History of Cairdeas in Uganda

Following a number of visits by our Medical Director, Dr Mhoira Leng, to Makerere University and Mulago Hospital in Kampala, she was asked to lead the development of an academic unit for palliative care in the national referral hospital and contribute in collaboration with key stakeholders Hospice Africa Uganda and the Palliative Care Association of Uganda to the development of education, training, access to essential medications and national capacity for palliative care. These partnerships are key to developments across the country and beyond with HAU the first palliative care programme in Uganda with leadership reaching across Africa and PCAU leading palliative care in Uganda to the levels where they have international recognition as on of the most developed services in Africa and rated high in international reports.

Makerere University is one of the most prestigious institutions in Africa with an established medical school that was already involved in palliative care training to undergraduates and Mulago Hospital is the major government tertiary referral hospital for Uganda, and the only cancer centre. With more than 1600 beds and many outpatients, the clinical challenges are immense within a resource constrained environment.

The Palliative Care Unit

As part of strategic planning the following objectives were agreed in 2011.

1. Clinical Service Provision - To provide and scale-up an integrated clinical service to patients and families on the Mulago hospital site.
2. Education and Training - To provide education, training and capacity building for healthcare workers at undergraduate and postgraduate level.
3. Advocacy - To enhance and promote academic and clinical credibility for Palliative Care
4. Research - To expand the evidence-base for palliative care by encouraging a research culture, and supporting and initiating research into palliative care in Africa.
5. Sustainability - To develop a well-resourced Palliative Care Unit, with the capacity and infrastructure capable of supporting a sustainable Ugandan-led team.

Key achievements to date

1. Development of holistic clinical support within an academic institution and national hospital setting
2. Representation on Lead Country team for Uganda led by the Ministry of health and including contributions to the National Policy for Palliative care
3. Development of national, approved symptom control guidelines
4. Development and mentorship of a link nurses a model for integration[ml3] 
5. Development and implementation of a volunteer programme to support holistic care
6. Development and delivery of integrated curriculum within undergraduate (BSc nursing and MBChB medicine) and postgraduate (MMed) programmes in Internal Medicine, Family Medicine, ENT and surgery
7. Development of research capacity, outputs and presentations[ml4]  including the first Research School for Africa (2012) and more than 80 publications of abstracts and papers.
8. Developing clinical capacity including scholarships for Diploma in PC for 2 Mulago nurses, Masters in Practical Theology (Ivan Onapito), MMed Internal Medicine (Jack Turyahikayo) and support for PhD studies (Dr Liz Namukwaya)
9. Development of research and project collaborations with partners in particular the University of Edinburgh, Global Health Academy[ml5]  with funding through THET and UKaid for Integrate health systems strengthening programmes[ml6]  and nurse leadership[ml7] . MPCU has offered technical support in Rwanda, Uganda, Kenya, Zambia, Sudan, Malawi and Tanzania.
10. Visiting Professor Julia Downing who is a key lead for much of our work and in particular the research and training. She also brings her expertise with the International Children’s Palliative Care Network. (http://www.icpcn.org/)
11. Development of Curriculum support tools including the Palliative Care Curriculum Toolkit produced as part of the Integrate project http://www.ed.ac.uk/global-health/research/project-profiles/health-systems-strengthening/thet/resources
12. Continued contribution to the HAU and MACHS Diploma and Degree in palliative care
13. Development of partnerships with Diane Fund (now closed), Yale University, OSI, Trus Colours and UCT

BSc in Palliative Care - a 'Degree for Africa'

The PCU worked with Hospice Africa Uganda (HAU) to develop a 3-year degree course leading to a B.Sc. in Palliative Care which was launched in 2010. The degree is offered by Makerere University through its Department of Medicine, and is run by Hospice Africa Uganda Institute of Hospice and Palliative Care in Africa from its campus at Makindye. The degree programme utilises the extensive experience of HAU palliative care clinical service and education department which has developed an affordable and culturally appropriate palliative care model for sub-Saharan countries.

The objectives of the degree programme are:

• To improve access to palliative care services in sub-Saharan Africa.
• To enhance knowledge, skills and competency of palliative care practitioners through field-based, competency oriented, experiential learning and clinical placements at recognised palliative care service organisations in Uganda and other African countries.
• To facilitate the integration of palliative care services into main-stream health care services.

The degree course got under way in February 2010 and now has students from more than 10 African countries with MPCU one of the partners in delivery specific modules and contributing to the overall governance.

One of the graduates Dr Elizabeth Nabirye who is now one of the senior trainers at MPCU shares her experience;
"As a palliative care graduate, my profile has been raised among other health professionals (Senior House Officers, consultants among others) I interacted with throughout the course during my research and specialist clinical placement. This has greatly changed their attitudes towards palliative care and I now receive many consultations for palliative care patients. With the added knowledge, skills and with my vast experience I now feel more confident and in a better position to fully get involved in the provision of education, training and capacity building of colleagues and others. The course experience greatly helped me in mentoring other students, especially in the application of theory into practice. “

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