Image: Dadaab Refugee Camp Kenya, Willie Ngetich
Author: Anindita Rochili
From Vital Signs to Vital Support, Khamis shares on The Role of Palliative Care in Humanitarian Settings
Ali Khamis has been working as a health worker and volunteer for palliative care in Kenya, including for MSF and other organisations or sectors in humanitarian settings (e.g., Red Cross, IRC). When asked about his day-to-day job, Khamis mentioned that he works to improve the quality of life (QoL) through care in the refugee camp, particularly one in Dadaab. ‘I attend to clients, take their vital signs – blood pressure, temperature, weight and height.’ Other than palliative care (PC), he mentioned that he has worked both in preventive and curative care. This includes, but not limited to, growth monitoring in children and various (medical) check-ups.
Any suspected illness will be tested in a laboratory, then based on the results and doctor’s report, they could start the treatment and follow-up on the given advice. Oftentimes, the type of service provided would be inpatient and outpatient care, though they may also do home visits. The protocols or orders would also differ if the patients are very ill, for example, in maternity care. In some cases, healthcare workers may also say whatever they can to help patients feel better. When asked about common conditions that require PC services, he answered that the workers may do weekly checks for cancer (e.g., prostate-specific antigen test for male patients), liver cirrhosis, and other illnesses related to oesophagus. Some cancer patients need to be attended to at home for admission into treatments. NGOs, including UNHCR, also assist with the processes and medications required (e.g., Morphine).
In primary healthcare settings, providing education and training for community health workers would be beneficial. Additionally, implementing health promotion and sanitation programs for patients could further enhance outcomes. Keeping the conversations going through planned talks and group meetings on health and well-being might help the patients to know what to do and understand what symptoms to be aware of (‘what would be the ‘right’ thing to do?’). It is also important to address specific concerns, such as smoking and substance or drug misuse, and to highlight how these lifestyle choices can be harmful. Support from interdisciplinary teams, including spiritual and local community leaders or members from various organisations, can improve outcomes and enhance diagnosis. As Ali stated, “We give them advice on managing high cholesterol levels and encourage them to talk to their doctor.”
Perhaps we need to keep in mind that the nonprofits and volunteers are doing a lot of unpaid work. It is not rare that they meet families with limited access to basic needs. ‘Some patients don’t have anything (e.g., soap and milk).’ Even in such cases, it is still their duty to assist the communities. In addition, according to Khamis, the most prominent challenge is the patient referral system. In refugee camps, the environment is more unpredictable and difficult to navigate, and there are additional issues related to accessing morphine and basic needs. He also mentioned that volunteers require support and recognition to work effectively in palliative care and emphasised the importance of mutual support to provide care at the community level.
He closed the interview by thanking Allah, with the message: ‘Palliative care is for all, we promote our people to be better individuals. And for the champions, let us be together and work hand in hand, and be brave in asking for support.’
About World Hospice & Palliative Care Day:
Today, Saturday 12 October, we advocate for better hospice and palliative care services around the world. With one accord, we will raise our voices and do what we can in our different contexts to send the message:
‘There is no Universal Health Coverage (UHC) without palliative care integration into healthcare systems across the globe.’
It’s important to recognise that more than 60 million people currently require palliative care every year, foreseeing the increased need for palliative care with ageing populations and the rise of non-communicable and other chronic diseases worldwide, considering the importance of palliative care for children, and in respect of this, acknowledging that Member States should have estimates of the quantities of the internationally controlled medicines needed, including medicines in paediatric formulations.
Furthermore, integrating palliative care into healthcare systems is integral to the achievement of Universal Health Coverage (UHC) including financial risk protection. Further access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines for all is essential.
WHPCD Sub-themes:
- Access to palliative care is everyone’s business
- Train all health professionals in palliative care
- Pain relief for all in palliative care
Key messages:
- Develop, strengthen, and implement palliative care policies to support the comprehensive strengthening of health systems
- Provide basic support, including through multi-sectoral partnerships
- Review and where appropriate, revise national and local legislation and policies for controlled medicines, with reference to WHO policy guidance
We need to include palliation across the continuum of care, especially at the primary care level for equitable access to such care.
The delivery of quality palliative care is most likely to be realised where strong networks exist between professional palliative care providers, support care providers, volunteers, and affected families, as well as between the community and providers of care for acute illness and the elderly.
We acknowledge that specialist palliative care training should be available to prepare healthcare professionals who will manage integrated care for patients with more than routine symptom management needs, and it is crucial to implement and monitor palliative care actions included in WHO’s global action plan for the prevention and control of noncommunicable diseases, including in humanitarian settings.
