Apresentação feita por Eddie Mwebesa no seminário internacional Conass Debate – Cuidados Continuados e Integrados: um desafio para o presente, realizado em Brasília nos dias 26 e 27 de dezembro.

1. Integrated & continuous Care:
Lessons from Africa for
Palliative Care
Dr Eddie Mwebesa
Consultant
For CONASS, Brasilia, BRAZIL
26 Nov 2019
Photos with permission; showing pathology

2. No one is immune to possibility of dying.
“And you can not delegate this”- Ana Claudia Arantes

3. Huge need for
Palliative Care
• World:
– 40M need PC care
– 78% of them in LMICs
– Only 14% who need
palliative care receive it.
• Africa: >80% of cancers are
advanced at diagnosis
• Uganda:
– Over 250,000 in need
– 1 Doctor: 20,000
– Only radiotherapy machine
broke down at some point!

4. HIV/ AIDS: More of the same?

5. Therapies for the
desperate
-Nanyonga’s “garden soil
cure”

6. Palliative care goal:
To improve quality of life
Disease
management
Loss, grief
End of life /
death
management Practical
Spiritual
Social
Psychological
Physical

7. When to start Palliative Care

8. Is Palliative Care actually beneficial?
YES
• For patients
– Less aggressive
treatment
– Better survival
– “Adds life to days, not
just days to life”
• For health services
– Saves costs

9. The Public Health Model
POLICY
DRUG
AVAILABILITY
EDUCATION
Implementation
s
i
t
u
a
t
i
o
n
o
u
t
c
o
m
e
s
Patient & Family

10. Changing this world’s culture
• Do not allow lack of a policy delay action, especially for
patients
• “If you were dying, what would be important to YOU?”
• Communicating with the sick& Please involve the patient
• Compassion
• The ethos of Palliative Care must permeate all disciplines
• 3 Ethos
10
Care for
the patient
Care for
each other
Support
partner
organisations

11. A model for Africa:
Hospice Africa and Uganda
11
Started 1993
by Dr Anne
Merriman
4th Hospice in
all of Africa
Vision&
Mission of an
affordable
Palliative Care
model for
Africa

12. Dedicated teams “go the extra mile”
12

13. Educating and pushing boundaries
• PC does not have an easily
recognisable tool
• Institute of Hospice and
Palliative Care in Africa
– Teaching undergrad &
postgrads, and in nursing
schools
– Distance-learning BSc
– PG Dip in PC and MSc
• Legislative change for nurse
opioid prescription

14. Africa consumes very little opioids while
there is a global drug crisis elsewhere

15. Why is oral morphine indispensable?
• Efficacious
• No ceiling dose
• Easy to titrate for pain
level
• Convenient oral route
• Simple to make

16. Recipe for making up morphine at
HAU…easier than making an omelet!

17. Weigh morphine powder & preservative

18. Mix in water

19. Stir to dissolve

20. Add in food
colour

21. Stir

22. Measure out quantities

23. Making
pain relief
universally
accessible
• Most inexpensive oral morphine in the world!
• Other countries have learnt from HAU& are making their own
• Balancing access for patients with restriction to avert misuse
23

24. Increasing availability/ accessibility &
building the fraternity, with PCAU
24

25. Palliative Care in Africa
• Commenced to
support other
African countries
with advocacy
and training
Countries where PC
message has been received
and commenced through
HAU IP and APCA (2018)
25

26. “Levels of palliative care development – all countries”
Global Atlas of Palliative Care at the End of Life
WHO & WPCA, January 2014

27. Why integrate & make care continuous?
• World Health
Assembly resolution
• Palliative Care is a
human rights issue
• Better care for patient
and the country

28. “Everyone we need is here…There
is no way this can go wrong”

29. SUPPORT HOSPICE
AFRICA UGANDA TO
EXTEND CARE FOR
PATIENTS
• Website
www.hospiceafrica.or.ug
• We are looking for partners
for Portuguese-speaking
Africa
• Donate

30. Obrigado
Thank You