Concept of Palliative Care and

Survivorship
David Musyoki- KEHPCA
Musyoki@kehpca.org
Facebook: kenya hospices and palliative care association
Twitter: @KEHPCA
www.kehpca.org
 PALLIATIVE CARE
Its origin in the Latin word
pallium, meaning a
cloak. It means to
mitigate the sufferings of
the patient, not to effect
cure.
HOSPICE
• Is a philosophy of care,
to meet the gap for
those seriously ill or
dying.
• Not a building. • Dame Cicely Saunders
 Life threatening conditions
• HIV/AIDS
• Congestive heart failure
• Cerebrovascular disease
• Neurodegenerative disorders
• Chronic respiratory diseases
• Drug-resistant tuberculosis
• Diseases of older people.
• Renal and other organ failure
• Paediatric conditions: congenital
malformations, birth asphyxia.
 Burden
• Globally 43 million people in need of palliative
care services.
– Less than 14% have access to PC services.
• 10 million Africans require PC
– less than 10% have access
• Estimated; 900,000 Kenyans require palliative
care.
- Less 3% have access.
http://www.who.int/mediacentre/factsheets/fs402/en/
http://www.eapcnet.eu/LinkClick.aspx?fileticket=vue6i9Gb56E%3D&tabid=17
20
STATISTICS-KENYA
 Definition (WHO 2002)
• It is an approach that improves the
quality of life of patients and their
families facing the problem associated
with life threatening illness, through the
prevention and relief of suffering by
means of early identification and
impeccable assessment and treatment
of other problems, physical, psychosocial
and spiritual
Palliative care for children is the active total care
of the child’s body, mind and spirit, and also
involves giving support to the family.
 Journey Through Hard To Cure Illness
Impact on family

DEATH
Treatment
options
Diagnostic GAP
Bereavement
process

Breaking bad news

Hospital Symptom control

Evolving model of Palliative Care
D
“Active Palliative E
A
Treatment” Care T
H

D
Cure/Life-prolonging E
Intent A
Palliative/ T
Comfort Intent H
 Vision
Quality Palliative care for all in Kenya
 Areas of Focus
1. PC Advocacy and
Awareness
2. Scale up of Palliative
care Service delivery,
Standards and Ethics
3. Education, training and
research in PC
4. Advocacy on palliative
care legal rights
 PC services
• Currently, there are 75 palliative care providers in
Kenya (14 in 2007).
• They include Hospices, palliative care units- in
government hospitals, private hospitals, faith based
institutions and community based centers.
 Main achievements from PC advocacy
• Two referral hospitals (level 6) integrated PC
• 11 Provincial hospitals (level 5 hospital integrated PC)
• 30 level four hospitals integrated PC
• National palliative Care policy 2021
• PC included in The Kenya National patients’ Rights Charter- 2013
• National Palliative Care Guidelines 2013
• National Palliative Care training curriculum 2013
• Legal Aspects in PC Handbook 2013
• National Cancer Control Strategy (2010-2016)
• PC mentioned in the national framework for NCDs
 KEHPCA’s Advocacy
achievements…
• Education & Training
• Scaling up services
• Support to partners including the MoH
• Key participants in policy /strategy formulations-Lead role for
PC-national, regional /Global level
• Research in PC
Education
Before After
 Never give up hope...

Quality Palliative Care for All

 Before and After

Machakos PCU
Kisii Level 5 Hospital PCU

Quality Palliative Care for All

Coast Hospice / PGH
Ownership...
Various advocacy means...
Kimbilio Hospice
 Essential components of palliative
care
• Pain and Symptom control
• Effective communication
• Rehabilitation
• Continuity of care
• Breaking bad news
• Psychosocial care
• Spiritual care
• Social care
• Terminal care/ End of life care
• Support in bereavement
• Education
• Research
 What does PC constitute ?
CARE OF THE WHOLE PERSON
“I believe we have more Caring than we know
what to do with it”.
- Bill Gates
Physical support
Psycho-emotional care
Social support
Spiritual support
End of life care
Bereavement support
 Physical Psychological
Functional Ability Anxiety
Strength/Fatigue Depression
Sleep & Rest Enjoyment/Leisure
Nausea Pain Distress
Appetite Happiness
Constipation Fear
Pain Cognition/Attention

Quality of Life

Social Spiritual
Financial Burden Hope
Caregiver Burden Suffering
Roles and Relationships Meaning of Pain
Affection/Sexual Function Religiosity
Appearance Transcendence

Adapted from Ferrell et al., 1991

Who is involved?
Our Goal
 WHO Foundation Measures

Education Drug Availability

Government Policy
 Survivorship
• An individual is considered a survivor from the
time of diagnosis of a serious health related
condition, during and immediately after
treatment, and through the balance of his or
her life.
• The disease also affects family members,
friends, and caregivers.

Quality Palliative Care for All

 Survivorship revolves around the
following domains;
• Social aspects
• Financial aspects
• Sexuality
• Psychological aspects
• Intellectual aspects
• Spirituality
• Physical aspects of care
 How to support survivors…
• A multi professional approach in care is
paramount
• A holistic approach that includes clinical care,
financial empowerment, reintegration into
society and rehabilitation among others.
• Strengthen the existing health care system to
ensure well-coordinated survivorship care
“You matter because you are you. You matter to the
last moment of your life, and we will do all we
can, not only to help you die peacefully, but to live
until you die”
Dame Cicely Saunders