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Over the past twelve months Hospice Africa has identified the need for a dedicated team to work with projects in countries other than Uganda. This small team, based at HAU, is funded by Hospice Africa and is led by Anne. Catherine Nawangi, who joined HAU as a palliative care nurse in 1999, has been appointed Clinical Trainer for International Programmes. Catherine is responsible for working with teams who are receiving funding from Hospice Africa and helping in setting standards, adapting palliative care to local needs using local obtainable tools, setting up evaluation tools and training on site. She also identifies dedicated individuals, from each team, to receive training at HAU. To date Catherine has worked with teams in Malawi, Cameroon and Nigeria. Her advice and support is very much appreciated by these teams.
Catherine keeps in touch with the teams by text after she returns to Uganda. She thought out this innovative method as many of the Nurses working on the ground do not have access to e-mail and calls are very expensive. However a text can give support and answer difficult questions.

Future support for Palliative Care in Africa
For the foreseeable future, Hospice Africa in the UK will remain a small charity run by volunteers but others are choosing different routes. Hospice Africa Ireland (HAI) has taken a leap of faith with the decision to employ a fundraiser. Angela Cooney works with the Board of Hospice Africa Ireland and is the first person to be employed by the wider organisation outside of Uganda.
Angela is based in the new office, lent to HAI free of charge, by the management of Our Ladys Hospice, at Harold's Cross in Dublin. Our Ladys Hospice is famous in the history of the Hospice movement and we are honoured to have their trust and support. The new office will coordinate funding from Ireland but also to be a hub for sharing ideas for advocacy, fund raising and other ideas for all the country groups: Hospice Africa, Hospice Africa (USA) and soon to be Hospice Africa (Australia) and Hospice Africa (France).
Also this year the idea of a Foundation or lead group to preserve the Ethos and spirit throughout the Hospices was initiated with a meeting of a steering group, in Dublin in April. This group will be meeting by email and other means. The group consists of the founding members, Anne and Lesley, and representatives from Ireland and US.
Mrs Naomi Nasasira from Uganda, was invited and consented to be the Ugandan representative.

For the past three years Hospice Africa has been supporting the Centre for Palliative Care, Nigeria (CPCN)., a home care team based at University College Hospital, Ibadan, (UCH), We have been their main donor and this has helped them to sustain a small team led by Professor Olaitan Soyannwo, Professor of Anaesthesia who introduced the concept of palliative care to UCH and who has persevered in spite of financial constraints.
CPCN (now a registered charity in Nigeria) was started as a model to introduce palliative care from the point of referral in UCH to caring for the patient at home. They now have a day care centre and clinic in the grounds of UCH who donated and renovated it. They also have a van which is used for home visits. The team consists of one nurse, a general worker, two part-timers, a secretary and two drivers who share in driving. Several of the team have trained in Uganda but Catherine held a training course for 30 Nurses in UCH, during February 2008 and she and Anne are returning for further workshops and liaison later this year. Olaitan has a vision for UCH to be the model for West Africa, bringing training to many health workers so that palliative care becomes a reality to all in need. There is presently studying for our Distance Learning Diploma! Malawi is really moving forward in palliative care and the importance of volunteerism is recognised.

Palliative Medicine joins the Department of Internal Medicine at Makerere University, Kampala!
Another contribution towards advancing palliative care in the rest of Africa is the commencement of a Palliative Medicine Unit in the Department of Internal Medicine at Makerere University. As well as being open for clinical training and research to Ugandans in the Medical School, it will eventually be responsible for the Distance Learning Diploma, now being upgraded to a degree. The Department and the Degree will be a first for this part of Africa. Dr Mhoira Leng will be the first Head of Department. Mhoira is from Scotland and has experience setting up the University Department in Aberdeen as well as wide experience in teaching palliative medicine in India.
It has taken quite a few years of planning to bring this to reality. HAU has been supported by the Dean of the Medical School, Professor Nelson Sewankambo, The Head of Internal Medicine, Professor Harriet Mayanja and Professor Dr Elly Katabira of Internal Medicine, who as Dean facilitated collaboration with Makerere University. Professor Katabira is also the Consultant to Education at HAU this year.

Sierra Leone:
Anne made her second assessment visit to The Shepherds Hospice (TSH) in February, on her way to Nigeria. Although called Hospice TSH has mainly worked with AIDS organisations for treatment and follow-up. Whilst important, this has not really been palliative care, which is so much needed in this, the poorest country in the world.
Since the assessment a doctor has committed himself to palliative care and will be coming to Uganda for 3 months specialist training. He will return to support Charles Madya and his team to bring palliative care to patients and their families. Charles is having to do home visits on a motorbike, which is so difficult in the hills in the bad weather.
So far we have only supported TSH through our contribution to the International programmes. They are now seeking direct funding from other donors, but will keep in touch with us through Anne.

Catherine and Anne went to Cameroon from Nigeria in February to follow up the team at Banso, who are receiving funding from Hospice Africa, and to advocate for the cancer services in Yaounde. They arrived an hour before the strike on the roads and when they tried to leave Douala the first morning they were stoned for moving! The team had to return to Douala where they remained until it was safe to go to the airport and leave 4 days later. but with plans to return soon. Meanwhile Dr Sandrine from Banso has been at Hospice Africa Uganda for 3 weeks, receiving training and practical experience.

The pdf files below have more infomation about palliative care in Cameroon.

Lesley and Anne visited Malawi in January to give support and make plans for the four initiatives we are supporting. They spent time in Salima with Lucy Finch in NdiMoyo, a home-care hospice based on the HAU model. They then went to Queen Elizabeth Central Hospital in Blantyre to visit the childrens programme, led by Dr Mary Bunn, a GP from Liverpool and the adult programme led by Dr Jane Bates. They also visited the Presbyterian Hospital at Mulanje, where the palliative care team were struggling because of changes in staffing and low financial support. It was decided to let Catherine spend a month with the Mulanje team which she did in May. There are plans for a follow up with the team early in 2009. In spite of poverty, Malawi is making tremendous progress, reaching patients in need. HIV was 28% in two of the Districts visited and there is a huge need for palliative care for both cancer and AIDS patients. There is now a palliative care desk in the Ministry of Health and the nurse.

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