As I See It: An Outside View on African Healthcare

Rebecca Kowaloff, DO

Hospice Africa (HA) is more than Uganda’s national hospice, it is a leader for the continent. From three sites spread across this Central African country, nurses, social workers, chaplains, and doctors serve patients in their homes at hospice clinics, and at community mobile clinics providing physical, emotional, and spiritual comfort for patients and their caregivers, relieving as much suffering as they can. Teams travel across bumpy dirt roads to visit cachectic patients curled on foam mattresses on the floor. They check vital signs and bring the most revolutionary of their interventions: oral liquid morphine.

I had watched the green liquid mixed from water and vats of powdered morphine at the Hospice’s main site in the capital city of Kampala. It is decanted into brown water bottles, prescribed, and distributed by HA’s trained nurses. Uganda was the first country in the world to legislate that nurses could prescribe morphine, a necessary measure given the country’s physician shortage. Opioid addiction has not become a problem in Uganda since the oral morphine program, a public-private partnership funded by the government, began in the mid-1990s. Now, morphine is provided for free through government funding. HA trains palliative care clinicians from across sub-Saharan Africa in all aspects of supportive care for seriously ill patients. Their services are vital in a country whose life expectancy just 30 years ago was under 40 due to HIV/AIDS and cancers not seen in the United States. Screening protocols in Africa are unfortunately not as common as they are stateside. In cancer “wards” that were open-sided pavilions with mattresses on the floor, to cement block shacks with dirt floors, and for caregivers juggling enormous family and financial burdens, the ability to provide real relief of suffering, not just from a brown bottle, but from a support team arriving in an old van, has made an enormous difference on a continent where global health disparities are most prominent.