Dr Catherine D’Souza

Introduction

Dr Catherine D’Souza, a palliative care specialist currently working in the UK, has shared her experiences working in Cameroon where she provided volunteer services to the Cameroon Baptist Convention and Hospice Africa.

Catherine’s Experience in Cameroon

When I arrived in Cameroon to work as a palliative care doctor in September 2009, I knew very little about what to expect. There were many questions in my mind such as “were drugs available?”, “what was the cultural approach to death and dying?” and “how did witch doctors fit in?”.

When I arrived in Cameroon, I found a dynamic, lively, bustling and very, very green country, full of smiles and welcomes. My husband and I came to Cameroon to help to develop the very new hospice services within the Cameroon Baptist Convention (CBC) Health Board which had established the first palliative care service in the country in 2007.

The first African hospice was established in Ethiopia in 1979. Dr Anne Merriman founded Hospice Africa Uganda in 1993 which led to the development of a model unit which could be replicated throughout Africa. Dr Merriman and her team visited Cameroon to aid the development of palliative care, particularly in Francophone West Africa. Until CBC opened its arms to the concept of palliative care after the intervention of Hospice Africa, when a person suffered from severe pain in Cameroon, they had to suffer. Many countries in Africa still have no access to strong opioids and frequently the strongest pain relieving agent is paracetamol. With cancer increasing, more will be need to be done to alleviate the pain and suffering experienced by patients with cancer, particularly for those who cannot be cured.

My husband and I dealt with a range of clinical scenarios; mostly patients with cancer, but also with patients who had HIV/AIDS related problems. It took some time to get used to the attitudes towards death and illness. Sickness was often regarded as a curse that needed the attention of a traditional healer in order to be relieved. Many people who came to the hospital were at the end stage of their illnesses with very little curative or life-prolonging possibilities. It was always difficult to see young people who could have been helped by medical therapies such as chemotherapy, suffer and die as they had come too late or had no money to pay for treatment.

The hospice team was able to provide hope and relief to the many who had been suffering in pain for periods of weeks or months. Absent for so long, smiles returned to the faces of patients and families. During our time in Cameroon, we worked with the team to develop services. Many changes were possible. We were able to expand to new areas, start a volunteer service, treble the number of patients seen, open new units and educate others about palliative care. Through educating people, we managed to dispel many of the old fashioned beliefs about the use of opioids because when we arrived most people believed that using morphine automatically caused addiction and hastened death. These wonderful changes and achievements were due to the openness and hard work of the team and the willingness of CBC to hear new ideas.

There is still much work to be done; palliative care and opioids are only readily available in a few areas of Cameroon, and we aim to expand to new regions. We need to spread the message of palliative care to more countries in West Africa. To meet these aims Alliance Mondiale Contre le Cancer (AMCC), INCTR’s French branch and Hospice Africa are working in partnership towards building palliative care model units and training centers for Central and West Africa.

There are so many opportunities to get involved in palliative care in Cameroon; as a member of the clinical team, in teaching, managing and development.

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The last home visit to a dying patient and her child

For additional information, please contact: gro.ccma-recnac|tcatnoc#gro.ccma-recnac|tcatnoc

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