The Paliative Care project in Ethiopia

Pain Management and Palliative care in Ethiopia.

This initiative began in 2016 when using a District Rotary grant I went out with an English based Palliative Care Works (PCW) Charity team to Addis Ababa. The aim of the visit was for us to assess what we could do to support the only hospice in Ethiopia.

Scoping the project.

It became evident that this Hospice was doing an excellent job but it was not, as had been expected, a hospital with beds for palliative care patients but rather was a service where a doctor and some nurses went to visit patients in their homes. The chairman of this charity was a Rotarian from the Addis Ababa Finot club and we met him and visited his club. But we also met Dr Ayres who was part of the Ethiopian Health Ministry who although a supporter of this hospice was passionate that nationally, a domiciliary model based on a hub and spokes approach, was the one that was the most sustainable. She knew that for palliative care to be accepted we needed to change the current medical thinking.  Pain relief was only available for trauma cases and palliative care patients were not eligible for narcotics in case they became addicted.

Identifying the project scope and cost

On our return I scoped the project which I felt was sustainable. The plan was to train health professionals in pain management and palliative care to the point where enough professionals were trained sustain growth and would be able to train themselves. Dr Ayres believed she could make the training happen and scoped a one week course.  She trained 24 professionals including 6 doctors and two social workers. All went very well and this proved the training could be done. Dr. Ayres from the MoH was our partner.

PCW was an expensive supplier but Dr. Ayres could not build the number of professional she needed by herself. PCW had experience of building care in Africa.

Testing the concept.

In November 2016 the Vocational Training Team delivered a week’s course to 6 doctors 24 nurses and 2 social workers. The training team were used to working in African countries but Ethiopia is not typical and provided some challenges that were unique to Addis, these were language and also the travel time. The professionals we were teaching had all been taught English at school but found speaking English limiting. The common language is Amharic of which Dr. Ayres is a fluent speaker. But given encouragement and time the students began to discuss well in Amharic and then write, in bullet points, on the A1 sheets, in English. They took well to role play and this proved a very useful tool in the later train the trainer courses. Travel in Addis is very difficult and the students were coming in from different areas. The only public transport they can afford is mini-bus and the queues in the morning are horrendous. So the course had to be modified on a daily basis.

This project needed both time and money.

The trainers were expensive and flying out from England not cheap. The costings suggested a need for over $34,000 so we needed Global funding. This meant working with a local, host, Rotary club. After a false start we found the RC of Shegar was an ideal partner and this has proved to be the case. Funding was made easier because I was then an Assistant Governor and appealed not just to my own club, but the Area clubs too. Everyone was very generous and we reached or target.

Delivery

In January 2017 we delivered two weeks of training and this included the first train the trainers’ event. The graduation ceremony on the final afternoon was important as the Minister of Health and the Directors of the contributing hospitals joined us. We then visited them at their hospitals where we saw the clinics already in action, staffed by Doctors from the earlier training. Rahel from the RC Shegar joined us and she and other Rotarians have continued to visit patients. PCW were due to deliver another two weeks in June but illness meant they could not so Dr. Ayres and her team delivered the courses themselves. This was not ideal but proved the Ethiopian team could sustain the training. The Ministry of Health provided the people and the accommodation, Rotary supported the travel and the food, a model which has continued.

Future

Training is planned for clinics specialising in child health and more geographic reach. A Conference in Addis is planned for October this year and project will finish in June 2019. The University of Addis will take on the training and palliative care will be part of the registration for every hospital in Ethiopia.

Chris Davies