Hospice Africa Uganda. A total of 1,121 health professionals and 553 non-health professionals have attended HAU palliative care courses since 1994 (Table 6).

Table 6 Training courses: Hospice Africa Uganda, 1994-2004

In addition, in-service training is given to the HAU team and to health professionals who support the work of the hospice. Certificates of practice are given to clinicians who follow up the courses, present case studies and pass an oral examination.

Hospice Africa Uganda provides teaching sessions for undergraduate and postgraduate doctors at Makerere University (from 1993) and Mbarara University of Science and Technology (MUST) Medical School (since 1998) – along with courses for pharmacy and nursing students.

The hospice has also been sharing expertise with HIV/AIDS organisations to ensure that palliative care is grafted onto community-based home care services^31,32. Anne Merriman:

Every village and every family in Uganda has experienced the death of a loved one from AIDS. Many of these patients have died at home. Many have also had cancer. The AIDS home care teams are under a lot of strain trying to spread themselves to cater for the increase in those dying at home. These teams are excellent at counselling and basic medications. However for those patients with extreme pain and symptoms, the lack of knowledge of the methods of control and the use of medications, have prevented pain and symptom control. Hospice has introduced this palliative care and the modern methods of pain and symptom control which are working in the home. The training of personnel in this specialty is a major part of the work of Hospice Uganda.³³

All three hospice organisations are working with the MoH to provide training programmes for 56 districts about to receive oral morphine through an initiative that has already introduced oral morphine to 15 Districts during the first phase.

In 2002, HAU established a Distance Learning Diploma in Palliative Care in conjunction with Makerere University. Twenty participants enrolled on the first course (including 9 from outside of Uganda, Table 7). Facilities include the resource centre and 14-room residential centre (Kateregga House) at Makindye. A second course with 18 participants began in 2003.

Table 7 Students enrolled on the Distance Learning Course from outside Uganda, 2002-3

Course director Michelle McGannon comments:

The diploma is training people to provide holistic care within the palliative care setting, and it’s so important to look at all the elements that are involved in that. Also, it’s an African diploma for an African audience; I think that’s the most important thing that I could say about it. And it’s trying to give people, not just the clinical skills, but the skills to be able to pass on that knowledge. We have modules on management, organisation and palliative care, so they can have information on what is most appropriate for their particular setting or country; and management styles - to give all-round tuition and help them to develop a service.³⁴

A course participant, Ndikintum George Mbeng (from Cameroon) comments:

The distance learning course is a very good way of teaching palliative care to health professionals in Africa, and [it] equips the students with the knowledge to train other health professionals. The compulsory residential weeks are very helpful because you have to come on site, see the practices and whatever. ³⁵

Training courses have also been delivered by HAU in other African countries, including: Ethiopia, Tanzania, Malawi, Nigeria, Kenya and Zambia.

To support the development of education and training a resource centre has been established with support from the Diana Fund. Centre manager Ronnah Abinaitwe spent a month at St Christopher’s Hospice, London, in preparation for her innovative role;³⁶ she here describes the library resources:

We have many books on pain and symptom control. I’ve classified them separately according to the different subjects. And we have a few publications from the Ministry of Health, Uganda, because some of them apply to us; some publications from the WHO; other publications from the UNDP, this will help especially the researchers, to know what they want. Then I have shut cupboards with journals. Most of the journals are palliative care journals - only that some of them don’t come very regularly because we don’t always have the money to subscribe to them; but then we have the British Medical Journal and the Lancet [which] come free for us - so we always get at least a copy every week of the two journals; we have quite a collection. Near the main entrance we have the information material that hospice publishes; we have the famous blue book by Dr Merriman and we have a few other manuals - trainers’ manuals that we usually give to the people that come for training.³⁷

Training has recently come into sharper focus as a result of a research project undertaken by Ekiria Kikule which sought to identify the palliative care needs of terminally ill patients in Uganda. Among a sample of 173 participants registered in palliative home care programmes, three needs were identified: the control or relief of pain and other symptoms; counselling; and financial assistance for basic needs such as food, shelter, and children’s school fees. Significantly, the home was the preferred setting for care, although all participants had access to healthcare services within 5 km of their homes.³⁸

The Mildmay Centre. The Mildmay International Study Centre (MISC) aims to develop initiatives that will introduce the knowledge and skills needed to provide comprehensive, holistic rehabilitation and palliative care for people living with HIV/AIDS. Training programmes are provided for government bodies, NGOs, faith-based organisations and companies in Uganda and the surrounding region. Programmes include:

• 1 day HIV/AIDS awareness seminars
• 1 and 2 week residential courses
• modular courses of up to 18 months duration. These include
  ~a Diploma in HIV/AIDS Care and Management in association with Manchester University, UK
  ~a 1 year course delivered up-country by two mobile training teams
• placement schemes

Julia Downing (MISC director), speaking in June 2004, comments:

We have had over 3,000 people on our short courses over the last three years, from about 45 of the districts in Uganda and from 22 countries - mainly Uganda, but we have regional programmes as well for people from within Africa. And then at our centre in Kampala we have a specialist outpatient referral centre/clinic, and so we have clinical placements as well, and we have people from all over coming on the clinical placements and the training programmes. The actual, the year-long programme in the districts, we’ve had –and I counted that just a few days ago – we’ve had about 220 people on that course. And the Diploma courses, obviously the numbers get smaller as the course gets more demanding, but the Diploma course, we’ve just graduated 23 people on Friday, and we have a further 24 undertaking it.³⁹

Edith Akankwasa, manager of the innovative mobile training team (MTT) writes:

The aim of the MTTs is to build capacity amongst health workers to deal effectively with the care needs of patients living with HIV and AIDS (PLWHA’s) in the rural communities. Each multi-disciplinary training team consists of a Doctor or Clinical Officer, a Nurse, a Counsellor and a Driver. The teams take trainees through a year’s modular training programme addressing issues such as clinical care, communication skills, teaching skills, Proposal writing and Management skills.⁴⁰

Association François-Xavier Bagnoud (AFXB) provides training for its staff and in Uganda this has been in association with the Mildmay Centre.⁴¹

PROMETRAUganda is an NGO which promotes traditional medicine and the role it plays alongside Western models. President/director Yahaya Hills Sekagya writes:

PROMETRA Uganda initiated a program for training and empowering traditional healers in the care and management of patients with cancer. HIV/AIDS and other diseases using traditional methods. The training covers areas of basic of basic anatomy, herbal identification, preparation, administration, diagnosis, danger signs and referrals. Traditional medicine and healers are an alternative resource in rural and poor communities as they are available, accessible, affordable, and in every village

 

Traditional healers have actively participated in hospice trainings, willingly share information with each other regarding medicinal plants for opportunistic infections, [and have] developed unique yet appropriate methods of communally looking after the sick. They have committed themselves to working as a team and are a strong resource for local communities.⁴²