While the first visit of any new patient generally occurs at a HAU clinic, the majority of patients are seen in their own homes in the community. For patients at the end of their life there are many reasons why this is preferable, the ability of a patient to comfortably travel to HAU, the comfort of the patient being in their homes and the norm of patients preferring to die at home with their families present. The main reason is that we get to know the family and circumstances where they live as well as becoming closer to the patient and family.
Thus there are teams of HAU clinical members that go out each week. The expected medication needs for each patient will be prepared prior to a visit. This will be based on the last home visit and any information received in the interim period, either from a call to or from the patient. Each home visit team will leave in the morning, attend to between 2 and 5 patients and return to HAU. Due to time and vehicle costs it is necessary that patients seen through home visits live within a specific catchment area around each HAU hospice. Across the three sites HAU teams will travel 45,000 kilometres every year to reach patients in need.
HAU teams also visit several hospitals weekly. This includes visiting patients that are on the HAU programme as well as seeing new patients in need of palliative care. This is often used for patients who are receiving treatment for cancer. Since there is only one cancer centre in Uganda, in Kampala those facing a cancer diagnosis are sent to Kampala for treatment from around the country. Thus being far from home patients are forced to stay in hospitals, where they are seen by HAU team members. Home and hospital visits are the most used means to care for patients in need of palliative care.
Patients outside the catchment area are referred to the nearest palliative care service to their homes. Palliative care is now available in 92 of the 112 Districts in Uganda and as the Districts are smaller thy ca often travel to the neighbouring District if no services in their own.
Those without services are followed up by phone or through relatives reporting back at Hospice on their progress and calculating their medical needs.