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TB Palliative Care in Sierra Leone
Gabriel Madiye , IPPF , DPH
Chief Executive
The Shepherd’s Hospice Sierra Leone
OBJECTIVES
• BACKGROUND OF SERVICE
• NATIONAL TB BURDEN AND MDR
• TB TREATMENT AND PALLIATIVE CARE
• LESSONS
• A case of Palliative care in TB : Sorie
BACKGROUND OF SERVICE
• Founded in 1995
• Providing Pain relief and symptom management for cancer , HIV /AIDS other life threatening illnesses
• In 2005 Service realized that TB was a leading cause of death among HIV patients
BACKGROUND OF SERVICE (CONTD)
• Started advocacy for national TB /HIV collaborative policy to assure increased access to TB and HIV services for co-infected patients (OSI Funding)
• 2006 Partnered with NLTCP to introduce DOTS Volunteers in 14 Health Districts
• Model of DOTS volunteers in TB now funded by GFATM Rd 7
BACKGROUND OF SERVICE (CONTD)
• DOTS volunteers identify cough more than two weeks and refer for diagnosis
• Supports treatment in the community
• Advocate for community participation in TB treatment
• Trains treatment supporters etc
Funding by IUATLD / CIDA
BACKGROUND OF SERVICE (CONTD)
• Currently TB/ HIV treatment and palliative care is implemented With funds from DFID , HtH , EU and BftW .
• Project works with 26 community health care centres , providing lab microscopes , train lab technicians, CHOs and DOTS Volunteers
BACKGROUND OF SERVICE (CONTD)
• Mobilizes TB suspects and refer for test and treatment
• Manages pain in TB patients especially suspected MDR TB ( Freetown)
NATIONAL TB BURDEN HIV AND AIDS TUBERCULOSIS
Adult HIVprevalence (%)
1.558 TB prevalence, all forms (number)
56,103
People livingwith HIV/AIDS
48,000 TB incidence, all forms (number)
29,690
People dyingwith AIDS
4,600 TB mortality, all forms (number)
6,848
Estimated number of people needing ARV therapy
13,000 TB incidence, smear-positive (number)
13,208
Estimated number of people receiving ARV therapy
2,600
AIDS orphans 31,000
Statistical data provided by World Bank, WHO, UNAIDS
2006
[i]
MDR TB is estimated as 1200 ( 200 MDR per 1,000,000 population, WHO)
TB TREATMENT AND PALLIATIVE CARE
The Shepherd’s Hospice , Lower Allentown Freetown
TB TREATMENT AND PALLIATIVE CARE
Summary of Diagnosis and treatment of pain in 3 TB Patients
Name Diagnosis Age
Date 1ST treatment start
2ND treatment 3RD treatment Morphine prescription
Abdul K Kamara
TB Haemoptysis, bilateral side pain 5/5,chest pain 4/5,lumbar-sacral pain 5/5
49 March 2007- Nov 2008(St John of God Catholic Hospital- Lunsar)
20th April - 14th Dec 2009(TSH SL Clinic)
4th Jan – 31st Aug 2010TSH SL Clinic
N/A
Vandi Conteh
TB, Haemoptysis, bilateral side pain 5/5,chest pain 4/5
45 Jul 2007 – Mar 2008Rokupa Govt. Hospital
2009- Home Treatment
9th Sep 2010Ongoing @ TSHSLClinic
Liquid Morphine 10mg 4hrlyThen 20mg Bedtime x 2/12
Fengai TB, Haemoptysis, bilateral side pain 5/5,chest pain 4/5abdominal pain 4/5
45 Feb- Aug 1999Stoko Hospital- MakeniAug 2002-Mar 2003Rokupa Govt Hospital
7th -26th Dec 2009(TSH SL Clinic)
18th Sep 2010-(Ongoing @TSH SL)Clinic
Liquid Morphine 10mg 4hrlyThen 20mg Bedtime x 2/12
TB TREATMENT AND PALLIATIVE CARE
Abdul –Karim and HCW at home
Going through TB treatment for the third time
Komba’s pain is assessed and prescribed morphine
Going through TB treatment for the third time
Consent granted
TB TREATMENT AND PALLIATIVE CARE
(Contd)
Komba is given first dose of morphine solution after pain scored as severe
•Numbness
•Coughing at blood
•Pain in the chest
• sleeplessness
•Pain in the joints
•Dyspnea
Complaints
TB TREATMENT AND PALLIATIVE CARE
(Contd)
Patients collecting morphine
LESSONS
Partnership with patients and affected families for advocacy
Multidisciplinary team Meeting
Community Palliative Care Team Discussing patient care
Street Campaign for policy change
HIV activist advocating for Universal access to HIV and TB services
A case of Palliative care in TB : Sorie’s Story
WEIGHT LOSSOESOPHAGEAL CANDIDIASIS
COUGHPAIN
DEMENTIA HUNGER
REJECTIONEXTREME POVERTY
Sorie’s Story (Contd)
Sorie, looking forward
Sorie at home with 63 yr mother , 3 grand children
Hospice meets sorie
Sorie’s Story (Contd)
SORIE AT THE HOSPICE SORIE BY THE FRANGIPANGI
Watch with me
When I see you I feel assured .
When you touch me Then you tell me “You matter “
When you visit me home You are reaffirming your promise.
When you plan with meYou accompany me with empathy.
When you listen to me You affirm life
When I take my drugs for painThen you accomplish your promise
When I smile broadly in comfortYou get the “high”
Care is for me And drugs for you
Gratitude Dr. James Russell , Pal Consultant
Dr. Eddie Mwabesa , Pal Trainer , HAU
Francis Kamara , Clinical Officer
Hannah NGobeh , Snr
Thank you