Where opioids are generally unavailable, the definition of palliative care can be problematic. We have taken the view that where a service is in the process of development from (largely) physical care to a broader form of holistic care that approximates to the WHO definition, it should be included in the review.

In resource poor areas, the blending of supportive care with hospice/ palliative care is frequently linked to the development of previously established services, particularly home based care (HBC). Family Health International (FHI) defines home and community based care (HCBC) as “the provision of care and support that endeavours to meet the nursing and psychosocial needs of persons with chronic illnesses and their family members in their home environment”.²

Interest in palliative care has come to light the Democratic Republic of the Congo, where a group based in Kinshasa are introducing a broader form of hospital care and pioneering a home care service.

Nurse Anselme Kananga, currently studying in Belgium, represented an NGO named the International Youth Association for Development at the European Association of Palliative Care conference in Aachen, (2005). He states:

There has been palliative care in a small hospital in Kinshasa for four years. Our organisation has 100 patients with cancers in palliative care. Some patients are cared for in the hospital but the condition is not good. Our organisation provides student nurses and doctors to help volunteers in Kinshasa; about 80 patients are being cared for at home.

We would like a clinic. If we have a clinic it would be easier for the patient. We would like to have autos for transport for the nurse volunteers, we want to have computers; and also education. We would like to give medicine for the patient at home, but we would like to have more experience with palliative care. There is a need for education for nurses and for doctors.

And now we would like [integration] for palliative care in Kinshasa because we have a different culture from Europe and we must take account of the culture of Congo too.³