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Only 14% of people worldwide who need palliative care receive It. Christian Ntlzlmlra talks to Tatum Anderson about the challenges of applying Western models of palliative care in an African setting.
Q: How did you become interested in palliative care?
A: After graduating, my dream was to be a surgeon, because I saw so many people who had suffered after the genocide against the Tutsi in 1994.That dream changed after I worked in internal medicine at Kibagabaga Hospital and met a 24-year-old patient who was dying of liver cancer. He was in a separate room because he was screaming with pain. The patient's mother knelt before me and begged me to do something. In Africa, it is not customary for an older person to kneel before a young person. I felt helpless and frustrated. I had never prescribed morphine before and anyway it wasn't readily available for cancer patients in the hospital. The protocol for prescribing morphine was highly restrictive: a prescription had to be written out in red ink and signed by three or four people. That night the young man died in a horrible state and his family was inconsolable. This made a deep impression on me. "Why become a physician if my role is just to watch patients suffer?" I asked myself.
Q: What training was available in palliative care at the time?
A: A year later, in 2009, I participated in 10 days training in palliative care, organized by two international nongovernmental organisations, IntraHealth and Mildmay, in collaboration with the Rwandan health ministry. The focus was on palliative care for patients with the end-of-life diseases associated with HIV. After that training I knew palliative care was my calling.
Q: How did you introduce palliative care into your hospital?
A: When I became the director of Kibagabaga Hospital, I made several changes to improve the quality of life of patients with life-threatening illnesses. One was to make palliative care, particularly treatment with morphine, accessible for end-of-life patients with severe pain. The idea was to integrate palliative care into other programmes and not to create a separate palliative care department. We started training nurses, physicians, physiotherapists and psychologists to work as a team to provide patients with palliative care. The physicians learned to...