Hospice Africa Uganda has been instrumental in disseminating information on palliative care to health officials and professionals. Further training is likely to come from experienced palliative care practitioners from other African countries, notably Uganda. An initial training of trainers session in April 2004 was led by Hospice Africa Uganda. Plans are in place to extend the training programme. Vinolia Tonugble, a physician and trustee of the Cancer Society of Ghana:

In the near future we will initiate training, proper training of trainers, and then we’ll spread it at three levels. We want to train the professional; we want to train the community staff; at the grass roots level we have the community’s health centres; and then we want to train Red Cross and volunteers and go into full-scale palliative care.¹⁰

Terry Magee tells of the training courses she has helped to deliver in Ghana:

We were first contacted two years ago by the African Medical Trust to talk about the development of palliative care services for people with cancer and AIDS in the nine regions of Ghana; and as a result of that, we started off by offering hospice placements, education and support to interested professionals who could get to England; experience life in a hospice and working alongside hospice staff.

Following that we worked together with the cancer society of Ghana in developing a national education programme for Ghana about palliative care, really an awareness-raising programme aimed at health and social care professionals, to tell them a little bit about hospice care and hospice services and to try to help them to think about how that service might develop within the cultural imperative that exists in Ghana.

So we wrote a course and we collaborated with Hospice Uganda and we went to Ghana for the first time two years ago; and we carried out, with our Ugandan colleagues, an introduction to hospice and palliative care services course in the capital of Ghana - Accra. We had 190-odd people on that, and that was a week, full time; and during that time I also visited the students in the hospitals and outreach programmes where they worked, to see the situations that they were practicing in.

That was a great success and so the Cancer Society of Ghana asked us if we would be willing to come back and take that programme, in a shorter form, out to the nine regions of Ghana. So this year - we obviously had to trim down the course, and we had to trim down the number of people that were going out there because this was a very big financial commitment for them to put a programme on in the nine regions so we had to slim it all down - we went back out in January and we travelled to another two regions of Ghana and carried out the programme again there; a region in the upper area of Ghana called Bolgatanga and we had about - I think we had about 80 or 90 people in Bolgatanga who took the course; and we also carried the course out in another region of Ghana which is called the Cape Coast region, and there we had again, about 90 health and social care professionals, and in Bolgatanga, we also had representatives from cultural healers and spiritual healers. Imams and Chaplains also did the course; and we have plans with the cancer society of Ghana to return as an when funding is available and we’re available to do it - and to continue to do that until we’ve covered the nine regions of Ghana - so that hopefully, everybody, you know, who has an interest in Ghana has come along and heard a bit about hospice and palliative care services and the theory which underpins this work; and has an opportunity to think that one through and look for ways in which some of what we’re doing in the west might influence some of what they will do in Africa.

Colleagues from Hospice Africa Uganda, Dr Henry Ddungu, and nurse Berna Basemera, comment on the course in May 2004:

The Opening ceremony took place at the Ghana International Trade Fair. It was attended by many dignitaries including executive members of the Ghana Cancer society, government representatives and all the course participants. It was a very colourful occasion. The Keynote address was given by Dr. Ken Sagoe, Director of Human resources, Ghana Health Services. He emphasized government’s position towards palliative care in Ghana and their (Government) willingness to incorporate it into policy and advocacy. The opening ceremony was on the headlines for the evening news on TV3 – a private TV company in Accra with a very wide coverage.

The training began on Tuesday 11th May 2004 with the first lecture given by Dr. Henry Ddungu, on the hospice concept. It was made clear that even with minimal funding one can care for a dying patient in need of palliative care, as long as there was commitment. Examples of locally available remedies that have been tried and found to be working were given and emphasized. Dr Jack Jagwe discussed the laws governing use of Narcotics as well as ‘Myths and Fears’ on use of morphine to such a degree that all the fears they (participants) had waned away. Berna and John took the group through spirituality in the hospice context and the discussion groups never wanted to stop! It was such a good experience for the groups discussing various issues and sharing the various experiences.

Grief and bereavement in Ghana was another interesting topic. The group agreed to divide into the different ethnic groups – the Gas, the Akans, the Ewes, the Dogombas and Mamprusis, and the Dagarees and Sissalas (Northern). Each of these groups gave their cultural beliefs towards grief and bereavement. It was so amazing to realize that even in the same country, different groups have differing cultures and beliefs when it comes to death and dying. It emphasized the importance of cultural considerations – Cultural Pain – and palliative Care.

The course ended well and it was explained to participants how they were to write a reflective diary to be submitted to the Cancer Society of Ghana before they could receive their certificates in June 2004. They were all ready and willing to do this and to-date, many have received their certificates.

As far as availability of oral morphine was concerned, this did not seem a very big problem because the department of health is already aware and willing to support the importation of oral morphine into the country. However we will see how this goodwill develops! It was however, emphasized that potential prescribers need to be sensitized on the use of morphine.¹¹