Hospice care
Hospice Saint Vincent de Paul, Jerusalem
Hospice has faced resistance springing from various factors, including professional or cultural taboos against open communication about death among physicians or the wider population, discomfort with unfamiliar medical techniques, and professional callousness towards the terminally ill.[15] Nevertheless, the movement has, with national differences in focus and application, spread throughout the world.[16]
In 1984, Dr. Josefina Magno, who had been instrumental in forming the American Academy of Hospice and Palliative Medicine and sat as first executive director of the US National Hospice Organization, founded the International Hospice Institute, which in 1996 became the International Hospice Institute and College and later the International Association for Hospice and Palliative Care (IAHPC).[17][18] The IAHPC, with a board of directors as of 2008 from such diverse countries as Scotland, Argentina, Hong Kong and Uganda,[19] works from the philosophy that each country should develop a palliative care model based on its own resources and conditions, evaluating hospice experiences in other countries but adapting to their own needs.[20] Dr. Derek Doyle, who was a founding member of IAHPC, told the British Medical Journal in 2003 that through her work the Philippine-born Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries."[18] Standards for Palliative and Hospice Care have been developed in a number of countries around the world, including Australia, Canada, Hungary, Italy, Japan, Moldova, Norway, Poland, Romania, Spain, Switzerland, the United Kingdom and the United States.[21]
In 2006, the United States based National Hospice and Palliative Care Organization (NHPCO) and the United Kingdom's Help the Hospices jointly commissioned an independent, international study of worldwide palliative care practices. Their survey found that 15% of the world's countries offered widespread palliative care services with integration into major health care institutions, while an additional 35% offered some form of palliative care services, though these might be localized or very limited.[22] As of 2009, there were an estimated 10,000 programs internationally intended to provide palliative care, although the term hospice is not always employed to describe such services.[23]
In hospice care the main guardians are the family care giver and a hospice nurse who makes periodic stops. Hospice can be administered in a nursing home, hospice building, or sometimes a hospital; however, it is most commonly practiced in the home.[24] In order to be considered for hospice care, one has to be terminally ill or expected to die in six months.
Africa
1980 saw the opening of a hospice in Harare, Zimbabwe, the first in Sub-Saharan Africa.[25] In spite of skepticism in the medical community,[15] the hospice movement spread, and in 1987 the Hospice Palliative Care Association of South Africa formed.[26] In 1990, Nairobi Hospice opened in Nairobi, Kenya.[26] As of 2006, Kenya, South Africa and Uganda were among the 35 countries of the world offering widespread, well-integrated palliative care.[26] Programs there are based on the United Kingdom model, but focus less on in-patient care, emphasizing home-based assistance.[27]
Since the foundation of hospice in Kenya in the early 1990s, palliative care has spread through the country. Representatives of Nairobi Hospice sit on the committee to develop a Health Sector Strategic Plan for the Ministry of Health and are working with the Ministry of Health to help develop specific palliative care guidelines for cervical cancer.[26] The Government of Kenya has supported hospice by donating land to Nairobi Hospice and providing funding to several of its nurses.[26]
In South Africa, hospice services are widespread, focusing on diverse communities (including orphans and homeless) and offered in diverse settings (including in-patient, day care and home care).[26] Over half of hospice patients in South Africa in the 2003-2004 year were diagnosed with AIDS, with the majority of the remaining having been diagnosed with cancer.[26] Palliative care in South Africa is supported by the Hospice Palliative Care Association of South Africa and by national programmes partly funded by the President's Emergency Plan for AIDS Relief.[26]
Hospice Africa Uganda (HAU) began offering services in 1993 in a two-bedroom house loaned for the purpose by Nsambya Hospital.[26] HAU has since expanded to a base of operations at Makindye, Kampala, with hospice services also offered at roadside clinics by Mobile Hospice Mbarara since January 1998. That same year saw the opening of Little Hospice Hoima in June. Hospice care in Uganda is supported by community volunteers and professionals, as Makerere University offers a distance diploma in palliative care.[28] The government of Uganda has a strategic plan for palliative care and permits nurses and clinical officers from HAU to prescribe morphine.