Lately we have been interested in this continent in palliative care and that’s because a lot of our patients, cancer patients, many of them are dying. The problems that we have about the patients that come with cancer, they come very late. They don’t get the care they need then; of course, they’re coming from a background with low resources, they don’t have money for their medication. So we feel that palliative care actually can help a lot of our patients. So palliative care is relatively new on the African continent, very new in Nigeria, and we’re so happy because countries where palliative care is more advanced like the US and Europe, Britain, they’re helping us, encouraging us to get on with the care. So what we are doing is we are trying to advance the cause of palliative care.

At this meeting I will be speaking about the relationship between oncology and palliative care, how that partnership, how that relationship can advance palliative care on the African continent. So that’s basically what I’ll be speaking on at the meeting.

How does that relationship work?

It works in the sense that you have a cancer patient seeing the oncologist primarily and we want to encourage the oncologists to remember there’s an aspect of the care that’s not just chemotherapy, radiotherapy, surgery, there’s also palliative care. If the oncologist can remember to bring in palliative care very early they can do it in a number of ways. Either they get the palliative care specialist or they give the palliative care, the basic palliative care, themselves. And that’s what we’re driving at, let the oncologists have the basic, what we call primary palliative care. Let them get the basics so that when it goes beyond the basic they can send to the specialists like us.

So if every oncologist is able to give basic palliative care then the care of the patient is a lot better because in palliative care we’re looking at symptom management, pain and other problems that come as a result of the suffering the patient is going through when they have the cancer. So if the oncologist is able to start palliative care early, even when the disease has not spread through the body, then the patient’s quality of life is much improved. That also gives the oncologists a good feeling that he or she is really doing something to help his patient or her patient.

What are the options within palliative care?

It’s not just pain related, the reason why it seems as if pain is a big thing is that in close to 80% of the patients that we see, we manage, cancer patients, pain is a big issue. HIV too patients, pain is a big issue. But the other things, we have things like other symptoms that will come, maybe side effects from chemotherapy – nausea, vomiting, problems with the cancer itself – anorexia, then depression about the body image, depression about the illness, anxiety about so many… So all those components too, we tend to look at them. The spiritual aspect, too. Sometimes a lot of them, especially in Africa, we tend to have a lot of things that have a lot of spiritual significance for us. So palliative care would help in that regard when patients question why the disease should come upon themselves and sometimes too it affects treatment. Some patients will say, ‘No, I’m not taking the treatments because this is not caused by… it didn’t just come. Somebody somewhere in the village, somewhere in my family, someone doesn’t like me. Someone put a curse on me.’ So palliative care helps to remove such beliefs, misconceptions, so that patients can access their treatment early and take their treatments and be consistent so that the quality of their lives will be better. So palliative care does all that too.

Are any of the palliative care options culturally specific?

Actually in Africa we have models that are, which is what we encourage, models that are aligned with the culture. I’ll give you an example in Uganda, in Tanzania, let me give you an example in Tanzania which is the family-centred approach, that’s what they call it where they involve the family. They teach family members what to do, teach them about the illness, teach them how to take care of patients in the home. Because we know most patients may not have the wherewithal to go to the big hospitals, the tertiary centres. Many of them live distances away, they can’t get to the city where they can get help. So going into the villages, going to the families, sit there and talk to them, the extended family system which runs in Africa, is a culture in Africa, where you carry everybody along, carry the family along in the management of the patient. That’s one model that is in existence in Africa.

So we’re looking at things that are culturally relevant to our practice in Africa. We think it will help a lot to move the cause of palliative care on the continent.

Is access to morphine an issue?

Previously, yes. Let’s say before 2009 it was a big issue, a big issue for many reasons. One was the taboo, everybody is scared. You say morphine, the next thing they’re thinking about is addiction. The second was the regulation. The governments, because they also have the fear of addiction, they put a lot of restrictions on it. So that was before 2009 but we’ve had a major breakthrough thanks to societies like the American Cancer Society, they made a big push, sat down with the federal government of Nigeria and then decided, listen, we need to get this into this country. And they’ve done it in a lot of African countries. So what they did is they brought in the oral powdered morphine, which is now compounded into a liquid solution and is widely available in the major hospitals in Nigeria. So morphine is no longer an issue now since 2009.