Background and Context:
Hospice movement/Modern-day palliative care is credited to Dame Cicely Saunders. A few models of palliative care approaches exist in Africa today. Palliative care was formally introduced to Nigeria in 2003. The Palliative care needs of Nigeria are enormous, compounded by rising cancer incidence, irregular analgesic supplies, opiophobia and lack of trained personnel.
Aim:
To establish a Pain and Palliative Care Unit, in the University of Nigeria Teaching Hospital (UNTH) Enugu, South-East Nigeria, home to approximately 17 million people.
Strategy/Tactics:
Collaborations with institutions abroad to ensure physicians, pharmacists, nurses and social workers receive regular training in Palliative care medicine.
Installation of linear accelerator in the new Radiotherapy department, the only one of its kind in South-East Nigeria.
Training of selected staff on Cancer Registry by Institute of Human Virology in Nigeria (IHVN), thus enabling revival of the moribund hospital cancer registry.
Affiliation of Pain & Palliative Care Unit UNTH with Hospice and Palliative Care Association of Nigeria and networking with other Palliative Care providers.
Programme/Policy Process:
Creation of awareness among physicians for early referral of patients, through presentations at monthly Multidisciplinary Oncology meetings.
Change misconception of physicians to opioid-prescribing through lectures at departmental meetings
Nurse-led referral: Encouragement of ward nurses to send consults directly to Palliative care team, on identification of in-patients needing palliative care and pain treatment.
Rotation of residents in Anesthesiology, Internal Medicine and Psychiatry through the unit to circumvent absence of postgraduate palliative care curriculum.
Institution of lectures in Palliative Care for medical students.
Home visits and family meetings with family caregivers, patients.Outcomes/What was learned:
Poor knowledge of Palliative Care amongst physicians contributes to low referrals.
Most patients have untreated pain from reluctance of physicians to prescribe opioids (opiophobia).
Nurse-led referrals have positively contributed to volume of patient referral to palliative care.