In 2003 Eunice Garanganga, RN
Traveled to: Uganda

Eunice Garanganga, RN
Palliative Care Nurse Consultant

Report

HOSPICE ASSOCIATION OF ZIMBABWE

INTERNATIONAL ASSOCIATION FOR HOSPICE AND PALLIATIVE CARE: TRAVELLING FELLOWSHIP SUPPORT.

REPORT ON CONSULTATIVE VISIT TO UGANDA 10 – 20 SEPTEMBER 2003

The sponsored trip came about after an invitation from Dr. Anne Merriman who is the founder of Hospice Africa Uganda, to attend their 10th Anniversary Celebrations and the Scientific Conference; Theme: “Completing the Circle of Care”. She extended the invitation to a Consultative Visit, where sharing and exchange of Palliative Care Skills could be done.

The very first day, Dr. Anne Merriman and I worked on a programme where we were both going to co-chair a Palliative Care workshop in Ghana at the African Organisation for Research and Training in Cancer (AORTIC) Conference 6-10 October 2003. The theme was “Adapting Palliative Care to Africa”. Not only were we looking at skills sharing in Uganda and Zimbabwe, but we also extended our services, skills and expertise to other countries in Africa. We outlined the goals, objectives and expected outcomes for the conference. Although Africa, especially sub-Saharan Africa, is most affected by HIV/AIDS, hospice and Palliative Care is still not practiced in many countries.

Mobile Hospice Mbarara: 12.09.03 to 14.09.03.

A team meeting was held with Martha Rabwoni who is the Co-ordinator of the programme; doctors, nurses and two 5th year medical students from Leeds University in UK on attachments and volunteers. It was a lively group that starts its day with singing and prayers. I made a presentation on what IAHPC does and what Travelling Fellowship is all about. This was done with many of the people I interacted with.

With the team I had the opportunity to examine a female patient at Mobile Mbarara offices who had reacted badly to Septrin. She spoke very highly of Hospice work. When I asked if she had any questions for me, she said, “Why is Hospice not seeing all the patients suffering in hospitals?” She posed a big challenge for Palliative Care and hospice in the whole of Africa where resources are, most of the time, meagre.

I made four home visits, and saw four patients, one of whom was a new patient in the village who had been referred from a private clinic by a private doctor. Discussions and planning of the treatment was done with the team. I made contributions on drug combinations and doses. A lot of discussion took place on a female patient +/- 70 with cancer of the stomach who had run out of morphine for about two days and we had to recalculate her dose of morphine.

In another home visit, both husband and wife were sick although only the husband was registered with hospice. The wife was encouraged to go and be seen at the hospital. A young couple indeed, with 5 children, all below 10 years. There were social problems relating to who will look after the children when both parents die. It clearly shows the breaking down of the extended family in the African culture. Many options were discussed but the future of the children seems uncertain.

The new patient in the village was an 85-year-old retired Anglican priest. He had been discharged the same day from a private clinic in Mbarara. He was touched and could not believe that the hospice team followed him in his village. It was a privilege to have met him. In his pain, he remembered others; he prayed for doctors and nurses and me from Zimbabwe, peace in the world and many others in his situation.

The day ended with discussions in detail of all patients seen, and plans were made for follow-ups.

On the 13th of September 2003, Martha Rabwoni and I attended Mbarara TASO (The Aids Support Organisation) Annual Meeting. It was a networking visit to support this programme which predates Hospice Uganda but which integrated Palliative Care into its activities only recently. I gathered information on their activities.

The 14th of September was specifically very special for Martha and I as it was the 1st Anniversary after attaining our Diploma of Higher Education in Palliative Care – Oxford Brookes in collaboration with Nairobi Hospice. We went down memory lane and were quite happy with the achievement we had made. Martha talked about the long road journeys from Uganda to Kenya, all for the sake of the Diploma, which has improved our Palliative Care skills. We remembered our tutors in Oxford; they too had made great achievement, as we were their pioneer group.

A day before the Uganda Scientific Conference, I worked with Dr. Anne Merriman. We adapted a questionnaire on “A Good Death” for participants at the conference. We also looked at presentations with the presenters and adjusted accordingly to fit into the time allocated. I had the opportunity to meet with Dr. R. Twycross and his wife. Dr. Twycross is a well-known specialist in Palliative Medicine.

The Scientific Conference (Uganda). 16th and 17th of September 2003. “Completing the Circle of Care”.

It was well attended with representatives from other major organisations in Uganda including NGOs such as TASO, representatives of the health professions, traditional healers, supporters, officials and representatives from other African countries and abroad. Most aspects of the developing Palliative Care network in Sub-Saharan Africa were well presented, namely Kenya, Malawi, South Africa, Tanzania, Zambia and Zimbabwe.

Dr. R. Twycross delivered the opening keynote address, entitled “Palliative Care: Yesterday, Today and Tomorrow”.

I gave an overview of Palliative Care in Zimbabwe focusing on the new project initiated through WHO Country Palliative Care Initiatives – “The Rural Model” that is funded by John Snow International, UK. Many people were interested in this model and would like more information when it has been evaluated.

I participated in a Panel Discussion – “The Next Decade”, whose moderator was Dr. Robert Twycross. The panellists included, doctors and nurses with experience in Palliative Care. From the description of the well-developed models of care in few countries, to the early stages of start-up in other countries, experiences were shared and new links were made. The conference atmosphere was one of mutual support and the importance of sharing experiences was re-emphasised many times. A participant urged well established countries in Palliative Care to organise exchange visits for teaching purposes, it was then that the chairperson Dr. Lydia Mpanga, who is the Director of Clinical Services and Clinical Education of Hospice Africa Uganda acknowledged IAHPC for sponsoring me to go to Uganda to share my experiences and expertise in Palliative Care.

The opportunity to exchange ideas and particularly to publicise what was happening through country associations such as Palliative Care Association of Uganda and the newly formed African Palliative Care Association were constantly reiterated. It is envisaged that Hospice Association of Zimbabwe would serve the same purpose. Despite the different approaches to the problems faced by many representatives in their own countries, it rapidly became apparent that the work of these pioneers and their organisations had common values and principles of patient care. The meeting had also developed the opportunities for dialogue between the delegates, and it became apparent that not only was there no competition between various groups, but there was a genuine will to work together.

On the 18th of September 2003, I joined in a weekly case conference (a review of selected new patients). It was a good forum for teaching and exchange of ideas on management of patients. In the afternoon I spent some time with the training team looking at their programmes and how they are conducted.

On the 19th of September 2003, I was taken to Mildmay Centre. They have huge training and clinical departments. Although Julia Downing was away, I spent some time with a doctor who is one of the training team members.

KEY AREAS:

ACKNOWLEDGEMENTS. 

 

Submitted by: Eunice Garanganga, RN Palliative Care Nurse Consultant