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