UICC WORLD CONGRESS: UICC WORLD CONGRESS: UICC WORLD CANCER CONGRESS UICC WORLD CANCER CONGRESS

20062006JULY 8-12JULY 8-12THTH , WASHINGTON, D.C. , WASHINGTON, D.C. WORKING WITH GOVERNMENT AND NURSING TO EXTEND PAIN WORKING WITH GOVERNMENT AND NURSING TO EXTEND PAIN

RELIEF TO THE PERIPHERY IN UGANDA.RELIEF TO THE PERIPHERY IN UGANDA.

Dr. Jack G.M. Jagwe, FRCP. FRCP (Edin)Dr. Jack G.M. Jagwe, FRCP. FRCP (Edin)

Senior Advisor, National Policy, Drugs and Advocacy.Senior Advisor, National Policy, Drugs and Advocacy.Hospice Africa Uganda, Kampala Hospice Africa Uganda, Kampala

Email: Email: jjagwe@hospiceafrica.or.ugjjagwe@hospiceafrica.or.ug

UGANDAUGANDA

Country size: 236,000 sq.kms

Slightly smaller than Oregon

On the equator

Temperate climate (20-30’C)

PEARL OF AFRICAPEARL OF AFRICA

Uganda: Demographic Uganda: Demographic indicatorsindicators

Population – 26.7 million (2004) UNPopulation – 26.7 million (2004) UN 52% of population below 15 years52% of population below 15 years 86% live in rural areas 86% live in rural areas 57% never see a health worker57% never see a health worker Life Expectancy at birth 39 in 1993, Life Expectancy at birth 39 in 1993, 45 yrs 2003 (MoH)45 yrs 2003 (MoH)Source: Uganda Demographic and Health Survey, 2006Source: Uganda Demographic and Health Survey, 2006

52% OF POPULATION BELOW 52% OF POPULATION BELOW 15 YEARS15 YEARS

Discovery of Palliative Medicine - Discovery of Palliative Medicine - 19671967

Dame Cicely Saunders discovered Dame Cicely Saunders discovered Palliative Care in 1967. Through Palliative Care in 1967. Through well researched methods of care, well researched methods of care, pain and symptoms for patients pain and symptoms for patients with life-limiting illnesses e.g. with life-limiting illnesses e.g. cancer and HIV/AIDS can be cancer and HIV/AIDS can be successfully controlled and successfully controlled and QualityQuality of Lifeof Life improved to the improved to the end of life.end of life.

FIRST STEPS: KAMPALA 1993FIRST STEPS: KAMPALA 1993

HAU 1993

Hospice Africa Uganda commenced with the arrival of Dr. Anne Merriman MBE, FRCP a distinguished physician who started palliative care in Uganda in 1993.The specialty of palliative medicine was introduced for the first time.

She came to address cancer pain but found more She came to address cancer pain but found more suffering arising from HIV/AIDS in 1994.suffering arising from HIV/AIDS in 1994.

Adapted cancer pain management to HIV/AIDS Adapted cancer pain management to HIV/AIDS pain.pain.

Insisted that Oral Morphine be made available.Insisted that Oral Morphine be made available. Ministry of Health granted her request.Ministry of Health granted her request. Oral morphine (liquid) formulation was registered Oral morphine (liquid) formulation was registered

in Uganda for the first time.in Uganda for the first time.

Hospice Africa Uganda, Kampala Hospice Africa Uganda, Kampala 19931993

Branches:Branches: Mobile Hospice Mbarara 1998Mobile Hospice Mbarara 1998 Little Hospice Hoima Little Hospice Hoima 19981998The 3 noble objectives of these Hospices:The 3 noble objectives of these Hospices: To provide palliative care services to patients and To provide palliative care services to patients and

families.families. To carry out education and training in palliative To carry out education and training in palliative

care so that this form of care is available to all care so that this form of care is available to all patients in need.patients in need.

To encourage palliative care in other African To encourage palliative care in other African countries.countries.

Teaching and ResearchTeaching and Research

Recruitment of Nurses & Clinical Officers.Recruitment of Nurses & Clinical Officers. Training them for palliative care.Training them for palliative care. Work in a defined area 20km radius from the Work in a defined area 20km radius from the

centre of Kampala.centre of Kampala. Research at the three above centres.Research at the three above centres.

Strategic exposure of many young doctors and Strategic exposure of many young doctors and nurses to palliative care and sustaining interest for nurses to palliative care and sustaining interest for pain management and symptom control for both pain management and symptom control for both Cancer and HIV/AIDS patients.Cancer and HIV/AIDS patients.

Lectures/workshops to Health Professionals.Lectures/workshops to Health Professionals. Research/Needs assessment of patients & people Research/Needs assessment of patients & people

suffering with pain in their homes in urban & rural suffering with pain in their homes in urban & rural settings.settings.

Collaboration with government and a large Non-Collaboration with government and a large Non-governmental organizations network offering governmental organizations network offering Home-Based care & support to HIV/AIDS patients.Home-Based care & support to HIV/AIDS patients.

ApproachApproach

Advocacy: Policy makers, Health Officials, Advocacy: Policy makers, Health Officials, leaders & community.leaders & community.

