B12. Incorporation of Palliative Care in the continuum of care for PLWAs
Dr M J Bates, Dr P Stephany, J Mackreill
Objectives and scope: Palliative care has been widely advocated as an essential part of the global response to the HIV/AIDS epidemic1. The Ministry of Health has incorporated palliative care in its guidelines for the management of HIV infection and the ARV scale up teaching programme. However few models of palliative care exist in Malawi at the present time. This paper describes the developing work of one such model - Tiyanjane clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi.
Methodology: Tiyanjane clinic operates in the Department of Medicine as a partnership between the hospital and the College of Medicine. The following services are offered - HIV counselling and testing for medical in-patients; discharge planning, advice and referral; and palliative care for medical in-patients. Palliative care teaching and training is also undertaken by clinic staff.
Results: Between July and December 2004 127 medical in-patients were referred to the Tiyanjane clinic team for palliative care. Of these 15% had a diagnosis of tuberculosis and 26% had a diagnosis of KS. 17% had a diagnosis of other forms of cancer. 31% died whilst on the ward and 54% were discharged, most to home based care follow up. 59% of palliative care patients received morphine either for pain or other symptoms.
Conclusions: Palliative care can be incorporated into the continuum of care for PLWAs within the context of hospital based management of patients, given a minimum number of dedicated, trained health personnel and access to opiate analgesia.
Recommendations: Further recognition and support of palliative care initiatives is required at a national level in Malawi in order to improve the quality of life for people infected and affected by HIV/AIDS, enabling people to ‘live until they die’.
1 The untapped potential of palliative care for AIDS.The Lancet 2003; 362:1773