World Hospice and Palliative Care Day is October 8

At the NHPCO Management and Leadership Conference in this year, I had the opportunity to sit down with Dr. Paul Zebadia Mmbando, manager of the Evangelical Lutheran Church in Tanzania Palliative Care Program.  We met to discuss the positive impact that results from U.S. and international hospice and palliative care programs partnering to increase access to hospice and palliative care where the need great and resources few -- like his home country of Tanzania.  Part of our discussion shifted to the need for more palliative care training, including more training on prescribing pain medication, for healthcare professionals in Tanzania. As prepare for World Hospice and Palliative Care Day here at NHPCO, I can’t help but reflect back on my meeting with Dr. Mmbando. 

The theme for WHPCD is ‘Living and dying in pain: It doesn’t have to happen’. According to the Worldwide Hospice and Palliative Care Alliance, “75% of the world population does not have adequate access to controlled medications for pain relief,” and because of this, “millions of people suffer from pain which is avoidable and could be managed with proper access to the correct medications.  

This year’s WHPCD aims to educate the world on three barriers for access to pain relief:  restrictive regulations, poor education, and economic barriers. Dr. Mmbando mentioned each of these barriers in our discussion and was particularly focused on education. He explained to me that “opioid phobia” is a challenge among healthcare professionals who do not feel educated enough to provide pain medication or fear that it will lead to substance abuse. Up until 2011, only four facilities in Tanzania were allowed to prescribe morphine. Four facilities…it’s hard to comprehend.

Despite that sobering statistic, Dr. Mmbando remained positive. “Through our program we train people,” he said. “All of our facilities now have a member of the palliative care team who is able to prescribe morphine.” 

He went on to explain that many physicians, especially those who are not trained in palliative care, are still very cautious when it comes to prescribing morphine. “They still call it a drug of substance abuse,” he says. “It’s something that is rooted in the training that they have had.” 

There are measures being taken to address this barrier. WHPCA cites the following:

• Countries are now including palliative care education for medical and nursing students.  
• The Hospice Africa Uganda morphine initiators’ course at the Institute of Hospice and Palliative Care in Africa trains healthcare workers from all over Africa in how to safely prescribe and administer morphine.
• The University of Cape Town runs a Master’s course and Postgraduate Diploma in Palliative Medicine which use distance learning so that busy professionals can expand access to palliative care and pain management, as well as the research base on this topic.
• In Tajikistan a course on pain relief and palliative care is being developed for police professionals.

Dr. Mmbando feels that more partnerships between U.S. and African hospice and palliative care organizations, would help increase and improve the training for healthcare professionals. His trip to the U.S. was an opportunity to network with interested organizations to educate about the need for more partnerships in Tanzania. Through knowledge sharing and financial support, healthcare facilities would be better equipped to help their patients manage their pain. 

There are currently twelve active partnerships but there are eleven programs that need a U.S. partner. “It’s a bit of a challenge that there are still so many facilities that don’t have a partner,” says Dr. Mmbando.

World Hospice and Palliative Care Day is October 8. Please take the time to visit the WHPCA website and review the key messages that help support this vital day of awareness.

Amanda Bow
NHPCO, Director of Communications