What constitutes a good death in sub-Saharan Africa? In Meru District in Eastern Kenya, we listened to 32 patients with ongoing cancer or AIDS, and to their carers as they talked about end-of-life experiences and care needs. Patients described how the support of close family relationships, and the care shown by their community and religious fellowships helped meet many of their emotional, social, and spiritual needs. But physical needs often went unmet. Patients died in pain. Some suffered in poverty, others were troubled by the guilt of using all available family resources to pay for treatment and care. Accessible pain relief, affordable clinic or inpatient care when required, and help to cope with the burden of care we~e among the key needs of patients. Until these are available, many will not die well. Resume I Qu'est-ce qui constitue une « bonne mort » en Afrique sous-saharienne? Dans Ie district de Meru, situe dans I'est du Kenya, nous avons interviewe 32 patients atteints du sida ou du cancer ainsi que leurs soignants afin qu'ils nous parlent de leurs experiences de fin de vie et des soins dont lis avaient besoin. Les patients nous ont dit a quel point Ie support de .Ieurs proches et "aide de leur eornmunaute et de leur Eglise leur avaient ete d'un grand secours en repondant a leurs besoins d'ordre emotionnel, social, et spirituel. Par ailleurs, leurs besoins d'ordre physique sont souvent derneures sans reponse. Les patients meurent dans la douleur. D'autres souffrent dans une grande pauvrete, ou encore eprouvent des sentiments de culpabllite parce qu'ils utilisent toutes les :essources flnancieres de leur famille pour payer les tralternents et les soins dont i1s ont besoin. Parmi les besoins primerdiaux qui ont ete souleves mentionnons I' acc.e~a des medicaments pour soulager la douleur, les cliniques a prix abordables, les soins dispenses en etablissements hospitaliers, et I'aide d'autres personnes pour partager et soulager Ie fardeau des soignants. Tant qu'on ne pourra repondre aces besoins, beaucoup de patients n'auront pas une « bonne mort ».
Objective To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country. Results 67 interviews were conducted in Scotland and 46 in Kenya. The emotional pain of facing death was the prime concern of Scottish patients and their carers, while physical pain and financial worries dominated the lives of Kenyan patients and their carers. In Scotland, free health and social services (including financial assistance) were available, but sometimes underused. In Kenya, analgesia, essential equipment, suitable food, and assistance in care were often inaccessible and unaffordable, resulting in considerable unmet physical needs. Kenyan patients thought that their psychological, social, and spiritual needs were met by their families, local community, and religious groups. Some Scottish patients thought that such non-physical needs went unmet. Conclusions In patients living in developed and developing countries there are differences not only in resources available for patients dying from cancer but also in their lived experience of illness. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care.
Asking a man "Are you circumcised?" is not sufficient. Classifying his circumcision status requires both a genital examination and an understanding of the precise local surgical techniques used. Even in a small geographic area, considerable variety may exist in the techniques of cutting, removing, altering, or leaving different portions of the foreskin. Each variation may affect the transmission of HIV and other infections.
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