Palliative care in Namibia

Rachel Freeman’s mother died suddenly of a heart attack in 2015 while she was pursuing her doctor of philosophy degree in palliative care.

Five years earlier, her father had died two months after being diagnosed with lung cancer, the leading cause of cancer-related deaths worldwide.

“My dad’s spiritual struggles of pleading with God to relieve his pain and suffering, and my father’s fear for cancer and his belief that cancer is equal to death contributed to his delay in seeking early medical attention," Freeman said in an interview on palliative care and the role it plays in enhancing the quality of lives and overall well-being of patients and their families.

“I learned through my dad’s experience that at that time he needed palliative care because his struggle with cancer went beyond his cancer diagnosis but included shortness of breath, chest pains, difficulty walking, tiredness and dizziness," Freeman explained.

First for Namibia

Palliative care consists of specialised medical care for people living with a serious illness and is focused on providing relief from their symptoms with the goal of improving quality of life for both the patient and the patient's family.

Dame Cicely Saunders is recognised for establishing the discipline and culture of palliative care when she opened Christopher’s Hospice in London, England, in 1967.

The Cancer Association of Namibia opened its first palliative care centre on 15 April 2024, in one of the upmarket suburbs in the city.

The 22-bed facility is the first of its kind in Namibia.

Namibia has an estimated population of three million, but there aren’t official statistics available for the estimated number of patients in need of palliative care.

“Globally, the number of adults and children in need of end-of-life palliative care is 20.4 million. In Africa, the estimate is 1.8 million and 346 203 of these would be cancer patients," a 2014 report titled 'The Global Atlas of Palliative Care at the End of Life: An Advocacy Tool' by Stephen Connor, published in the European Journal of Palliative Care, states.

Growing demand for palliative care in Africa

The demand and need for palliative care are vital in contributing to the quality of life for both adult and child patients. This is highlighted in the African Palliative Care Associations (APCA) mission to adapt African traditions, beliefs, cultures and settings (which vary between and within communities and countries on the continent).

APCA strives to provide African solutions to African problems by ensuring that palliative care is understood and integrated into continental health systems to reduce pain and suffering on the continent.

Projections of Global Mortality and Burden of Disease from 2002 to 2030 by Collin D. Mathers and Dejan Loncar state that “Africa is characterised by an increasing rate of communicable diseases such as HIV and AIDS and a high burden of non-communicable diseases such as cancer, cardio-vascular diseases, diabetes and respiratory diseases.”

Palliative care still remains absent in many African national health policies, with almost half of African countries identifying no hospice or palliative care activity. This means that NGO’s, hospices and faith- and community-based organisations fill the gap through home-based care or by family volunteers with the support of health professionals.

But is this not the African way?

Namibia’s health and social services minister Dr Kalumbi Shangula said in the Namibian context, palliative care happens when someone who has been taken out of acute care is given medication and allowed to go home to free up bed space at the hospital.

“Because their condition is irreversible and they have reached the end of their lives, some opt to travel to their rural homesteads, where they feel at peace with the prospect of death, and that is why we say that palliative care does not always have to be institutionalised, but perhaps there is a need to review the standardised guidelines on how family members in rural communities can become an extension of the national health workforce through consistent and remedial training," Shangula suggested.

Dr Freeman said there is a growing demand and need for palliative care globally and on the African continent, which was accelerated by the Covid-19 pandemic.

“The demand and need for facility-based and home-based palliative care will continue to grow because of our ageing populations," she said.

“It is within this context that healthcare services in Namibia need to reform and undertake more research to enhance and strengthen the provision of palliative care to improve the quality of life of patients diagnosed with life-threatening illnesses even as death approaches because early delivery of palliative care reduces unnecessary hospital admissions and the use of health services," she added.

Research-based strategy

A colon cancer survivor herself, Dr Freeman’s PHD in sociology on social workers' perceptions of their role in providing palliative care to patients with life-long limiting illnesses, is titled 'A qualitative study among social workers in primary settings in Namibia as scientific evidence to motivate and mobilise resources for the establishment of palliative care in Namibia'.

This thesis was applied by Rolf Hansen, the chief executive officer of the Cancer Association of Namibia, in establishing the first palliative care centre in Namibia, which can be used as a benchmark for more centres across the country and the continent.

Hansen said the recommended approach to helping patients in Freeman’s thesis was incorporated in the guidelines for palliative care at the palliative care centre – a first for Namibia.

“Very often, symptoms management is the focus in care settings, while the interdisciplinary approach of 'helping a patient' as opposed to 'treating a client' is ignored. Dr Freeman focused her thesis on the holistic approach to helping people. This is greatly aligned with the vision we have for bringing this very same disciplinary approach to Namibia," Hansen explained.

*Vitalio Angula is a socio-political commentator and independent columnist with an interest in feature writing on contemporary social issues.