Why palliative care is a global health issue?

Palliative care, has been defined by the World Health Organisation as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual from the point of diagnosis, through the course of the disease and into bereavement. In sub-Saharan Africa, the need for palliative care is significant. In 2009, an estimated 22.5 million people were living with HIV/AIDS – 67% of the global disease burden- with 1.8 million new infections reported in that year alone. There were over 700,000 new cancer cases and nearly 600,000 cancer-related deaths in Africa in 2007 and cancer rates on the continent are expected to grow by 400% over the next 50 years. In addition, as people’s lifestyles on the continent change, Africa may experience an increase in the incidence of chronic non-communicable diseases (NCDs). (Palliative care In Africa: Faith M.P and Dix. O)South Africa hosted a triennial conference of Africa Palliative care Association and Hospice Palliative care association of South Africa at Johannesburg in September 2013. This conference was about coming together to improve the lives of African patients living with life-threatening illnesses through innovation and dialogue. It was about bringing our area of expertise to the table in an exchange of ideas to uphold and strengthen the health care systems that African patients and their families rely upon for physical, social, psychological and emotional support.The theme was “Spanning Diseases, Crossing Borders,” reflects our drive to constantly consider the “net effect”, the ultimate impact of our work with patients in Africa. With this in mind, the conference served as a celebratory opportunity to consider the inclusive nature of palliative care, spanning the disease spectrum – from infectious diseases to non-communicable diseases and the interplay between the two. During the conference, the evidence showed that the burden of NCDs & Palliative care in Africa will be double in the future years which will affect directly the economic perspective of most of the countries. For example, over 80% of world has no access to palliative care; 32 African countries with almost no access to morphine for pain relief and Africa only accounts for 2.3% of world’s medical doctors, registered nurses and midwives.Out of 53 African countries, only 5 have palliative care integrated into either their health or their strategic plans (Rwanda, Kenya, South Africa, Tanzania and Uganda) and while two countries (Rwanda and Swaziland) have developed stand-alone national palliative care policies.The understanding of palliative care is still new in the world especially in Africa. Technologies made the world a small village though internet access, social Medias, cell phones and modern transport tried to reduce distance between towns, countries, continents. A problem that affects me as individual will impact my community, my society, my country, continent and the world. The concept of global health must be seen in all different perspectives: equity, science, participation and sustainability not only focusing on a good system but the willingness of each of us on that perspective.Palliative care is a global health issue which will have implications not only in health structure but in all different layers of our society “Boomerang effect”. Last week on October 12, 2013 the world celebrated “Hospice and Palliative care day” and the theme for this year was “Dispelling the myths”; for many health providers the word palliative is still end of life care which reflect death and nothing to do. I remember a conversation I had with one of my patients, 60 years old, well educated, and diagnosed with a penis CA during his last days, he said: “Death is still the elephant in the room” and I replied: “how can we help?” after seeing me with a small smile he answered: “Either we eat the elephant which will take time or chase it out but be sure itwill destroy the room”. Let’s think about it.Dr Christian Ntizimira is a Palliative Care Educator