We have recently returned from our fourth visit to Addis Ababa. With less than 1% of the estimated 150,000 new cancer cases annually in Ethiopia receiving specialist oncological treatment [1], the need for affordable palliative care in the country is huge.

Hospice Ethiopia, the only palliative care unit in the country providing symptom control treatment, was set up in 2003 by Sister Tsigerada Yiswafossen. It is a non-governmental organisation and as such has to raise 90% of its funds from outside the country. When funding is dependent on donors there is a continuous need of international and domestic networking.

The objectives of Hospice Ethiopia are quality of life for their patients, training of health professionals, and raising awareness of palliative care needs and treatment. The four nurses and one part-time doctor at Hospice Ethiopia provide community based palliative care free of charge to terminally ill people in three districts (estimated population of 900,000) in the east/north of the city.

Access to opiates is finally improving. Since we first visited four years ago, the number of hospitals in Addis Ababa that have access to oral morphine has increased from one to nine. With training from Hospice Ethiopia staff, support from the Ethiopian government, and funding from the US, 700 healthcare professionals are now able to appropriately use strong opioids. It has been a privilege to see and be a small part of this process, (which puts our NHS work as a GP and Community Specialist Palliative Care Nurse into perspective). Hospice Ethiopia staff have also helped to produce national palliative care guidelines, published by the Ethiopian Ministry of Health.

A recent exciting development is a project supported by the WHPCA to enable Hospice Ethiopia to work with the traditional burial societies known as Iddirs to promote palliative care delivery to Ethiopia’s rural population. Iddirs were originally set up to help with the costs of burials but are now used for a wide range of community issues.

We are part of a small group based at Priscilla Bacon Lodge Specialist Palliative Care Unit in Norwich who support Hospice Ethiopia. We have close links with a similar group led by Dr Norrtsrom in Sweden and with Professor Anne Merriman at Hospice Africa Uganda. We endeavour to promote much needed palliative care in this fast changing part of Africa. We will be back in the new year!

References:

1 Woldeamanuel YW, Girma B, Teklu AM. Cancer in Ethiopia. Lancet Oncol 2013;14:289–90. doi:10.1016/S1470-2045(12)70399-6.

Jamie Mumford is a GP in north Norfolk and Sue Mumford is a community palliative care nurse.

Photo: patient consent obtained.