ECHO palliative care in Africa: Improving access to quality palliative care

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Published: 11 Jun 2019
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Runcie C.W. Chidebe - Executive Director, Project PINK BLUE

Mr Runcie C.W. Chidebe speaks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about the ECHO palliative care program to increase knowledge among healthcare professionals in Sub Saharan Africa.

He describes the development of the survey, which helped identify gaps in the knowledge of these professionals.

Mr Chidebe also explains some of the challenges of palliative care in Nigeria, which includes the lack of structured programs in this area.


In 2016 I was invited by the US government to be part of the IVRP, International Visiting Researcher Program, and the US government supported me to travel to about sixteen cities in the US to learn about different programmes and what different institutions are doing in cancer care and civic participation. So I was lucky to visit the UT MD Anderson in Houston and I met the Vice-President and they were planning a programme known as ECHO Palliative.

So the idea was to use the ECHO palliative project from New Mexico to engage nurses, to engage pain doctors, to engage people working in palliative care, especially in the area of giving access to pain drugs and all the rest. So when they mentioned that to me I said, ‘Why not? Do you have anyone in Nigeria doing this programme?’ and they said no. I said, ‘Well, why don’t we bring it to Nigeria because we have nurses, we have doctors, who want to learn and exchange ideas?’ So that’s how we started that programme.

So after one year into the programme Dr Yennu and me and a couple of others we put together some survey and decided to turn this into research for us to see how we can expand this programme across other sub-Saharan Africa.

What did you find?

It’s really, really very interesting because the survey actually helped us to understand the gap that is actually in the telemedicine that we are providing and what needs to be done, especially with knowledge. There was a dramatic increase in knowledge from how we started over a year and where we are today with the clinicians that have been receiving this training.

So what we are looking forward now is to see how we can find more funding to provide especially internet access, probably some gadgets just to find facilities across Africa that are connected to this programme. Because some of them sometimes they connect today and you don’t get to see them next month, maybe because of access to internet or funding to get those electronics and otherwise.

The challenges are really huge. For instance, for Nigeria specifically one major challenge that we have is getting palliative care into the real academic structure. What I mean is you really do not have a clear-cut defined programme that you can do maybe a Masters or probably some specific core programme that is focussed on palliative care. What we really have is people just pick different courses on palliative care. The truth is that over 80% of people who are diagnosed of cancer in Nigeria and so many African countries usually need palliative care. So it’s a very serious issue but it’s really not given the kind of priority it needs, maybe because the policymakers, a lot of people, really think that it’s an impending death and you really don’t have to make so much investment in them. But that’s not really correct and that’s really not good because even though we know anyone is going to leave but let’s give the person a happy ending.

So I myself am also an MBCE, a metastatic breast cancer advocate, and that’s one of the really core areas I’ve really been advocating – to find how we can increase knowledge in palliative care. How we can also increase people who are working in that area. Another challenge, again, is the limited professionals. We have very limited people that are working in palliative care so you tend to see a situation whereby it’s actually the Rad. Onc. who actually provide palliative care. So you really have very few pain doctors who are focussed in this area.

Also psycho-oncology is also a very big issue. Because when people are really going through death they really need people to also talk to them, provide some kind of talk therapy, psychotherapy and all the rest. And in Nigeria you really don’t have hospice homes, unlike in other places. That’s really cultural – people don’t want to hear that they are going to die. So that’s also a huge challenge. But we can mitigate this if we continue to create awareness, if we continue to advocate, to engage policymakers especially to invest more in cancer control, palliative care and otherwise.