Presentation to the Parliamentary Portfolio Committee by Hospice and Palliative care Association of South Africa, Wits Palliative Care and the Palliative Care Society of South Africa

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Presentation to the Parliamentary Portfolio
Committee by Hospice and Palliative care
Association of South Africa,Wits Palliative Care
and the Palliative Care Society of South Africa

• 12th September 2006

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Who we are

• PCSSA
• Palliative care Society of
• South Africa

University of the Witwatersrand
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Translating policy into action

• Palliative care is part of South African Health
  policy

• The Patients' Rights Charter
• Access to healthcare
• palliative care that is affordable and effective
  in cases of incurable or terminal illness

GOVERNMENTS COMPREHENSIVE HIV AND AIDS CARE,
TREATMENT AND MANAGEMENT PLAN Strategic Plan
2006/7-2008/9 Health Department
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Why are we here

• Government has recognized that pain and symptom
  relief is a human/patients right
• Traditionally palliative care has been provided
  by NGOs and FBO
• Access to pain and symptom relief remains a
  problem to many South Africans
• Need to work to strengthen palliative care in the
  public sector and partnerships
• An oversight hearing will raise profile, identify
  gaps, explore challenges of implementing
  government policy and support development of new
  services

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Many illnesses are accompanied by huge pain and
suffering

• Gauteng suffered 95 186 deaths in 2002 (Stats
  SA)
• 38 from AIDS and cancers
• Significant number from other chronic illnesses
• Almost all would have attempted access to a
  hospital several times
• Inpatient mortality about 20
• Nurses and doctors are traumatized since they do
  not know what to do
• But much of pain and suffering with AIDS and
  cancers could be alleviated using simple approach

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WHO expert cmmtee on cancer pain and active
supportive care 1996

• In most parts of the world, the majority of
  cancer patients present with advanced disease.
  For them the only realistic treatment option is
  pain relief and palliative care
• Freedom from pain should be seen as a right on
  every cancer patient and access to pain therapy a
  measure of respect for this right

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Sr Zodwa Sithole

• A primary health care nurse and a palliative care
  nurse-clinician from Kwa-Zulu Natal

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palliative drugs

• All on the essential medicines list
• In SA 8 drugs (all on the EDL) can do this
• (cancers and AIDS)
• In the UK 4 drugs shown to ameliorate most pains
  and symptoms
• Nurse-clinician prescribing

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What is Palliative Care?

• When the doctors say there is nothing more that
  can be done
• caring for those we cannot cure
• Adds life to days, not days to life
• Provides pain relief and symptom alleviation from
  diagnosis until death
• Provides bereavement support

PHYSICAL
EMOTIONAL
SOCIAL
SPIRITUAL
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What palliative care is not

• Synonymous with home-based care
• Care without drugs or health care workers
• Terminal care provided only by hospices
• A luxury for the rich, that is unaffordable
• A vertical programme
• A nice to have
• Step-down care

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Why we cannot afford not to have palliative care

• Children and the elderly are left unsupported to
  care for dying family in pain
• Health care workers and home based carers are
  traumatised by watching on helplessly
• Lack of palliative care increases the
  feminisation of poverty

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Why We Can Afford To Provide Palliative Care In
The Public Sector

• Direct costs
• Less than a hospital
• R1600 vs R300
• BUT rational visits with strict referral criteria
• Nurse-clinicians utilized effectively diagnosis,
  treatment, and referral

• Savings
• Save multiple unnecessary admissions into
  tertiary centres
• Will make HBC programmes more effective
• Integration will reduce duplication in management

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Palliative care effectively mitigates suffering

• Studies have shown a gap in access to effective
  pain and symptom relief
• Barriers include lack of knowledge and
  misconceptions, cumbersome regulations of some
  drugs, not mainstream medicine

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Challenges in providing palliative care in South
Africa

• The Public and the providers knowledge about
  palliative care
• Myths about morphine and pain relief in cancer
  and other life-threatening illnesses
• Misconception that palliative care is about
  euthanasia

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Enhances Home Based Care Programmes

• Policy states palliative care should be available
• This model does not replace HBC but supports them
• HBC needs palliative services to do their work
  more effectively.
• Our Palliative services are enhanced by working
  with HBC groups in the Soweto Care Givers
  Network, and region 6 10 meetings

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Palliative care supports patients and their
families

• Relief from pain and alleviation of suffering is
  a basic human right
• Palliative care is affordable, do-able
• Allows people to live until they die and to die
  in dignity

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WHO Model
Education Of the public Of
health care professionals (doctors,
nurses, pharmacists)
Of others (health care
policy-makers, administrators, drug regulators
Drug availability Changes in health care
regulations/ legislation to improve drug
availability (especially of opioids)
Improvements in prescribing,
distributing, dispensing and
administration of drugs
Government Policy
National or state policy emphasising the need to
alleviate chronic cancer pain
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An interview with a family member who received
palliative care
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Palliative care services at the Chris Hani
Baragwanath HospitalSoweto

• Dr Natalya Dinat

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Equity by public sector provision
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Mr Martin passed on 5 days after this visit

• Our patient for 5 months. We helped with
  breathlessness choking feeling pains which
  needed morphine fits incontinence family
  issues and feeding ensuring that the family were
  able to cope at home, so preventing more
  admissions to CHB, and probable death at CHB

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Collaboration with the DoSD

• Palliative team work with DoSD to distribute food
  parcels to patients who require it
• Do the means test
• Provide distribution points
• Keep records

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Palliative care and children

• Joan Marston from St Nicholas Childrens Hospice,
  Bloemfontein

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A vision for palliative care

• Quality palliative care will be accessible to
  everybody
• Less suffering using local innovations, EDL,
  community partnerships

• All HCW will confidently use a palliative
  approach
• Multidisciplinary palliative team in each DHS
• Patients rights realised
• Patients and their families suffering mitigated

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Contact us

• Loveday Penn Kekana
• Email loveday.penn-kekana_at_nhls.ac.za
• Dr Natalya Dinat
• Tel [phone]
• Fax [phone]
• Email dinatn_at_chse.wits.ac.za
• Zodwa Sithole
• Email advocacy_at_palliativecare.co.za