Programme Director
North West MEC for Sport, Arts and Culture Ms Grace Pampiri
The Executive Mayor of Klerksdorp
Bishop Kevin Dowling
Dr Liz Gwayther, CEO of the Hospice Palliative Care Association of South Africa (HPSCA)
Ms Zodwa Sithole, Advocacy Manager of HPCA
HPCA member hospice, funders, representatives from various health forums and the non-governmental organisations (NGOs) sector
Our partners from President's Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for International Development (USAID)
Good morning
I bring you warm greetings from the Ministry of Health and congratulate the Hospice Palliative Care Association on hosting World Hospice and Palliative Care Day. This is an important day when we jointly celebrate and support hospice and palliative care in our country and around the world.
In the National Guideline on Palliative Care for Adults (2003) the Department of Health expressed its commitment to enhancing the capacity among health professionals to provide this care.
In addition we acknowledge and recognise the invaluable work done by the many committed organisations like yourselves in making the service available to people in need and for ensuring that the last days of their lives is lived with dignity. We recognise your support of the families facing problems associated with life threatening illnesses. I am informed that the during October 2008 to March 2009 members of hospice and the development sites cared for a total of 52 806 patients and that during 2008 Hospice Palliative Care Association (HPCA) run training programmes for palliative care for more than 8 000 people, many of whom were health professionals.
As you might know we have quadruple burden of disease in our country. We have HIV and AIDS, Tuberculosis (TB) and other communicable diseases including parasitic diseases, heart disease, stroke and diabetes.
Additionally we are informed by World Health Organisation (WHO) that cancer accounted for 12,5 percent of deaths in 2005; and they estimate that by 2020 new cancer cases are projected to reach about 15 million every year; 70 percent of which will be in developing countries and over a million in Africa.
While prevention must be the mainstay of our strategy to reduce the burden of diseases, it clear that we must provide in addition provide treatment care and support. This is most clearly seen in our response to the HIV and AIDS epidemic that our country faces, however, focus on prevention is also central in our response to prevent chronic non communicable diseases, in particular cancers.
It is therefore my pleasure to add the voice of the ministry to the urgent call to increase access to palliative care by all our people, especially those most vulnerable communities that bears disproportionate burden of disease as a result of poverty and poor access to health services.
Additionally I would be failing in my duty if I didn’t commit to your initiative to raise awareness and understanding of the needs medical, social, practical, spiritual of people living with a life limiting illness and their families.
The WHO defines palliative care as an approach that improves the quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering, the early identification and impeccable identification and treatment of pain and other problems, physical, psychological and spiritual.
The WHO definition of palliative care tells us that the goal of palliative care is not to extend life but to improve quality of life for patients and family members facing the diagnosis of life-threatening or life-limiting illness. A good way to understand palliative care is to look at what it is not and what it should be:
* Palliative care is not just a literal service earmarked for persons who are terminal ill but is a continuum of care that embodies the PHC approach and a holistic philosophy for quality of care for all
* Palliative care should not be restricted to care provide at the end of life of individuals but should care that address all the needs of the patient through their interactions with the health care service and should integral part of care that is applied according to the principle of Batho Pele from the moment of diagnosis and extended along a continuum of care
* Palliative while recognising instances that family’s wishes and patient needs could lead to decisions to limit further active care for patient but it should not be about euthanizing or shortening people’s lives. In fact good pain relief has been shown to increase survival times
* Palliation by definition means bring comfort and peace as part of caring and responding to the needs of patients and their loved ones therefore relief of pain and providing palliation to reduce unnecessary suffering of people with progressive and life-threatening illnesses is an essential and necessary care for patients especially those that are suffering from conditions such as end stage renal failure, heart disease, HIV and AIDS, TB, cancer
* From a primary health care perspective it is desirable that we encourage the use of teams that from different skills and expertise include religious and spiritual practitioners and move away from exclusive use narrow domain specialists basic pain and symptom management can and should be done by generalists and there is a role for medical, nursing, home based carers and allied health palliative specialists
* Patients and their families are members of communities it is therefore important that we provide support and encouragement to many dedicated individuals, groups and organisation that provide community based support to care and provide for those in need, the Department of Health and other government departments including the Department of Social Development support the role played by these important organs of community in providing care to the needy.
At face value this appears like what every patient should be receiving when they access health care in our facilities be it in hospitals, clinics, step down care units, or in home and community based services such as hospices. However, truth be told, this level of care is not provided in all our health facilities as yet.
The needs of the patients must be address in a comprehensive and holistic manner in clinical setting. We need to be able to tailor our interventions to the specific needs of individuals and the also take into, where appropriate the needs, wishes and aspirations of their families. This is a tall order for an already overburden health system. Herein lays the importance of community involvement and participation. It is clear that the public health system cannot do this alone. We need support of our community to ensure that we provide compassionate care to everyone in need of care and support.
Sometimes as health workers we tend to focus on the aspects that we think are this often means focusing only clinical needs the psychological need of our patients. As health workers therefore we need to ask if our practices provide the comprehensive care. The following are therefore some of the questions that we need to ask ourselves as we evaluate the type of service we provide.
Our patients must get psychological, physical, spiritual support, care and empathy that meet both their spiritual and physical needs and aspirations.
We must ensure that our facilities are equipped to provide adequate and comprehensive services for those in need of relief of suffering and discomfort get adequate and appropriate medication for the relief from pain.
We should ensure as provider of palliative care services that our interventions do consider the rights of patient to dignity, confidential and right to make informed choice about options that are available to them. We must ensure that our hospice service use and choose methods and modalities that we know will provide enhancement of the quality of life?
We build strong ethos of compassionate care based on human by make sure that patient's families are informed, advised and supported at the time of diagnosis, during the illness and at the difficult time of bereavement and beyond?
If we honestly review our palliative care services, it is clear that there are gaps in our service. There are gaps with respect to accessing proper nutrition, to rehabilitation and recreational facilities, gaps related to psychosocial services and support to families. As a country we must accept responsibility for not giving necessary recognition to the development and sustenance of quality palliative care.
In ensuring that palliative care is optimally delivered, we look to the Hospice Palliative Care Association together with other organisations for solutions for the many challenges that we have. We are currently in the process of reviewing the national guidelines on palliative care and we hope that you will assist us in both the review and reshaping the guidelines. More importantly we would like to invite you to be partners on its implementation.
You are however assured of our commitment to ensure high quality and sustainable palliative care which will be accessed and afforded by all our communities.
This endeavour will require that care is fully integrated into all levels of service o delivery; that partnerships are built; that full multidisciplinary teams; are developed that the desired medication is available and accessed at a local level of care; that the invaluable role of community care workers is optimised and engagement with community is optimised, faith based and other organisations enriches care in our joint effort to help person live with dignity.
You are once again congratulated on the sterling work you have undertake in stated vision to increase the availability of hospice and palliative care, and raising awareness and understanding of the needs of the people living with live limiting illnesses and their families. The government and the department of health in particular once again congratulates you and wishes you a successful World Hospice and Palliative Care Day and we look forward to our partnership in making palliative care a reality for those many persons who die unnecessarily in pain and suffering.
I thank you!
Issued by: Department of Health
9 October 2009
Source: Department of Health (http://www.doh.gov.za/)
