Hospice Africa Uganda continues to compassionately care for patients, some of whom had formerly been told, “Return home to die, since there is nothing more that can be done for you!”
The last decade at HAU, in many ways, mirrors events that have occurred in Uganda over time with regard to the evolution of the HIV pandemic, the epidemiology of cancers, and advances in the medical field.
The nearly 5-fold increase in numbers of patients on HAU’s program from 759 in 1999/2000 reflects increase in Uganda’s population, the rising awareness of Palliative Care in country, the outcome of educating and training of medical and nursing professionals, and the tremendous input of the Community Volunteers we work with.
Although the overall patient population has increased, the number of HIV patients leveled off. This reflects the decrease in country-wide HIV prevalence from over 20% in 1999 to 6.4% today. Also highly active antiretroviral therapy became more widely available in 2002 and Uganda’s guidelines were revised to commence treatment at a higher CD4 count of 350. HAU over this period realized a peak and recently a drop in number of HIV-related cancers. Although Kaposi’s sarcoma was no.1 for the first ten years of Hospice in Uganda it has been falling. Cervical cancer is now the top female cancer followed by breast, while prostate cancer is now the highest for men at HAU. Esophageal cancer is now the 3rd commonest cancer among males seen at HAU, and accounts for a fifth of all cancer diagnoses, and the commonest cancer among males seen at Mobile Hospice Mbarara. This may be partly attributable to enhanced diagnosing capacity at two hospitals in western Uganda but may also be a consequence of increased alcohol and tobacco consumption in the country. Uganda has one of the highest recorded intakes of alcohol in the world.
Generally cancer is on the rise particularly in the developing world where only 10% of all resources committed to controlling malignancies are available to patients. Most cancer patients therefore present with far advanced and disfiguring tumors in a setting where radiotherapy and chemotherapy is largely unavailable. In Uganda palliative care reaches only10% of those who need it in the villages and communities.
Palliative Care is more needed than ever before, and in the next decade HAU is being offered a golden opportunity to be relevant to this need, and to move forward to excellence in this medical specialty. Our vision of “Palliative care for all in need” remains the impetus for continuing the great work at Hospice Africa Uganda
THE WORK OF HOSPICE AFRICA UGANDA
By 31 May 2011 Hospice Africa Uganda has cared for 18,138 patients across the 3 Hospice sites in Kampala, Mbarara and Hoima. Most patients are referred from hospitals and health units, but self referrals and from community volunteer workers have risen in the recent years. There are 1,462 patients on the program, and we estimate that a similar number is being looked after by those we have trained and are working with in health facilities and Hospices in the country.
Palliative care involves investing time to build relationships with patients and their families. We do not have in-patient facilities as this is too expensive in a resource-limited setting. We work with patients and families in their own homes and in hospitals where we are asked to see them. Research and experience have shown that most patients want to die at home. In Uganda, our own experience has shown that patient and families can share this time together in a meaningful way, when pain and symptoms are controlled and they are at peace. The family are supported in the knowledge that they can call on Hospice for any problems that may arise.
On referral, we visit the patient at home or in hospital within 24 hours. The patients are followed up at home if they live within a 20 km radius of a Hospice. Those who live outside this catchment area have their pain and symptoms controlled before returning to their homes, from which they report back periodically. However with the training of health professionals throughout the country, some are managed closer to home by palliative care trained nurses, clinical officers or doctors.
Kindly click on the links below to read more about the 3 Hospice sites