Why palliative care is a human right

The need for worldwide palliative care coverage has never been greater. As the incidence of non-communicable diseases like cancer is rising in resource-limited settings, the need for palliative care alongside curative treatment is also growing. Basic symptom control and holistic support are not expensive and do not require highly specialised personnel, but are often lacking even where health structures and home based care programmes are in place. Inadequate drug supplies are partly to blame, but equally important, also lack of basic understanding of palliative care amongst healthcare providers at all levels, a lack of confidence in communication skills and as well lack of knowledge of symptom control techniques.All of these may compound the inadequate procurement of the needed palliative care drugs. For these reasons communities and health workers can be overwhelmed by palliative care needs that they do not feel equipped to meet.Despite these challenges, it is not acceptable that we have to suffer and die without dignity solely because of the place we are born and live. In Rwanda, we consider comprehensive healthcare as basic human right, and thus have decided to address these challenges by implementing a coordinated Palliative Care programme and while this will certainly be a great undertaking, we will take it step by step. As a well-known Indian proverb says; “when you want to eat an elephant, you need to decide where to start and then just eat a little bit at a time.”The aim of palliative care is to provide a better quality of life to patients and families facing a potentially lethal disease by preventing and treating suffering through symptom control (including pain) and psychological and spiritual support (including support for the family). Most Rwandans including those in the medical field think that palliative care should start when the patient is in critical condition but it’s not true. Palliative care starts at the diagnostic stage till the aftermath of the patient’s passing because it also focuses on family. Secondly palliative care is not only for someone who is dying and subsequently not intended to hasten or to delay death; Pain relief is a central aspect of palliative care, but palliative care is not only about pain! The most common diseases where patients most need this kind of care are: cancers, HIV/AIDS advanced diseases, heart failure, kidney failure and progressive neurologic diseases.The Rwanda situationSince the National Policy of Palliative Care was adopted by Rwanda Ministry of Health in March 2011, Rwanda has devoted a great deal of time and energy toward improving the quality of life of patients with life-threatening illnesses. A centre of excellence for Palliative Care (PC) has been set up at Kibagabaga Hospital with success stories of task shifting in the community, all working hand inhand with Palliative care Association of Rwanda which made that dream possible.Two hospitals have already started to integrate PC as a routine activity using Kibagabaga hospital’s experience: Teaching Hospital (CHUK) and Rwamagana Hospital. The national plan has several parts, including training health professionals to be more comfortable to manage patients in the Palliative Care programme. This is included in both clinical teaching and supply chain management.Kibagabaga Hospital has developed a specialised palliative care service and has become a centre of excellence in the field. Over a 12 month period, the hospital, which sees 55,000 patients per year (inpatients and outpatients), is using 0.12kg of oral morphine or opioid. In our decentralised health system, the level below referral hospitals is the District Hospitals and currently, Rwanda has 42 such hospitals, all of which have a Multidisciplinary Team including physicians. At district level, in its phase one of the implementation plan, 10 hospitals and their catchment area will use the same amount of opioids as Kibagabaga Hospital and at the same time the 30 remaining hospitals will use half of that amount: 0.6kg.This accounts to a morphine quantity estimated at 3.12 Kgs.Finally, with a buffer stock that accounts to 10% (0.5 KG), the total morphine that is required during the period 2013-2014 for the National Palliative Care programme is estimated to 5 Kgs.Dr Christian Ntizimira is an expert and educator on Palliative Care.