China
Africa
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The development and practice of palliative care
Published in John Lombard, Law, Palliative Care and Dying, 2018
Outside the confines of the UK and Ireland, several international palliative care groups formed. At a European level, the European Association of Palliative Care [‘EAPC’] was established in 1988. At the time of writing it has 58 member organisations from 32 European countries as well as individual members from 48 countries across the world.49 The organisation has published multiple recommendations, white papers, and statements. The practice and formal recognition of palliative medicine has spread beyond Europe and several international palliative care groups were formed in the early 2000s. The Latin American Association of Palliative Care was established in 2000. The Asia Pacific Hospice Palliative Care Network was set up in 2001 and represents 14 countries. While in 2002 the African Palliative Care Association was founded and serves to act as a hub and focal point to encourage the dissemination of palliative care services across the continent. Among the early work of the African Palliative Care Association was the Cape Town Declaration which set out that ‘[p]alliative care is a right of every adult and child with a life-limiting disease’50 and ‘[t]he control of pain and symptoms is a human right, and therefore, appropriate drugs should be available in every country in sub-Saharan Africa as part of the essential drug list, including opioids such as morphine.’51 The effect of such a declaration will be considered in Chapter 3 along with the Korea Declaration,52 and the Prague Charter.53
Access to palliative care in HIV services in Cape Town
Published in AIDS Care, 2018
Liz Gwyther, Marion Heap, Leslie London
The study was introduced to staff at the study site. The staff identified patients who met the inclusion criteria for the study. The research assistant followed up and approached potential participants consecutively. She explained the research study in the participant’s language of choice, either English, isiXhosa or Afrikaans; and invited the potential participant to take part in the research. All HIV patients and all cancer patients approached to take part in the study agreed to do so. Of the 15 MND patients approached, 4 refused to take part because of reasons of frailty and difficulty with speech. On obtaining voluntary, informed consent, the research assistant administered a questionnaire. The questionnaire explored the participant demographics and any other sources of care. Care was assessed at first visit and monthly by telephone over the next 6 months using the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS), a validated palliative outcome scale (Harding, Selman, et al., 2010) The participant were interviewed in their language of choice (English, isiXhosa or Afrikaans) using translated questionnaires. The APCA African POS asks participants to rate their problems on a scale of 0–5. Problems identified in the questionnaire are grouped as physical – pain, other symptoms; psychosocial – worry, ability to share; spiritual – life worthwhile, being at peace; and informational – having enough information to plan for the future.