Challenges of Hospice and Palliative Care in Nigeria

HIV has affected people all across the world. HIV comes with physical and mental symptoms. The body symptoms include skin flaking off, being dry, skin peeling off (Saliba 23) , fingernails falling off (32), and weight loss (14). Mentally it is hard to sleep, people become weak, and are tired all the time (23). People all across the world are infected with this disease, and the problem with this is the fact that most do not even know they have it. The most people who are infected each year are African Americans, gays, or bisexuals. 10,315 African Americans were infected in 2015. The U.S.A. has estimated about 1.1 million are infected with the disease. Equally to about 12,333 deaths happened in 2014 from AIDS related diseases, and 6,721 deaths from AIDS directly. Although there are a large amount of people getting infected, on the other hand eighteen percent of the population with HIV is declining since 2008-2014 (“U.S. Statistics”). In the world about 33.2 million people worldwide have HIV, with 22.5 million people in sub Saharan Africa are living with this condition, one out of nine people who live in South America have HIV or AIDS (Saliba 8).

Nearly three decades ago, there was an increase in deaths of HIV in sub-Saharan Africa. Developing countries have experienced the greatest HIV/AIDS morbidity and mortality, with the highest prevalence rates recorded in young adults in sub-Saharan Africa. In South Africa over three million people are killed by this disease (Macfarlene3). After this epidemic spreaded in Africa and killed people it branched out to other countries in the world.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

There are an immense amount of problems in Africa caused by the AIDS disease. Healthcare providers are available and located all over Africa. Even though they are available, they have only “enough medicine for long-term survival available for 30,000 Africans” (Copson, 3).

In almost every case of a terminal disease, pain is intolerable and seeing someone in such agony is heartbreaking. For example, Brittany Maynard, a 29 year old brain cancer patient who had to move to Oregon so she can avail of the Death with Dignity act. “Maynard knew that her form of brain cancer would be excruciating. She would endure swelling of the brain that would very likely cause seizures, painful headaches and the gradual loss of bodily function. Doctors know that for about 5 percent of the population, no amount of morphine can block the agonizing pain the terminally ill endure” (EDITORIAL: Dying with dignity). Palliative care can often be provided for the dying patients and alleviating pain to provide comfort for the dying has always been the priority. “Palliative care focuses on relieving the symptoms, particularly the pain, of incurable illness.” (Palliative Care) But, in relieving pain through the prescribed medications there are also side effects that are caused by the prescribed pain suppressors and two examples will be lethargy and it compromises breathing. In most cases the effectivity of the pain medication may no longer alleviate the pain. If a patient will be in such agony for the remaining days or weeks the quality of life is no longer present. The agony of pain prevents a patient from performing even just the bodily functions.

Every culture has its own way of dealing with sickness and illness. Growing up both in Angola and the United States, a person is able to reflect on cultures and their own myths as well as beliefs. These cultures are very different from one another in respect to their outlook on illness and hospitalization. Being Angolan in the American healthcare industry, they experience many different attitudes about how to best treat medical illness. During the time of sick or for curing disease in Angola, the people would rather see their traditional healer than a doctor for such things as; fever, stomachache, bad dreams, pain, or mental disorders. They don’t have access to the same kind of healthcare services as the Americans do. Only a few people can afford good medical care and unfortunately many have a life expectancy that is below fifty years of age mostly related to poverty related diseases such as; tuberculosis, malaria, and measles.

What was once believed to be a form of neglect has resulted in a change in practice with the idea that doing less is more. Culture is an important factor in how care is rendered and thus, the limitations of palliative and hospice care lie within the desires of the family and patients. A thorough understanding of our surrounding demographics helps to ensure a seamless approach to providing care without bias or imposition of ones beliefs. However, just as with all things, providing care for the sick and comforting the dying should be rendered in moderation as to prevent the effects of burn out. Likewise, the same effects occur in the caregivers who sacrifice their responsibilities in order to care for their love ones. Finally, and with some closing thoughts, the writer wishes to express with gratitude the benefit of having taken this course to better understand oneself and others in the realm of healthcare. The lessons learned throughout have expanded this writer's knowledge and understanding of the human desire to make a connection through communication, emotion, compassion, and spiritually - the platform from which this writer wishes to continue seeking further knowledge and

Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).

Health care is defined as the efforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals (Merriam-Webster dictionary). The study of human societies has revealed that people have always find different ways, depending on their environment, to restore their health. In early societies, they used plants, animals and mineral extracts and even religious rituals, to drive away evil spirits, to relieve their symptoms. The healthcare system as we know it today is the fruit of centuries of evolution and is in perpetual improvement. It appears clearly that healthcare has always been a major concern for people. The healthcare setting is appropriate for people who are sick; better tools and well-trained professionals can help reduce the impact of a

Although ninety-five percent of people living with HIV/AIDS are in developing countries, the impact of this epidemic is global. In South Africa, where one in four adults are living with the disease, HIV/AIDS means almost certain death for those infected. In developed countries however, the introduction of antiretroviral drugs has meant HIV/AIDS is treated as a chronic condition rather than a killer disease. In developing countries like South Africa, the drugs that allow people to live with the disease elsewhere in the world, are simply too expensive for individuals and governments to afford at market price.

Currently in South Africa there are 5.26 million people living with HIV. This means that 10% of the South African population is directly affected by the virus and requires us to ensure clear guidelines are in place for the management of HIV (Statistics South Africa, 2013).

2.4 million people died of an AIDS-related illness in Africa, and since the beginning of

Sub-Saharan Africa is the region of the world that is most affected by HIV/AIDS. The United Nations reports that an estimated 25.4 million people are living with HIV and that approximately 3.1 million new infections occurred in 2004. To put these figures in context, more than 60 percent of the people living with the infection reside in Africa. Even these staggering figures do not quite capture the true extent and impact that this disease causes on the continent. In 1998, about 200,000 Africans died as a result of various wars taking place on the continent. In that same year, more than 2 million succumbed to HIV/AIDS (Botchwey, 2000).

HIV is a virus that is spread almost all over the world. Although in some places health care isn’t as developed and therefore it spreads more in those regions. Sub-Saharan Africa holds more than 70%, 25 million, of all HIV positive people in the world. Second highest is Eastern Europe together with Central Asia with 1.3 million. It is spread over most of the world, including Asia and the Pacific, the Caribbean, Central and South America, North Africa and the Middle East and Western and Central Europe (“The Regional Picture”).