Palliative care is explicitly recognised under the human right to health as an approach that aims to improve the quality of life of patients and their families facing the problems associated with different life-threatening illnesses, including Non-Communicable Diseases (NCDs).
The World Health Organization (WHO) recognises palliative care as a crucial part of integrated and people-centered health services, at all levels of care.
Dr Zipporah Ali, a palliative care physician expert and public health specialist who is currently serving as the President of NCD Alliance Kenya is aware that most people think that palliative care is a service dedicated to cancer patients, given that it started many years ago when cancer patients were extremely suffering and the treatment focus was a lot on improving quality of life when they were dying.
"It has changed since then,” she explains. "Palliative care is for any serious illness that affects somebody’s quality of life. It could be cancer, advanced diabetes, hypertension issues, and cardiovascular diseases, among other diseases. Among children, congenital diseases are also part of it. The focus is on any chronic disease that is not curable and probably ends up killing somebody. This service is integrated from the beginning of a diagnosis and continues over the course of the illness.”
According to Dr Ali, NCDs affect everybody’s life on a day-to-day basis and most of them come with symptoms like pain, cough, constipation as well as wounds and need to be addressed as well as managed, hence the need for palliative care with a focus on four dimensions of care: physical, emotional, psychosocial and spiritual.
"Palliative care is not just about the patient only,” she continued, "it also focuses on the family of the patient. Families will probably need a lot of counseling especially if the patient has got cancer. Most of the time, the family dealing with this patient is going through a lot because they know, in Africa, the disease feels like death because of late diagnosis and treatment. The family also suffers financially.”
Dr Ali also noted that part of palliative care also includes end-of-life care that takes place when the medical team knows the patient is not going to make it alive.
"For example,” she explained, "if you were focusing on treating the patients by using antibiotics, you can now shift to managing the pain and smell as well as communicating with the family members. We emphasize a lot on good communication with the patient which is something that is missing in our medical field. There is a need to let a patient in that stage know the truth about their condition so that if they have any unfinished business, they can focus on it.”
Tackling the biggest challenge hindering palliative care in the East African region, he pointed out people’s understanding, declaring that there is fear and stigma around palliative care where most Africans think that once a patient is being given that care, it means the medical team has given up on them.
"We need to tell them that it’s about living and the quality of health,” she said, adding that some African countries have not yet integrated palliative care into their healthcare services which is another big challenge.
She noted that however, countries like Uganda, Rwanda, and Kenya have tried integrating it; have palliative care policies, guidelines and access to palliative care medications like Mofen that control severe pain.
"As we do advocacy,” she continued, "we have to ensure that the services are available nearest the patients and that good communication, as well as treatment support services, are also there. There is an issue in some parts of Africa where the governments have not yet prioritized the service. We want palliative care to be part of national budgets and be taught in schools; nursing and pharmacy.”
Since palliative care is recognised by WHO, Dr Ali declared that the recognition should be domesticated and actualized at the community level so that the person in need of the service can understand how to access it.
According to the WHO, palliative care is most effective when considered early in the course of the illness. Early palliative care not only improves quality of life for patients but is also a cost-saving public health intervention that reduces unnecessary hospitalizations and the use of healthcare services.