabwe and Kenya started the African Palliative Care Association with its offices in Kampala to spearhead the spread of palliative care in Sub-Saharan Africa. Uganda has worked with organizations wishing to spread palliative care in Africa through advocacy for availability of narcotic analgesics namely; Tanzania, Zambia, Malawi, Botswana, Ethiopa, Ghana, Nigeria, Cameroon, Rwanda and Sierra Leone.

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