Government moved to incorporate palliative Government moved to incorporate palliative care into the five year Health Support care into the five year Health Support Strategic Programme 2000- 2005.Strategic Programme 2000- 2005.

Palliative care is now part of the Health Care Palliative care is now part of the Health Care Package of the Essential Clinical Services Package of the Essential Clinical Services availed at all Public Health Institutions.availed at all Public Health Institutions.

Education: Health Institutions, two medical Education: Health Institutions, two medical schools, Health Officials & communities.schools, Health Officials & communities.

Exposure of young doctors to palliative care Exposure of young doctors to palliative care by lectures to 4by lectures to 4thth year Medical students and year Medical students and student Nurses.student Nurses.

International exposure to overseas Medical International exposure to overseas Medical students who come to do their electives at students who come to do their electives at Hospice Africa Uganda.Hospice Africa Uganda.

Drug Availability: Government through Ministry of Drug Availability: Government through Ministry of Health and the National Drug Regulatory Authority Health and the National Drug Regulatory Authority procured powdered morphine for use.procured powdered morphine for use.

Local manufacture (reconstitution of powdered Local manufacture (reconstitution of powdered morphine) keeps the cost very low.morphine) keeps the cost very low.

Proper Guidelines worked out by Ministry of Health Proper Guidelines worked out by Ministry of Health and stake holders on how to handle Narcotics and stake holders on how to handle Narcotics according to the laws.according to the laws.

Progress on Palliative Care in Progress on Palliative Care in UgandaUganda

Expansion of access to opioids.Expansion of access to opioids. Government has authorized specialized Palliative Care Government has authorized specialized Palliative Care

Nurses and Clinical Officers to prescribe morphine since Nurses and Clinical Officers to prescribe morphine since March 2004 by revisiting and amending the law on March 2004 by revisiting and amending the law on narcotics.narcotics.

Education, sensitization and familiarization seminars have Education, sensitization and familiarization seminars have demystified fears and misconceptions about morphine.demystified fears and misconceptions about morphine.

23 of the 56 districts now access morphine for severe pain.23 of the 56 districts now access morphine for severe pain. With a population of 27.6 million and a doctor : population With a population of 27.6 million and a doctor : population

ratio of 1:18,000 to 1:50,000 in remote areas, someone in ratio of 1:18,000 to 1:50,000 in remote areas, someone in remote village can now access oral morphine.remote village can now access oral morphine.

Hospice and Palliative Care Hospice and Palliative Care Association of UgandaAssociation of Uganda

Hospice Africa UgandaHospice Africa Uganda Country Palliative Care Team in Ministry of Country Palliative Care Team in Ministry of

Health. Brings together:Health. Brings together:– Ministry of Health OfficialsMinistry of Health Officials– Hospice Africa Uganda- Palliative Care WorkersHospice Africa Uganda- Palliative Care Workers– WHO OfficialsWHO Officials– Makerere University Medical SchoolMakerere University Medical School

– Mbarara University Medical SchoolMbarara University Medical School– Mildmay InternationalMildmay International– TASO etcTASO etc– Kitovu Support Care OrganizationKitovu Support Care Organization

To guide, set standards and ensure drug To guide, set standards and ensure drug availability for patient care.availability for patient care.

International CollaborationInternational Collaboration

Hospice Africa Uganda collaborates with Hospice Africa Uganda collaborates with Palliative Care Association of S.Africa, Palliative Care Association of S.Africa, Zimbabwe and Kenya.Zimbabwe and Kenya.

To spread Palliative care to Sub-Saharan To spread Palliative care to Sub-Saharan Africa.Africa.

Hospice Africa Uganda works with Hospice Africa Uganda works with organizations wishing to spread Palliative organizations wishing to spread Palliative care in Africa through Advocacy for opioid care in Africa through Advocacy for opioid availability.availability.

Examples: Tanzania, Zambia, Malawi, Examples: Tanzania, Zambia, Malawi, Botswana, Ethiopia, Ghana, Nigeria, Botswana, Ethiopia, Ghana, Nigeria, Cameroon, Rwanda, Sierra Leone and Cameroon, Rwanda, Sierra Leone and Seychelles.Seychelles.

African Palliative care Association African Palliative care Association (APCA)(APCA)

Hospice Africa UgandaHospice Africa Uganda Co-founder of APCACo-founder of APCA Collaboration with NHPCO, FHSSA, Help Collaboration with NHPCO, FHSSA, Help

the Hospices, WHO and Pain and Policy the Hospices, WHO and Pain and Policy Study Group of the WHO collaborating Study Group of the WHO collaborating Centre, Madison USA etc.Centre, Madison USA etc.

ConclusionsConclusions

Through collaboration with Government.Through collaboration with Government. Through Advocacy based on the 3- WHO Through Advocacy based on the 3- WHO

Foundation Measures for starting Palliative Foundation Measures for starting Palliative Care.Care.

Through collaboration with Nursing Through collaboration with Nursing profession- the backbone of Palliative Care.profession- the backbone of Palliative Care.

It has been possible to take pain relief to the It has been possible to take pain relief to the periphery in Uganda.periphery in Uganda.

THE ENDTHE END

Hospice Africa

Uganda