Global Health Nursing & Midwifery

Hi. Thanks for the info on the conference. I wanted to let you know that late last year Zambia hosted a pediatric palliative care conference. A pediatrician with whom I work commented on how health care has progressed since she helped set up ART programs here about 10 years ago. There is still unmet need with regard to pain relief and palliative care, but I wanted to highlight that strides are being made.

These recent pubs on relieving pain in America (not always a resource-rich environment) might be interesting:

Alleviating Suffering 101 — Pain Relief in the United States
Philip A. Pizzo, M.D., and Noreen M. Clark, Ph.D.
N Engl J Med 2012; 366:197-199January 19, 2012
http://www.nejm.org/doi/full/10.1056/NEJMp1109084 (subscription)

IOM report June 2011
Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research
http://iom.edu/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-...

Blog post by Judy Foreman, longtime health reporter in the Boston area: http://commonhealth.wbur.org/2012/02/judy-foreman-pain/

Thanks all--Below I posted some notes that Marie Connelly posted in the NCD community. I was able to stay for the film and most of the panel discussion. Film was interesting and definitely worth watching. Role of nursing was limited but Dr. Faith Mwangi-Powell did discuss a very interesting program in Uganda and hopefully expanding in other countries in Africa that does give nursing additional training and certification to provide morphine in rural areas.. A great example of how nurses as front line providers can provide excellent community based care. Does anyone know more about that program or have experience with it?

From Marie Connelly post--
For those who are able to stream video, the film screened at last night's event, Life Before Death, can be accessed online at: http://www.lifebeforedeath.com/movie/

The film highlights palliative care experts, advocates and patients who share their experiences with pain, end-of-life care, and the stigma and challenges that create barriers to effective palliative care and pain relief for 80% of the world’s population.

Some of the challenges raised by the film, Dr. Faith Mwangi-Powell’s remarks, and the panel discussion include: lack of education amongst health care providers, fear ...

Thanks all--Below I posted some notes that Marie Connelly posted in the NCD community. I was able to stay for the film and most of the panel discussion. Film was interesting and definitely worth watching. Role of nursing was limited but Dr. Faith Mwangi-Powell did discuss a very interesting program in Uganda and hopefully expanding in other countries in Africa that does give nursing additional training and certification to provide morphine in rural areas.. A great example of how nurses as front line providers can provide excellent community based care. Does anyone know more about that program or have experience with it?

From Marie Connelly post--
For those who are able to stream video, the film screened at last night's event, Life Before Death, can be accessed online at: http://www.lifebeforedeath.com/movie/

The film highlights palliative care experts, advocates and patients who share their experiences with pain, end-of-life care, and the stigma and challenges that create barriers to effective palliative care and pain relief for 80% of the world’s population.

Some of the challenges raised by the film, Dr. Faith Mwangi-Powell’s remarks, and the panel discussion include: lack of education amongst health care providers, fear of prescribing medications for pain relief, and frequent stockouts of morphine due to unreliable supply chains and limited production.

Access to physicians is another limiting factor for many patients in need of palliative care. Uganda has developed a diploma in palliative care that provides training for nurses in this field. Upon completion of the program, these nurses are also certified to prescribe morphine. The African Palliative Care Association is hoping to help implement similar programs to improve access to care in other countries.

Dr. Mwangi-Powell also discussed the need for research into both the quality and cost effectiveness of palliative care. Having these numbers, she argued, will make it easier to persuade leaders to integrate palliative care into existing health services.

During the panel discussion Dr. Lachlan Forrow stressed the importance of individual advocacy on this issue, and Dr. Gene Bukhman expressed hope that a growing awareness of the global burden of non-communicable diseases will also highlight the immense need for pain relief and palliative care.

This message (and attachments) is subject to restrictions and a disclaimer. Please refer to http://www.unisa.ac.za/disclaimer for full details.

The contemporary concern in pain management should also focus on the complexity of self-medication which is compounded by availability of counterfeit medicines. These have penetrated urban, rural, indigent sectors of community life & have assumed alternative forms of health service/delivery in resource constrained settings. The competition is "fierce" because the suppliers counterfeit medicine profit and of course market & promote their supplies to vulnerable communities.
ON Makhubela-Nkondo

An important problem is that many health care workers equate pain relief with pain killing medication.

I want to duff my hat to this initiative to exchange on this very important issue surrounding HIV/AIDS palliative care which is quite a weak spot along the HIV/AIDS prevention, care, treatment and support continuum. I have participated in the training of palliative care providers in Cote d'Ivoire while working with the UN peace mission and the best practice was expected to be at home, that would use the community-based, house to house approach given that HIV/AIDS care is heavily dampened by the epidemic of stigma and discrimination. In Cameroon the Baptist Health Board Health system has scaled up a lot of palliative care within the framework of HIV/AIDS. Some state regional hospitals have established palliative care committees within the hospital premises to handle unbearable(sometimes terminal) pain using pain medication. These are institutional-based facilities most often not accessible to those who really need such care. Sometimes the nurses are both emotionally, technically and competently deficient and even if they were, the human resource and motion do not accompany their efforts, hence performance and outcomes could be embarrassing.
The best approach, though costly in terms of money and time, may sound most appropriate but it ...

I want to duff my hat to this initiative to exchange on this very important issue surrounding HIV/AIDS palliative care which is quite a weak spot along the HIV/AIDS prevention, care, treatment and support continuum. I have participated in the training of palliative care providers in Cote d'Ivoire while working with the UN peace mission and the best practice was expected to be at home, that would use the community-based, house to house approach given that HIV/AIDS care is heavily dampened by the epidemic of stigma and discrimination. In Cameroon the Baptist Health Board Health system has scaled up a lot of palliative care within the framework of HIV/AIDS. Some state regional hospitals have established palliative care committees within the hospital premises to handle unbearable(sometimes terminal) pain using pain medication. These are institutional-based facilities most often not accessible to those who really need such care. Sometimes the nurses are both emotionally, technically and competently deficient and even if they were, the human resource and motion do not accompany their efforts, hence performance and outcomes could be embarrassing.
The best approach, though costly in terms of money and time, may sound most appropriate but it may be that both the political and technical commitment would be in short supply.
Whatever the case, it remains a real challenge that we are faced with someone critically in need of pain relief and this is poorly given or that someone out there in the community in excruciating and chronic pain and is surrounded only by their relatives with lack of modern pain medication and techniques who are forced to use only their traditional psychological and social support and alternative medicine to 'nurse' their departing one. What can we do then? would there be a need to review the curriculum in favour of safe and effective pain relief to the dying person? What could be the link between facility-based and community-based pain relief practices?