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The 10/80 gap

Author: Santana Githaiga
03 March 2017
  • Dr.Zipporah Ali facilitating a CME session at MP SHAH Hospital

“We are all aging and we may all need palliative care. Diseases are increasing and palliative care services should then be included in our health care services so as to have flourishing lives until the last moment of our lives.” This is the message Dr. Zipporah Ali, the Executive Director, Kenya Hospices and Palliative Care Association (KEHPCA) conveyed to the health care professionals who had attended the continuous medical education (CME) session at MP. Shah Hospital.

The CME session drew out quite a crowd of individuals who were eager to learn about what palliative care is about. Dr. Ali started off the session by explaining what palliative care is and its history both globally and nationally. Palliative care is a specialized care given to people with life-threatening illnesses in the hope of improving their quality of life from the time of diagnosis to whatever trajectory the illness takes. The care consequently usually goes beyond the patient because of its holistic approach which not only focuses on the physical but also supports the patients and their families spiritually, emotionally and psychosocially. It sounds simple, doesn’t it? You may be asking yourself the question, “Isn’t that the care people receive all around the country?” Well, not to a certain extent so. The truth of the matter is, palliative care services, even though a fundamental prerogative for every individual is not always accessible to all Kenyan citizens for various reasons. For instance, it is critical to consider what the WHO commission on the social determinants of health found that “The unequal distribution of health-damaging experiences such as not being able to access needed services is not in any sense a natural phenomenon. The limitations then arise from a toxic combination of poor social policies and programs, unfair economic arrangements and most significantly bad politics,” (2008:1). This is the reason that hospices, who critically rely on charitable support and are integral palliative care providers, still struggle to reach everyone. A matter of fact is that education and training in palliative care is lacking in healthcare professionals, combined with a double burden of the diminished affordability and access for those who need it most.

This is why Dr. Ali continues to advocate and educate on palliative care. The health care professionals were advised to provide continuous palliative care that goes beyond the patient and not be shy to talk about death as it is, in fact, a normal process.  Dr. Ali also emphasized the importance of the spiritual element of palliative care especially in our culture which sometimes results in people believing they are bewitched and being punished for some of their actions in life. It is as a result necessary in such situations to carefully help the patients understand their condition which is best done as a team that goes from doctors to nurses, social workers, family members among others. Applying such approaches, therefore, equates to treating the patient and not the disease which is also very critical when it comes to palliative care given to children. “Holding a patients’ hand while engaging in difficult conversations is one of the ways that can ease the tension and make the patient feel valued,” acknowledged one of the participants. He added that the talk was timely and more sessions on communication and pain management should be conducted.

Palliative care reduces suffering, promotes quality of life, supports the caregivers and allows death with dignity. It is not a one size fits all kind of care due to the fact that the pain threshold and the way patients respond to treatment vary. 80% of people who need palliative care services live in low and middle-income countries yet those countries only 10% have access to it. Dr. Ali added that "It's unfortunate that only 10% or less of the global pain relieving medicines are directed to 80% of the global population who require them."

Dr. Ali continues to hold the CME sessions because the only way to beat those statistics is through advocacy, continuous education and research.

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