Developing a palliative care service for children in the Queen Elizabeth Central Hospital, Blantyre, Malawi

Abstract

There are too few palliative care services for children in resource poor countries. Health carers are overwhelmed with cases of acute illness that need their urgent attention, and chronically ill children with life-limiting diseases have been sidelined. The HIV epidemic in southern Africa revealed the huge needs in our own hospital, and in 2002, we started a hospital-based paediatric palliative care service. It was the first in Africa. We describe here how it developed and expanded in the ensuing years and how it has affected our staff, the children and their families in our care.

Approaches to integrating palliative care into African health systems: a qualitative systematic review

“…This was facilitated using referrals and members from the PC team attending ward rounds or offering consultations on symptom management. ‘Outpatient clinics’: many interventions used this mechanism to integrate PC into a facility, ( Molyneux et al , 2013 ; DesRosiers et al , 2014 ; Cornetta et al , 2015 ; Lowther et al , 2015 ; Zipporah, 2016 ; Gwyther et al , 2018 ). Usually individuals were seen together with their caregiver; however group outpatient clinics were also described ( DesRosiers et al , 2014 ).…”

“…Usually individuals were seen together with their caregiver; however group outpatient clinics were also described ( DesRosiers et al , 2014 ). ‘Drop-in clinics’: two interventions ( Hongoro and Dinat, 2011 ; Molyneux et al , 2013 ) used drop-in clinics, for which the patient did not need to make an appointment but could attend when they were at the hospital for other treatments. ‘Outreach visits’: outreach visits were used to provide specialist PC services away from the facility, to reduce hospital admissions in one study ( Hongoro and Dinat, 2011 ).…”

“…‘Drop-in clinics’: two interventions ( Hongoro and Dinat, 2011 ; Molyneux et al , 2013 ) used drop-in clinics, for which the patient did not need to make an appointment but could attend when they were at the hospital for other treatments.…”

“…Some interventions created a PC network through the development and linking of PC services in a geographic area using horizontal and vertical integration ( Defilippi, 2005 ; Nanney et al , 2010 ; Molyneux et al , 2013 ; Herce et al , 2014 ; Zipporah, 2016 ; Krakauer et al ,2018 ). Others developed a hospital-based PC team ( Kirk and Collins, 2006 ; Herce et al , 2014 ; Gwyther et al , 2018 ) providing specialist PC, usually to hospital inpatients, or functioning as consultants for symptom management.…”

“…Others developed a hospital-based PC team ( Kirk and Collins, 2006 ; Herce et al , 2014 ; Gwyther et al , 2018 ) providing specialist PC, usually to hospital inpatients, or functioning as consultants for symptom management. They also performed a supervisory role to CHWs ( Nanney et al , 2010 ), hospital ward staff ( Downing et al , 2016 ; Zipporah, 2016 ; Gwyther et al , 2018 ) or staff in other health facilities ( Molyneux et al , 2013 ; Herce et al , 2014 ). In certain interventions, the hospital-based team developed treatment plans for care coordination and acted as links between hospital departments or between the hospital and external community resources, such as Hospices.…”