American Society of Regional Anesthesia and Pain Medicine May 2018 - 37

third of patients who are seen at HAU can afford to pay the fee
(less than $3 USD), whereas the remainder receive charity care.
Clinic hours are held daily and complemented by a home visit
and outreach programs. HAU also trains community volunteers
and offers palliative care courses for health care workers in other
African countries.

Linden AF, Sekkide FS, Galukande M, Knowlton LM, Chackungal S, McQueen
KAK. Challenges of surgery in developing countries: a survey of surgical and
anesthesia capacity in Uganda's public hospitals. World J Surg. 2012;36:1056-
1065.

LeBrun DG, Chackungal S, Chao TE, et al. Prioritizing essential surgery and
safe anesthesia for the post-2015 development agenda: operative capacities
of 78 district hospitals in 7 low- and middle-income countries. Surgery.
2014;155:365-373.

In June 2017, I travelled to Kampala, Uganda, to work with HAU
as part of my palliative medicine fellowship. I traveled with the
hospice staff and saw patients in multiple care settings (Figures
1 and 2). Many of our patients were locals, others had travelled
to Kampala for cancer evaluations not available in their home
districts, and some were refugees. I took care of a 7-year-old
child presenting with AIDS and severe abdominal pain because
of bulky lymphadenopathy, a 10-year-old child with a hepatic
mass and massive ascites, a woman who sustained extensive
third-degree burns to her face and chest wall after seizing and
falling into a cookfire, and another young woman who had just
undergone hip disarticulation for hemangiopericytoma. All of these
patients received pharmacologic pain management in addition
to psychosocial counseling. HAU also offered a small stipend for
additional care costs for families that were financially struggling.

Jagwe J, Merriman A. Uganda: delivering analgesia in rural Africa: opioid
availability and nurse prescribing. J Pain Symptom Manage. 2007;33:547-551.

Clark D, Wright M, Hunt J, Lynch T. Hospice and palliative care development in
Africa: a multi-method review of services and experiences. J Pain Symptom
Manage. 2007;33:698-710.

Hospice Africa Uganda. 23rd annual report 2015-2016. Available at: http://www.
annemerrimanfoundation.org/wp-content/uploads/2017/04/Annual-reportonine-version.pdf. Accessed November 30, 2017.

Cleary J, Powell RA, Munene G, et al. Formulary availability and regulatory
barriers to accessibility of opioids for cancer pain in Africa: report from the
Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013;24:xi14-xi23.

Harding R, Simms V, Penfold S, et al. Availability of essential drugs for managing
HIV-related pain and symptoms within 120 PEPFAR-funded health facilities
in East Africa: a cross-sectional study with onsite verification. Palliat Med.
2014;28:293-301.

Merriman A, Harding R. Pain control in the African context: the Ugandan
introduction of affordable morphine to relieve suffering at the end of life. Philos
Ethics Humanit Med. 2010;5:10.

Although the resources and pharmacy supplies at HAU may be
small (Figures 3 and 4), the institution offers a distinct vision of
multimodal symptom management. In spite of limited resources
and training, the staff takes a comprehensive approach to patient
care, which has had a substantive impact on the lives of over
28,000 patients to date.
REFERENCES
1.

Kiwanuka JK, Ttendo SS, Eromo E, et al. Synchronous distance anesthesia
education by Internet videoconference between Uganda and the United States. J
Clin Anesth. 2015;27(6):499-503.

10. Harding R, Selman L, Agupio G, et al. The prevalence and burden of symptoms
amongst cancer patients attending palliative care in two African countries. Eur J
Cancer. 2011;47:51-56.
11. Lewington J, Namukwaya E, Limoges J, Leng M, Harding R. Provision of
palliative care for life-limiting disease in a low income country national hospital
setting: how much is needed? BMJ Support Palliat Care. 2012;2:140-144.
12. Hospice Africa Uganda. Fact sheet October 2016. Available at: http://www.
friendsofhospiceafricausa.org/wp-content/uploads/2017/03/Finall-for-Oct16.
pdf. Accessed November 30, 2017.
13. Norval DA. Symptoms and sites of pain experienced by AIDS patients. S Afr Med
J. 2004;94:450-454.

American Society of Regional Anesthesia and Pain Medicine
2018

http://www.annemerrimanfoundation.org/wp-content/uploads/2017/04/Annual-reportonine-version.pdf http://www.annemerrimanfoundation.org/wp-content/uploads/2017/04/Annual-reportonine-version.pdf http://www.annemerrimanfoundation.org/wp-content/uploads/2017/04/Annual-reportonine-version.pdf http://www.friendsofhospiceafricausa.org/wp-content/uploads/2017/03/Finall-for-Oct16.pdf http://www.friendsofhospiceafricausa.org/wp-content/uploads/2017/03/Finall-for-Oct16.pdf http://www.friendsofhospiceafricausa.org/wp-content/uploads/2017/03/Finall-for-Oct16.pdf

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine May 2018