palliative care making a difference in rural uganda, kenya and malawi three rapid evaluation field studies姑息治疗在农村发挥作用的乌干达、肯尼亚和马拉维三个快速评价领域的研究.pdf

Grant et al. BMC Palliative Care 2011, 10:8 /1472-684X/10/8 RESEARCH ARTICLE Open Access Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies 1* 2 3 4 1 Liz Grant , Judith Brown , Mhoira Leng , Nadia Bettega and Scott A Murray Abstract Background: Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. Methods: Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics. Results: We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home. In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks. Conclusions: Programmes were reported to be successful because they inte