Care beyond cure: Why medics must still rise to the occasion

As a society, we help bring people into the world; we should help them leave it as well. I have come to realise that society needs to concern itself with the journey of human beings from cradle to grave. The concept of birth is more understandable than the concept of death, but both are entirely natural. Life is not eternal. It has a beginning and an end. Many health providers shun the concept of palliative care because they equate it to defeat and a feeling of shame at their inability to save lives. We find it normal to help mothers bring healthy babies into the world, yet we are often at a loss as to how best to assist at the end of a life. What kind of assistance should we be offering? The concept of Ubuntu states that social assistance, especially to those in need, is fundamental to society. It is not only the weak, fragile, or sick who need assistance, even the strong among us need social support. Are not weddings, concerts, sporting events and school graduations more enjoyable when we are joined by family, friends, and even people we do not know? If the strong among us need social support, imagine how great the need must be for someone facing a life-threatening illness. Palliative care, according to the World Health Organisation (WHO), is an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Just last month, on January 20, 2014, the Executive Board of the WHO adopted a resolution urging countries to integrate palliative care into healthcare systems; improve training for healthcare workers and ensure that relevant medicines, including strong pain medicines, are available to patients. It also urged the WHO to increase its technical assistance to member countries in the development of palliative care services (report by the WHO Secretariat on palliative care, which will be referred to World Health Assembly in May 2014). If implemented, the resolution represents an important victory for not only palliative care activists and advocates but also, and most importantly, patients and their families affected by life-limiting illness. Palliative care will no longer be considered a kind of fringe option but rather an integral part of healthcare systems the world over. Rwanda is in many ways a palliative care pioneer. It was the first country in Africa to adopt a standalone policy on palliative care, a strategic plan, and an implementation plan. And the Ministry of Health (MoH) is integrating palliative care into the healthcare system by organising trainings at all levels. Referral and district hospital personnel have been trained at the national level. Trainings will soon be organised at the health centre and community health worker levels. In addition, the MOH has made available an initial consignment of five kilogrammes of morphine to 18 district and teaching hospitals for 2013-14. Yet palliative care does not replace other forms of care. It can be integrated into existing programmes and should be a part of the care given to everyone with life-limiting illness. The impact of care beyond cure cannot be overstated. We, health providers, often think that if we are unable to cure we are wasting our time. Maybe when we think such thoughts we are forgetting our own humanity. After all, we too will one day follow the same path as our patients. I recognise from my experience looking after patients with life-limiting illness that life is precious. Of course, patients, at first, all want to recover, but when they realise that they have an incurable disease, their only wish is to die peacefully and without pain. Our responsibility as health providers and human beings is to help them achieve that wish and in so doing assist and accompany all members of society, especially the most vulnerable, from cradle to grave. The author is a palliative care expert & educator, and works with Kibagabaga Hospital, Kigali.