Establishing palliative care in Tanzania, Africa

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Published: 21 Apr 2015
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Dr Karilyn Collins - Muheza Hospice Care, Tanzania, Africa

Dr Karilyn Collins of Muheza Hospice Care in Tanzania, Africa talks to ecancer at IAPCON 2015 about setting up the hospice with her husband Dr Richard Collins after recognising the lack of palliative care services in Africa. Their pioneering success at integrating palliative care training programmes for the entire Tanga region ensure that their mentors have the confidence they need to practise palliative care in their communities.

I’m Karilyn Collins.

I was an English GP for twenty odd years in rural Herefordshire and then went into palliative care after a sabbatical where I’d been out to Tanzania and realised what a huge gap there was and what a lack there was in care of anybody with life-limiting disease.

So I went to Cardiff and did the diploma in the year 2000, which I thought was a fantastic experience, and I took that diploma over to Tanzania. I was the only person in the country with any qualification.

For the next five and a half years my husband and I were medical missionaries in Tanzania.

He was in charge of the hospital and I set up a palliative care service within the hospital called Muheza Hospice Care, which is an independent NGO.

We had in-patients, out-patients and home-based care just for Muheza district.

By 2007 the Diana Princess of Wales Memorial Fund said to me, ‘OK, enough is enough.  You’ve had a lot of funding for this one place, get it out. Get it to more regions.’

So we started a training programme for palliative care for the whole of Tanga region and trained seven district hospitals and the regional hospital.

But the thing that became very obvious to me was that whereas I had been in Muheza mentoring the team all the time, these teams were trained, went back to their hospitals and they lost the impact.

They were trying to do two jobs at once and the palliative care became rather side-lined.

So I started up a system of recruiting mentors to go into the hospitals for between three to six months to live with that team and help them to have the confidence to prescribe the morphine which none of the doctors did, they were all completely opiophobic, and to get the community links working.

So this then became a model that we’ve replicated in the Lake Zone in Tanzania and then it was taken up by the THET programme that has been expanding palliative care in four different African countries.

How will your work in Africa apply to India?

What we’ve done is we’ve had a grant that has used the experiences of Tanga, has expanded that, so we are now down to village level in Tanga.

We’ve been using a book called The Palliative Care Toolkit which was published by Help the Hospices and we’ve now got the toolkit in I think it’s 590 of 760 villages in Tanga region with somebody able to use it and a pathway for people with life-limiting disease and pain to be referred back to the district hospital that now has the team that has the morphine and the expertise.

That model we have brought to the Emmanuel Hospital Association in India and now they’ve had their training using the toolkit and we’re now putting the mentors into those hospitals and hopefully we’ll be getting into the community and doing the same sort of thing over here and expanding further.

In what way has your diploma affected your work and career?

The course itself was tough and when you get above 50 taking in facts and reading papers is really hard work.

But it was hugely beneficial, a very good course.

I have since managed to find the funding for one of my doctors in Tanzania to come and do both the diploma and the Masters in palliative care.

So George now, George Loy, is working with WHO in Tanzania implementing palliative care.

So I feel that’s one of my babies that has gone a long way.

So, yes, the course was a real stepping stone to being able to get out there and do it.

Not only was the information good but the fact that I had it, as I said before, meant that they believed in Tanzania that I knew what I was doing.

What advice would you give to anyone working in palliative care?

I’d like to mention to all those doctors still working in palliative care that palliative care is a career with no ending and that my diploma was fifteen years ago now and I’m still mentoring in palliative care and enjoying a very active retirement of palliative care.

So just keep at it.

When you’ve got the knowledge just don’t give up.