EDITORIAL: Integrate palliative care into health care, education systems

In 2011, Rwanda became the first African country to roll out a national palliative care policy, setting in motion a four-year strategic plan.

Six years later, the country has made good progress in an aspect of health care that is largely neglected in most parts of the world.

Palliative care is an approach designed to improve the quality of life or ease the suffering and pain of patients faced with life-limiting illnesses as well as their family.

Some people tend to limit this essential part of public health care to end-of-life care but it is much broader because it’s a holistic approach that places the patient and their family at the centre of it all.

The whole idea is to ensure that patients retain their dignity during the most difficult phase of their failing health.

Palliative care is composed of different aspects, including physical, psychological, social and spiritual – all designed to prolong life as long as possible while easing the patient’s pain and helping them and their families to make informed decisions, such as avoiding pointless procedures.

Research has indicated that patients with terminal illnesses that receive palliative care live longer than other patients in similar conditions with no access to palliative care.

Since the adoption of the national palliative care policy in 2011, Rwanda has registered gains in this area, including making pain killers more available (an average of four kilogrammes of morphine is currently prescribed for patients in the country every year, up from just 0.2 kilogrammes between 2007 and 2009), and training of hundreds of health care practitioners in palliative care.

The Ministry of Health recently deployed some 200 home-based health care practitioners to provide palliative care services across the country and more are expected to be trained and deployed in the near future. This is critical especially because our social and family structures still allow for home-based care as opposed to the situation in many Western countries.

In addition, the country got its first modern outpatient facility that provides palliative care services: the Catholic-run Hospice St John Paul II based in Kabuga in the capital Kigali.

Nonetheless, serious challenges remain. With research showing that Non-Communicable Diseases are on the rise in developing countries like Rwanda, there is need for continued interventions from all stakeholders to broaden these services and ensure that the public fully grasps the essence of palliative care and embraces it.

Palliative care should be fully integrated in the national education programmes, especially at the undergraduate level, and be treated as a cross-cutting issue in all the NCDs programmes. There is also need for more physicians and nurses to be in position to prescribe morphine (syrup) to relieve the pain of patients and extend other end-of-life care services to patients and their loved ones.