Authors: Anindita Rochili and Germanus Natuhwera
“No man is an island, no one can work alone.” Germanus
HAU and Kyangwali Refugee Settlement
Hospice Africa Uganda (HAU), founded in 1993 by Professor Anne Merriman, delivers culturally appropriate, person-centred palliative care through pain relief, training and education, and partnerships. Headquartered in Kampala, with mobile hospices in Mbarara and Hoima, HAU integrates palliative care into existing health services and supports holistic care addressing physical, psychosocial, and spiritual needs. A landmark innovation is the local manufacture of oral morphine solution for treatment of severe cancer pain through a public–private partnership with Uganda’s Ministry of Health.
Uganda hosts Africa’s largest refugee population, primarily from South Sudan, the DRC, Rwanda, and Burundi. Refugees face a high burden of cancer, HIV, trauma, and mental health conditions, compounded by poverty, displacement, language barriers, restricted mobility, and limited access to health services. These factors intensify unmet palliative care needs and prolong serious health-related suffering.
Research and Education in Kyangwali
HAU emphasizes integrating palliative care into routine services while documenting and sharing best practices. Low-cost, pragmatic research, such as needs assessments and patient interviews, is central to identifying gaps, demonstrating impact, and guiding service improvement. Community empowerment is a core strategy. Training healthcare workers and community volunteers strengthens identification, referral and follow-up of patients, while performing advocacy for palliative care within the settlement and neighboring communities. He cited findings from a recent study led by an undergraduate medical student from University College Dublin, Ireland as part of her Student Summer Research Awards (SSRA) at HAU in 2025. The research project confirmed the growing palliative care needs among refugees in Kyangwali and showed that palliative interventions significantly reduce serious health-related suffering when essential medicines are available.
Palliative care was introduced in Kyangwali in 2008 through Little Hospice Hoima (LHH), providing home-based care and monthly outreach clinics. In collaboration with UNHCR, LHH trained 16 healthcare workers from 10 facilities across the settlement in 2022. These trained focal persons improved identification and referral, leading to a marked increase in patient numbers and the expansion of outreach services. This strengthened capacity led to a sharp rise in referrals and patient numbers, prompting service expansion: the former roadside clinic, about 40 km from the settlement that was being conducted alongside the outreach clinic became a busy, independent outreach clinic seeing about 20 patients per month, while the main clinic in the settlement continues to see 30–35 patients per month.
To overcome knowledge, access and referral barriers, LHH also trained community volunteers (CVWs/CHEWs) who live within the settlement and maintain close contact with residents. Supported with basic equipment, supervision, and regular refresher meetings, these volunteers are essential links between patients and services, ensuring continuity of care and early identification of need.
“By empowering people (community volunteer/health workers) who are in close touch with the community, we are actually not only empowering communities to be able to identify and support us in identifying, referring, and following up patients, but also creating and strengthening awareness and advocacy for palliative care.” Germanus
These trained volunteers are supported with practical resources provided by HAU, including umbrellas, gumboots, raincoats, bags, reporting tools, information leaflets and bicycles. All this to facilitate their movement and work in the community. The hospice team also conducts regular (quarterly and on-need) one-on-one support supervision and twice-yearly update meetings with the volunteers to refresh their knowledge and to review their progress, challenges, and needs, ensuring they remain well-equipped and supported to be more effective in their work.
Pain Control
Delays in referral and reluctance to involve specialists allow pain and other symptoms to worsen, particularly among patients living with HIV and receiving ART, resulting in preventable health-related suffering. Collaborative practice may be able to answer and solve challenges in this case.
Inadequate pain assessment remains a key barrier. Limited clinical knowledge, poor prescribing practices, and rushed evaluations often lead to missed diagnoses and inappropriate treatment. These gaps result in failure to effectively use essential adjuvants, inappropriate escalation of analgesics, and unnecessary polypharmacy, all of which reduce treatment effectiveness. Opiophobia further undermines optimal care, as unfounded fears of addiction or respiratory depression lead clinicians to withhold opioids even when they are clinically indicated.
Effective pain management therefore requires a holistic approach that recognises the complexity of suffering. Careful assessment of the whole person, early multidisciplinary collaboration, and attention to psychosocial and spiritual needs alongside medical treatment are essential. Treating pain well means looking beyond symptoms to understand and address the full context of a patient’s suffering.
Working Together
In Kyangwali, collaboration between health workers, volunteers, and community leaders has led to more patients identified, better symptom control, and care delivered with dignity and compassion. Collaboration is the most practical and cost-effective solution. No single provider can meet all patient needs; teamwork improves community trust, referrals, access to medicines, and shared learning. This, as echoed in the African adage; “If you want to go fast, go alone. If you want to go far, go together”
