In October 2015, the World Health Organization Eastern Mediterranean Region (WHO EMRO) organised the third ‘Train the Trainers’ workshop about palliative care. As a special adviser to the WHO EMRO, Prof Sheila Payne met leaders in palliative care from the region and invited them to contribute to this special series on palliative care in North Africa and the Middle East.
Today, we hear from Dr Samy Alsirafy, Professor of Clinical Oncology, Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
In the early 2000s, Mr MA was one of the patients included in the study of my PhD in oncology. He was a recently married farmer from a village in Beni-Swif, around 90 km south of Cairo. Unfortunately, he did not respond to treatment and was receiving the best possible supportive care for his terminal cancer. During his terminal illness, I did my best to control his symptoms and helped in addressing his psychosocial and spiritual issues. He missed a follow-up appointment with us and after a few weeks, his brother came to visit me at the cancer centre and told me that MA had died at home. The brother gave me one of the gifts that I will never forget. MA, while dying, had asked his brother to come to me after his death to say “Thank you”. I did not expect that feedback from MA and his family.
My experience with MA and other dying cancer patients led me to believe that a specialized terminal care service was needed for dying cancer patients in Egypt.
In 2008, the first university hospital-based palliative medicine unit (PMU) was established at Kasr Al-Ainy School of Medicine – Cairo University.1 Currently, more than 600 new patients are referred annually to the PMU; the morphine consumption increased gradually at our cancer centre and had exceeded three kilograms/year before the morphine shortage crisis in Egypt.2, 3 The service is provided through an outpatient clinic held six times a week with an average of 22 consultations per clinic. In addition, there are two other models of service provision, inpatient beds and home care. The home care is provided in collaboration with a local home care service. Research is a priority of the PMU and focuses on assessing the needs of palliative care patients, development of culturally sensitive palliative care models and overcoming barriers to palliative care and cancer pain control in Egypt.
There is a rising awareness of the importance of palliative care in Egypt, especially among cancer care professionals. However, very few palliative care services exist and these are mainly for cancer patients. Palliative care development is slow and is faced by many obstacles. For example, the very low consumption of opioids in Egypt indicates highly inadequate cancer pain control.3 The current restrictive regulations limit significantly the access of cancer pain patients to opioids, especially morphine.4 This is further complicated by the unavailability of essential opioids such as immediate-release oral morphine; and the negative attitude towards tramadol, the only weak opioid available in Egypt.3, 5
Palliative care in Egypt has a long way to go. There is a need to develop culturally sensitive palliative care delivery models suitable for the country’s resources. Home care models are a priority because the majority of Egyptian cancer patients die at home.1 The opioid restrictive regulations should be revised and affordable opioids should be made available in Egypt. Palliative care education at all levels is necessary, as well as governmental support.
- Alsirafy SA, El Mesidy SM, Abou-Elela EN. Where do Egyptian palliative care patients with cancer die? Am J Hosp Palliat Care, 2010; 27(5): 313-315.
- Alsirafy SA, Ibrahim NY, Abou-Elela EN. Opioid consumption before and after the establishment of a palliative medicine unit in an Egyptian cancer center. J Palliat Care, 2012; 28(3): 135-140.
- Alsirafy SA, Farag DE. A shortage of oral morphine in Egypt. Bull World Health Organ, 2016; 94(1):3.
- Alsirafy SA, El Mesidy SM, El-Sherief WA, et al. Opioid needs of patients with advanced cancer and the morphine dose-limiting law in Egypt. J Palliat Med, 2011; 14(1): 51-54.
- Alsirafy SA, Saleh RN, Fawzi R, et al. The fear of using tramadol for pain control (tramadolophobia) among Egyptian patients with cancer. J Opioid Manag, 2015; 11(6): 474-480.
Note: For reasons of patient confidentiality, the patient’s name has been changed.
Read more posts in this series
Click here to read our first post in this series from Dr Nahla Gafer in Sudan. Next week, Dr Sami Ayed Alshammary will be writing about palliative care in Saudia Arabia.