Journal of pain and symptom management
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In India, a million people with cancer and an unknown number of people with other incurable and disabling diseases, need opioids for pain relief. Only about 0.4% of the population in need have access to them. Major barriers to access to opioids are complicated regulations and problems related to attitude and knowledge regarding pain relief and opioids among professionals and the public. ⋯ Establishment of simple standard operating procedures to implement the simplified regulations, advocacy, and improved education of professionals are essential for further improvement of the situation. The past decade has demonstrated that government policy can be changed if palliative care enthusiasts work in tandem with the government. The progress has been slow, but real and encouraging.
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J Pain Symptom Manage · May 2007
Promoting the integration of quality palliative care: the South African Mentorship Program.
This article provides a brief outline of the HIV/AIDS situation in South Africa and the development of the Hospice Palliative Care Association (HPCA) as the background to an exploration of the changing face of palliative care in light of the demands of HIV/AIDS. It describes the South African Palliative Care Mentorship Program, including a description of the Integrated Community-Based Home Care (ICHC) model and its promotion of collaboration with the formal health care sector and other networking partners. The role mentorship played in its application to HPCA member hospices in response to the increasing demands of HIV/AIDS is outlined. ⋯ The key results of the promotion of the ICHC model and the effects of the mentorship program are highlighted, including possibilities for the expansion of the model beyond its original context in South Africa. The difficult issue of sustainability within an African context is also mentioned. In conclusion, there is a challenge to readers to explore the use of mentorship within their own palliative care settings.
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J Pain Symptom Manage · May 2007
Case ReportsUganda: delivering analgesia in rural Africa: opioid availability and nurse prescribing.
Hospice Africa Uganda introduced palliative medicine to Uganda in 1993 with enough funds to support a team of three clinicians for three months. Training in the medical and nursing schools was introduced in 1994. Since then, Uganda has achieved the three essential components of an effective public health strategy. ⋯ This is being done in collaboration with the Ministry of Health (MOH) and other organizations that collaborate in two umbrella organizations: the Palliative Care Association of Uganda and the Uganda Palliative Care Country Team. The former works "on the ground" in each district, establishing standards, collaborating, and carrying out continuing medical education in palliative care for all. The latter, chaired by the MOH, operates with the government to implement an integrated, coordinated, affordable, and culturally acceptable palliative care service throughout the country.
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Good policies lay the groundwork for an effective health care system and society. They facilitate the implementation of palliative care programs aimed at providing care for all people in need of these services, and they ensure equitable access to affordable medications and therapies. The lack of good policies can lead to unnecessary suffering and costs for patients, families, and society. ⋯ Ideally, palliative care is incorporated as a priority within all aspects of each country's national health plan, so that all patients living with or dying from any chronic disease may have their suffering relieved, including children and the elderly. To this end, policies that address essential medicines must include a list of palliative care medications. Supplies of affordable, generic medications that are "equally efficient" must be adequate and available throughout the country wherever patients live (especially opioids for pain control).
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J Pain Symptom Manage · May 2007
ReviewPalliative medicine teaching program at the University of Cape Town: integrating palliative care principles into practice.
The article describes the development of the postgraduate palliative medicine programs at the University of Cape Town (UCT) through collaboration with the Palliative Medicine Division from the University of Wales College of Medicine in Cardiff, United Kingdom. The course is presented as a distance-learning program supported by web-based learning with three face-to-face teaching sessions during the course. ⋯ Using the experience from UCT in distance-learning programs, the Hospice Palliative Care Association developed an interdisciplinary course, "Introduction to Palliative Care." This course recognizes that, although improvement in patient care and palliative care will come as undergraduate training in palliative care is established, it is essential that previously qualified health care professionals are able to enhance their palliative care knowledge, skills, and attitudes. Trainers provide support to participants over a six-month period and assist in the transference of knowledge and skills into the workplace.