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An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent
Includes bibliographical details.
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| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Department of Public Health and Family Medicine
2014
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| _version_ | 1867613139989692416 |
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| access_status_str | Open Access |
| author | Hartwig, Kristopher |
| author2 | De Vries, Elma |
| author_browse | De Vries, Elma Hartwig, Kristopher |
| author_facet | De Vries, Elma Hartwig, Kristopher |
| author_sort | Hartwig, Kristopher |
| collection | Thesis |
| description | Includes bibliographical details. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/10624 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:24.573Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2014 |
| publishDateRange | 2014 |
| publishDateSort | 2014 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/10624 An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent Hartwig, Kristopher De Vries, Elma Palliative Care Includes bibliographical details. In Tanzania, palliative care is relatively new, and faces the common challenges of access to services, crucial medications, and education. Since 2004, an initiative within the health system of the Evangelical Lutheran Church in Tanzania (ELCT) began to promote and develop palliative care, using as a model the Selian Hospice and Palliative Care Programme. The hospitals which are the sites for team development and service delivery are widely scattered throughout rural Tanzania. Access to oral morphine was only a dream, as it is for much of the rural population of the world. In 2007, a program called CHAT (Continuum of care for people living with HIV/AIDS in Tanzania), funded by the U.S. government, allowed the up-scaling of these palliative care programs, resulting in 13 strong and mature teams by 2011, though still lacking oral morphine. Part of the monitoring and quality assurance of the program has been use of a tool developed by APCA: the APCA African Palliative Outcome Scale (POS). Hundreds of people living with cancer and HIV were subjected to the questions of the tool, which was always sent on to the core supervising team for assessment and feedback. Tramadol was the strongest analgesic available to the teams throughout the study time. 145 APCA African POS results on cancer patients were assessed, looking at differences in pain scores (0 to 5 scale) over time as well as assessing the other domains of care (psychological, spiritual, social, and family). 11 Palliative care nurses were also interviewed, asked to reflect on specific cases from their experience with both good and bad pain control. 5 of the nurses came from Selian, with access to oral morphine, while 6 of them came from the CHAT hospitals. Significant improvement in pain scores over 4 weeks was noted (3.83 to 2.31, p < 0.0001). All other domains assessed in the POS also improved significantly. Nurse interviews revealed an emphasis on the holistic approach and a strong preference for having access to oral morphine. In this rural Tanzanian environment, effective palliative care services – including pain control - were delivered even in the absence of oral morphine. Such services can become a strong advocacy at the government level for achieving breakthroughs in palliative care, including access to oral morphine. 2014-12-30T19:49:24Z 2014-12-30T19:49:24Z 2011 Master Thesis Masters MPhil http://hdl.handle.net/11427/10624 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Palliative Care Hartwig, Kristopher An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| thesis_degree_str | Master's |
| title | An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| title_full | An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| title_fullStr | An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| title_full_unstemmed | An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| title_short | An evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent |
| title_sort | evaluation of palliative care in rural tanzania where availability of oral morphine is intermittent or absent |
| topic | Palliative Care |
| url | http://hdl.handle.net/11427/10624 |
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