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Background. Every year an estimated five million people in developing countries die from cancer, but little is known about their end of life care. In developing countries, health services are struggling with population increases, under funding, wars, the HIV pandemic, and natural disasters. Heal
MASCC Palliative Medicine Study Group. Challenges Facing T...

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1. MASCC Palliative Medicine Study Group. Challenges Facing The Dying In Africa. Dr. John Weru Senior Medical Doctor Nairobi Hospice Email: drweru@yahoo.com; clinical@nairobihospice.or.ke Website: www.nairobihospice.or.ke

2. Background Every year an estimated five million people in developing countries die from cancer, but little is known about their end of life care. In developing countries, health services are struggling with population increases, under funding, wars, the HIV pandemic, and natural disasters. Health care for the dying has a low priority compared with preventive and curative services. Global opioid consumption measure of success in the acceptance of pain relief for cancer confirms that palliative care is currently available only for the rich nations, with little or no morphine consumed in half of the world's countries

3. A dying person needs Preservation of their human rights until the last minute Respect of his/her decisions Dynamic participation in the last minute decisions if possible. Maximum Physical Comfort maximum Pain Control Fulfillment of the spiritual needs Fulfillment of his/her social needs Fulfillment of his/her personal realization needs Satisfaction of the emotional needs Peaceful environment

4. Palliative care across the continuum of care

5. The Cape Town Declaration (2002) Palliative care is a right of every adult and child (accessibility, affordability) Control of pain and symptoms is a human right (drug availability) All members of health care teams and providers need training in palliative care Palliative care should be provided at primary, secondary and tertiary levels

6. Poverty, development and governance Africa poverty represents an affront on social justice and insults the ethics of global socio-economic relations. Justice insulted- over $900 billion- manufacturing arms and trading weapons of death and destruction, while only $50 billion annually needed to help Africa make a dent on poverty African leaders have embezzled Africa?s riches and policies are not geared towards care for the dying.

7. Health care infrastructure In the developing world, access to basic health services and the existence of a functioning health system lacks. The lack of health care infrastructure and capacity in sub-Saharan Africa is a more fundamental barrier, that inhibit the ability to deploy funding. The symptoms of insufficient health care capacity in Africa are known. It is now time to begin addressing the causes.

8. Access to essential medicines Access to sufficient and affordable quantities of anti-retroviral drugs and opiods remains an issue, partly due to extended patent protection under the Agreement on Trade-Related Intellectual Property (TRIPS). WTO ministerial meeting in Doha in November 2001 adopted a declaration on intellectual property affirming that nothing in the TRIPS Agreement prevents WTO members from taking measures to protect public health, clearly asserting the right to issue compulsory licensing and to use other means to decrease drug prices, such as parallel importing.

9. Culture and ethno medicines Medical systems are intimately intertwined with a culture?s economic, social, political, and philosophical systems Culture affects health behavior in many ways: understanding, naming and explaining illnesses ;informing symptom recognition and care seeking; mediates response to ailments In most of Africa, illnesses, death and dying are communal affairs

10. Main concerns Murray, et al 2005

11. What about the children?. ?

12. References CULTURE, ETHNOMEDICINES AND BIOMEDICINE. 2007. Medical anthropology: http: //www.medanthro.net MERRIMAN, A., and KAUR, M., 2004.Palliative care in Africa: an appraisal; The Political Economy Of AIDS. MURRAY, S., et al., 2005. Dying of cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers OGBUNWEZEH, F., 2006.Poverty, Development and the Burden of Governance in Sub-Saharan Africa TIMMERMANS, S., 2005.Deathbrokering: constructing culturally appropriate deaths. Journal of sociology of Health & Illness. WALTERS, G., 2004.Is there such a thing as a good death? Journal of Palliative Medicine. 18: 404-408. WALTER, T., 2006. Historical and cultural variants on the good death. British Medical Journal

13. Thank you


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