American Society of Regional Anesthesia and Pain Medicine May 2018 - 36
An estimated 46% of patients admitted to hospitals in Uganda
had a life-limiting disease (vs estimates of 5-23% in comparable
European studies). When interviewed, patients expressed concerns
across multiple dimensions, including inability to afford medical
care (50%) and limited access to food (14%), in addition to ofteninadequate symptom relief.11
patients at HAU have a primary diagnosis that is not cancer or HIV.
This subgroup includes patients with autoimmune disease as well
as chronic pain; both conditions have limited treatment pathways.
Patients frequently present with advanced malignancy and are
subsequently referred for hospice management. For example,
one patient sought care
after her right breast
had autoamputated from
necrotizing cancer. Other
patients present with HIVassociated neuropathy or
with a debilitating lowerextremity pain syndrome
associated with AIDS.13
"An estimated 57% of Ugandans do not
have access to health care and some
250,000 are in need of palliative care to
improve their quality of life."
HAU is the main referral site
for all outpatient palliative
care in the Kampala area
and accommodates roughly
800 new patients per year. In
total, 58% of the patients who
present to HAU have cancer,
most commonly cervical cancer (38%), followed by cancers of the
breast (18%), esophagus (16%), or prostate (13%). Among HAU's
patients, 9% present with comorbid HIV and cancer, and 21% follow
up for other symptoms and issues related to HIV.12 Only 12% of
Figure 3: Morphine supply under lock and key at a community hospital
near Mbarara.
36
Patients treated at HAU receive multimodal analgesia in the form
of morphine and nonopioid adjuvants, as well as wound care and
medical supplies in exchange for a small donation. Roughly one-
Figure 4: Stock of donated antiretrovirals at a community hospital.
American Society of Regional Anesthesia and Pain Medicine
2018
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