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Uganda – Cuidados Continuados Integrados: lições da África

Apresentação feita por Eddie Mwebesa no seminário internacional Conass Debate – Cuidados Continuados e Integrados: um desafio para o presente, realizado em Brasília nos dias 26 e 27 de dezembro.

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Integrated & continuous Care:
Lessons from Africa for
Palliative Care
Dr Eddie Mwebesa
Consultant
For CONASS, Brasilia, BRAZIL
26 Nov 2019
Photos with permission; showing pathology
No one is immune to possibility of dying.
“And you can not delegate this”- Ana Claudia Arantes
Huge need for
Palliative Care
• World:
– 40M need PC care
– 78% of them in LMICs
– Only 14% who need
palliative care receive it.
• Africa: >80% of cancers are
advanced at diagnosis
• Uganda:
– Over 250,000 in need
– 1 Doctor: 20,000
– Only radiotherapy machine
broke down at some point!
HIV/ AIDS: More of the same?
Therapies for the
desperate
-Nanyonga’s “garden soil
cure”
Palliative care goal:
To improve quality of life
Disease
management
Loss, grief
End of life /
death
management Practical
Spiritual
Social
Psychological
Physical

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Uganda – Cuidados Continuados Integrados: lições da África

  • 1. Integrated & continuous Care: Lessons from Africa for Palliative Care Dr Eddie Mwebesa Consultant For CONASS, Brasilia, BRAZIL 26 Nov 2019 Photos with permission; showing pathology
  • 2. No one is immune to possibility of dying. “And you can not delegate this”- Ana Claudia Arantes
  • 3. Huge need for Palliative Care • World: – 40M need PC care – 78% of them in LMICs – Only 14% who need palliative care receive it. • Africa: >80% of cancers are advanced at diagnosis • Uganda: – Over 250,000 in need – 1 Doctor: 20,000 – Only radiotherapy machine broke down at some point!
  • 4. HIV/ AIDS: More of the same?
  • 6. Palliative care goal: To improve quality of life Disease management Loss, grief End of life / death management Practical Spiritual Social Psychological Physical
  • 7. When to start Palliative Care
  • 8. Is Palliative Care actually beneficial? YES • For patients – Less aggressive treatment – Better survival – “Adds life to days, not just days to life” • For health services – Saves costs
  • 9. The Public Health Model POLICY DRUG AVAILABILITY EDUCATION Implementation s i t u a t i o n o u t c o m e s Patient & Family
  • 10. Changing this world’s culture • Do not allow lack of a policy delay action, especially for patients • “If you were dying, what would be important to YOU?” • Communicating with the sick& Please involve the patient • Compassion • The ethos of Palliative Care must permeate all disciplines • 3 Ethos 10 Care for the patient Care for each other Support partner organisations
  • 11. A model for Africa: Hospice Africa and Uganda 11 Started 1993 by Dr Anne Merriman 4th Hospice in all of Africa Vision& Mission of an affordable Palliative Care model for Africa
  • 12. Dedicated teams “go the extra mile” 12
  • 13. Educating and pushing boundaries • PC does not have an easily recognisable tool • Institute of Hospice and Palliative Care in Africa – Teaching undergrad & postgrads, and in nursing schools – Distance-learning BSc – PG Dip in PC and MSc • Legislative change for nurse opioid prescription
  • 14. Africa consumes very little opioids while there is a global drug crisis elsewhere
  • 15. Why is oral morphine indispensable? • Efficacious • No ceiling dose • Easy to titrate for pain level • Convenient oral route • Simple to make
  • 16. Recipe for making up morphine at HAU…easier than making an omelet!
  • 17. Weigh morphine powder & preservative
  • 21. Stir
  • 23. Making pain relief universally accessible • Most inexpensive oral morphine in the world! • Other countries have learnt from HAU& are making their own • Balancing access for patients with restriction to avert misuse 23
  • 24. Increasing availability/ accessibility & building the fraternity, with PCAU 24
  • 25. Palliative Care in Africa • Commenced to support other African countries with advocacy and training Countries where PC message has been received and commenced through HAU IP and APCA (2018) 25
  • 26. “Levels of palliative care development – all countries” Global Atlas of Palliative Care at the End of Life WHO & WPCA, January 2014
  • 27. Why integrate & make care continuous? • World Health Assembly resolution • Palliative Care is a human rights issue • Better care for patient and the country
  • 28. “Everyone we need is here…There is no way this can go wrong”
  • 29. SUPPORT HOSPICE AFRICA UGANDA TO EXTEND CARE FOR PATIENTS • Website www.hospiceafrica.or.ug • We are looking for partners for Portuguese-speaking Africa • Donate