From crisis to sustainability: Building palliative care with limited resources

Only 22 days to #EAPC2019 … The 16th World Congress of the European Association for Palliative Care: ‘Global Palliative Care – Shaping the future’ will explore how palliative care fits with the current global health and identify areas where more needs to be done. 

Today, Dr Christian Ntizimira gives a glimpse of the plenary lecture that he will give at #EAPC2019 in Berlin on Saturday 25 May 2019. Dr Ntizimira is currently a Fulbright scholar in Global health and Social Medicine at Harvard Medical School, USA, and also City Cancer Manager at the City Cancer Challenge Foundation, Geneva, Switzerland.  

Dr Christian Ntizimira

I was 16 years old when I witnessed the April 1994 post-genocide against the Tutsis in Gisenyi, the major city of Rubavu district in the north-west of Rwanda. The city of Gisenyi was empty and full of dead bodies everywhere and nothing could give a sense of hope and future.

I remember walking to the public hospital and seeing people suffering from wounds and different diseases; but the most difficult part of this atrocity was the sense of humanity, which seemed to be lost during that period. This bad experience motivated me to devote my career to preventing and relieving the unnecessary suffering of all Rwandans.

I remember after my medical school, I met a young man of 24 years old, dying of liver cancer and suffering from unimaginable pain. Worse than the pain he was enduring was the fact that I, a trained medical doctor, could not relieve his suffering because of regulations that prevented access to morphine prescription, an essential pain medication. The young man died in so much pain and without dignity. At that time, to prescribe one dose of morphine the protocol required signatures in red ink from three different department heads to prevent drugs abuse. In developing countries, family members typically shoulder a great deal of the burden of caring for patients – both financially and in other ways. Current models for advance care planning and end-of-life care decision-making have grown out of the Euro-American clinical and cultural experiences.

In the past 25 years, Rwanda has made remarkable steps towards recovery. The country hasbeen able to rebuild the national security and stability, revitalise the economy and other sectors, including, the health sector. In 2011, Rwanda became the first country to launch a national palliative care policy, strategic plan and implementation programme to improve the quality of life of HIV/AIDS and cancer patients and their family members during treatments. Cultural values, beliefs and preferences often drive decision-making processes and the effectiveness of communication, as well as the quality of clinician-patient relationships.

It is therefore imperative that palliative care specialists, who are collaborating with patients – arguably during the most pivotal moments of living and dying – understand the role and implications of delivering equitable care, characterized by cultural inclusion, respect, and sensitivity.

The Rwanda Ministry of Health has created a locally relevant and people-centred model for end-of-life care that ensures the dignity and humanity of patients. This model is in keeping with the priorities and values of local Rwandans by training home-based care practitioners to support patients and family members. But it is important to understand that education doesn’t necessarily mean duplication but rather adaptation – and palliative care must be adapted to local realities.


Dr Christian Ntizimira will give his plenary lecture, ‘From crisis to sustainability: Building palliative care with limited resources’ in Convention Hall II at 11.15 to 11.45 on 25 May 2019 at the 16th EAPC World Congress in BerlinView the congress programme for all other congress presentations and posters. 

The abstract for this lecture, and all other abstracts for the 16th EAPC World Congress, will be published on 22 May 2019.

This entry was posted in 16th EAPC World Congress Berlin, ADVOCACY & POLICY. Bookmark the permalink.

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