Working with the critically ill and the dying is a special calling and it is usually a joy. The reason I say this is because of the closeness we gain between ourselves and our patients. Also, because of the modern methods of palliative care and the fact that we have affordable medications that work in the African situation, we see our patients relieved of their pain and symptoms within their own homes, where they want to be, which brings joy to the patient as well as the family.
When we first come to work in palliative care and move away from curative care we often have to change our attitudes. The patients get to make their own choices and we have to go along with these choices. Unless we have the philosophy that our patient is our guest and has choices, we will not be acceptable to them in the realm of spirituality. Many of us feel uncomfortable when we first try to work with patients in this way but I assure you that this is a normal feeling as one expands one’s comfort zone.
This is more readily accepted within the clinical team that is on the first line working with patients, but when those who play a supportive role such as finance or management have this commitment, they are more efficient, caring and fulfilled in their work.
Palliative care in Africa needs a fund of health workers not only trained, but willing to give a good service to those in need. The heart of palliative care, where the patient and family are the centre and their needs are paramount, can change the face of medicine in Africa. Many health workers have given up on the humanitarian approach because they have seen so much suffering that they are unable to do anything about. But they need to be uplifted with the hope that palliative care can bring, when in the hands of a caring team. There is never a situation where we cannot do something to improve matters for the patient. We must always say ‘There is something we can do’. A formidable responsibility.