In the quest to enhance the quality of life for those battling serious illnesses in Rwanda, the significance of palliative care cannot be overstated, demanding focused attention and innovative solutions.
Palliative care refers to an approach that aims to enhance the quality of life for patients and their families who are confronting the challenges posed by life-threatening illnesses.
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According to Dr Theoneste Maniragaba, a clinical oncologist at the Rwanda Cancer Centre, Rwanda has made significant strides in integrating palliative care and pain management services into its healthcare system, extending from teaching hospitals to local communities.
He said this has been achieved through comprehensive training programmes for healthcare providers at all levels, including community health workers.
Maniragaba noted that in recent years, Rwanda has also made progress in ensuring access to pain relief, particularly opioids. The country now produces oral morphine solutions that are distributed to patients free of charge.
According to Maniragaba, the initiative aims to ensure that individuals can access quality palliative care and pain management services without financial constraints.
Furthermore, he highlighted collaborative efforts with civil society organisations to offer holistic care, including home-based palliative care.
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Discussing the primary challenges facing Rwanda in the endeavour, Maniragaba pointed out the need to ensure equitable access to palliative care across all regions of the country. He identified limited funding as a major obstacle, particularly in providing psychosocial support to vulnerable patients.
To address these challenges, Maniragaba stated that advocacy efforts have begun to strengthen the integration of palliative care into existing programmes and allocate funds to support various palliative care activities.
Additionally, he mentioned the absence of a pre-service training curriculum for medical doctors and nurses in the field of palliative care. However, there are ongoing collaborations with the University of Rwanda to incorporate palliative care knowledge and skills into the training of nurses and doctors.
This, he said, will complement the existing palliative care courses already offered.
He added: "We are collaborating with civil societies in improving palliative care awareness. Moreover, there is inclusion of palliative care into the celebration of Cancer Day as well as involving media to raise awareness for the community about palliative care service availability and accessibility.”
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Dr Christian Ntizimira, Executive Director of the African Centre for Research on End of Life Care (ACREOL), highlighted the significant progress made in recent years, emphasising that palliative care is now integrated into cancer and Non-Communicable Disease (NCD) policies.
Tackling the existing challenges, Ntizimira acknowledged that the landscape has shifted due to the Covid-19 pandemic, necessitating a re-evaluation of their services.
He posed critical questions about the readiness for potential future pandemics and the country’s ability to provide palliative care to patients within their communities, suggesting the digitalisation of services, allowing people to access palliative care information even via USSD codes on their feature phones.
Ntizimira emphasised that the primary need is not just increasing the number of caregivers within communities, but ensuring that people understand the services and can access them.
"The first support a patient receives comes from the community," he noted. "When the community is well-informed, it helps eliminate stigma and provides stronger support to patients and their families. Palliative care is everyone’s business; it extends beyond medical personnel."
Ntizimira further described the three essential pillars of civil society's work in this field, which encompass training, education, and research.
He explained that they train both medical and non-medical personnel, including volunteers. In terms of education, their focus is on dispelling the misconception that cancer equates to a death sentence, addressing its social, psychological, and spiritual aspects. In research, they work towards identifying gaps and needs within the palliative care landscape.