Selian Lutheran Hospital

Kristopher Hartwig suggests “what is very successful about Selian is… they’ve neither been able or not bothered to really copy anyone else, they’ve done their own things”.³⁵ This ability to chart their own way in providing a unique and effective service has been made possible by active leadership and a willingness to network with allied services to spread palliative care skills. Their plan to expand their training to many more hospitals in the country will increase coverage significantly.

Muheza Hospice Care

A combination of different hospice and palliative care models results in this hospice providing a comprehensive service to many patients. The sound relationship with the hospital means that continuity of palliative care is provided from time of admission to community based support and follow up. Successful community programmes, an active day centre, expansion of education and training programmes and the development of a children’s programme attract sustained donor funding and encouragement to replicate this service elsewhere. Despite the many successes the team identifies areas for development.

There are areas that are not working well, for example the bereavement programme, it’s not yet tackled, and I see that we really need a lot of social workers… And then we are not also much trained on how to deal, how to do palliative care… How to arrange programmes, so that these sick people may generate their own income, that also is another gap, because we just give them the money, just giving the money, the food, things like that… So we just have the one step, but we need to move farther, to help them generate their own income so that they may not depend too much.³⁶

PASADA

Mary Ash:

I think one of the things that I found in PASADA that impressed me immediately and obviously was due to who came before me, was the motivation of the staff. It was obviously faith-based, people who come to work in PASADA are people who believe in doing something for others, and that comes from their own personal faith. Without that staff motivation I think it would be very difficult to provide the quality of care that we do, and that is one of the successes of PASADA, the quality. And the compassionate care – I dare to use the word ‘compassion’ in the sense that everybody here cares about the clients and I think that’s one of the most important things for people. I think ... the success is the model itself. Also, the recognition that PASADA gave a long time ago and a long, long while before the government did or anybody else did, to the importance of care and support [to those living with HIV/AIDS]. PASADA is the only organisation in Dar es Salaam, probably in Tanzania, offering this kind of holistic service. So what does that mean? When people go to drop-in VCT centres and they unfortunately end up with a positive result, so the question is, ‘What do I do now? Where do I go?’ so everybody says, ‘Go to PASADA,’ because they know it’s the only place where they will get this kind of help. So I think the success is also that recognising that model so long ago and in time developing it into what it is today, it was a very good intuition. And I hope that we will be able to help other people to set up in their own environment, obviously modifying it to their own environments, but to set up services like this.³⁷

She identifies areas for attention:

…the kind of people obviously who are now working, and including myself, are those who have, have been trained and have certain qualifications and experience to give to the organisation. So that has also cut out a lot of people living with HIV/AIDS because many of them don’t have those qualifications, and that is something that I would like to work on more in PASADA …it’s still a community-based organisation, definitely, and that is another aspect of its success, but for example now we’ve, the collaboration or the participation of people living with HIV/AIDS is, apart from being clients obviously very limited. We have trained some in counselling, we’ve trained other in other things as well, and they are active within the sector, but it’s not enough. We have monthly client meetings where we have 450 people at a time at the meetings and there’s a lot going on there but it’s ... I mean, let’s face it, if people were not HIV positive, we wouldn’t be here, so why should we be here and them not be more involved in what’s going on? And this is one of the things I see for the future that we need to look at.³⁸

PASADA has been successful in forging good relationships with the Tanzanian government, including the Ministry of Health and the National AIDS Control Programme. Their collaboration is regularly sought in developing policies relating to AIDS. Proof of the respect in which PASADA is held came in the form of a certificate of recognition for their work presented by the President at a Global Fund ceremony in 2004.

Ocean Road Cancer Institute

ORCI is the sole distributor of oral morphine to other hospices in the country and succeeds in ensuring an uninterrupted supply. The numbers of staff who are receiving palliative care training is seen as a success although AIDS home based care providers still require training to improve end of life care for all patients.

What they are doing, is just visiting patients, talk with them, they don’t even … have pain medication. So we are trying to [teach] them to use morphine … but also to see cancer patients, not only to concentrate on AIDS because they are visiting mainly [AIDS patients]…now doctors … are going for training and nurses, so there is a change in knowledge and skills which are applied to patients and they’re teaching to other staff, so this is one of the success. Also we are getting more co-operation from colleagues.³⁹

Hussein Mtiro shares his impressions of the success of his team:

There is a lot of difference actually because at least now we know our patient, those in the ward or those at home, those in difficulties, those in pain, they, at least they know where they can, their problems can be solved. It was not easy before the palliative care team: patients say it’s nobody’s business, anybody that comes there, they don’t know what to do, but after this training people are more skilled in communication skill and also knowledge of how to control their symptoms, so most of our patients they are, we consider they are symptom-free because of all the medication and we can talk with them. There is really difference in the ward and also those at home.⁴⁰

He identifies areas for improvement:

We just feel that we have a long way to go, we are still very much back, we are lagging behind, we are missing a lot of service to some of these patients. We can give them medication, we can talk with them, we can counsel them, but really we are not open to the maximum especially that we can’t follow them at their home, we can’t see how they are dying, how the family is supported day after day. So we still think we need to do more.⁴¹

He identifies a need to network with other agencies, and to avoid an over-emphasis on AIDS. Early diagnosis of cancer through screening would help to increase survival rates.