American Society of Regional Anesthesia and Pain Medicine May 2018 - 35
Pain Management and Palliative Care in Sub-Saharan Africa:
Reflections From Uganda
P
ain management is a subspecialty still in development in much
of sub-Saharan Africa. Access to providers and medications
is severely constrained over much of the region. Cultural
factors, such as mistrust both of providers and concerns regarding
opioid use, also act as barriers to care. Although some academic
anesthesia training programs exist,1 the majority of palliative and
anesthesia care in Uganda is provided by individuals who have
limited formal medical or nursing training.2 Regional anesthesia
is largely unknown,3 and access to pain medications is severely
constrained. As a result, pain management training has been
limited to the palliative care setting.
Palliative care was introduced in Uganda in 1993 by Dr Anne
Merriman, founder of Hospice Africa Uganda (HAU) in Kampala.
HAU is a nongovernmental organization that provides support and
care to those dying from cancer and HIV/AIDS. Over the past few
decades, services have expanded to include affiliated clinics in
two other districts as well as training programs and collaborations
throughout much of the country. Palliative care is cited as an
essential health service in the Ugandan National Health Plan and
prioritized by the government in multiple reports,4 but financial
constraints mean that funding for palliative care is still highly
dependent on extramural donors.5
only intermittently available
in 7% of facilities, whereas
nonopioid adjuvant agents were
available in 73% of facilities.8
HAU opened a morphine
sulfate-processing production
in an attempt to address the
limited opioid availability and
is now the only manufacturer
of morphine in the country.9
Studies of selected patients in
Kenya and Uganda suggest that
patients diagnosed with cancer
in this region experience a high
burden of symptoms (a mean
of 18 reported physical and
psychological symptoms over
the course of 7 days), with pain
as the predominant complaint.10
Rachel A. Hadler, MD
Assistant Professor of
Anesthesiology and Critical Care
Department of Anesthesiology
and Critical Care
Hospital of the University of
Pennsylvania
Philadelphia, Pennsylvania
Figure 2: Hospice complex.
According to statistics HAU compiled in 2016, an estimated
57% of Ugandans do not have access to health care6 and some
250,000 are in need of palliative care to improve their quality of
life. Legislative efforts to broaden morphine-prescribing abilities
to palliative care nurses and clinical officers have increased the
availability of symptom relief in rural communities.4 However,
drug supplies are frequently limited.7 In a survey of governmentfunded HIV care facilities in Kenya and Uganda, morphine was
Figure 1: Examination room.
American Society of Regional Anesthesia and Pain Medicine
2018
35
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine May 2018
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