1. What is palliative care?
Martin LaBrie MD, CCFP(PC), FCFP
Palliative Consulting Physician,
Alberta Health Services – Calgary Zone
Clinical Assistant Professor,
Department of Family Medicine and
Division of Palliative Medicine,
Department of Oncology
Cumming School of Medicine
University of Calgary
Vientiane, Laos
January 2017

2. dealing with death…
At some time, in some way, we must all face the end of life. And most of us share a common hope – that when death comes to us or to a loved one, it will be peaceful and free of pain. We hope to face death surrounded by those we love, feeling safe, comfortable and cared for

3. …but what about living until you die?

4. Hospice Palliative Care
Intends to relieve suffering and to improve quality of living and dying for individuals and families who are confronted with a life-limiting illness
Strives to help individuals and families
Address physical, psychological, social, spiritual and practical issues
Prepare for and manage the dying process
Cope with loss and grief during illness and bereavement
Aims to
Manage all active issues
Prevent new issues from occurring
Promote opportunities for meaningful experience
Source: Canadian Hospice Palliative Care Association

5. Hospice Palliative Care:
Is appropriate for any person or family living with a life-threatening illness
May complement disease-modifying therapy or it may become the total focus of care
Source: CHPCA

7. Palliative Care: Beliefs and Values
The intrinsic value of each person
The value of life and the natural process of death
The need to address a person’s suffering, expectations, needs, hopes and fears
The right of an individual to accept or refuse care
Quality of life is defined by the individual
Therapeutic relationships are based on dignity and integrity
A unified response to suffering strengthens communities

8. Palliative Care: Guiding Principles
Care is focused on the person and family, sensitive to their values, beliefs and practices
Care is of high quality, adhering to ethical principles and standards of practice
Care is safe and effective, ensuring confidentiality, accountability, continuity and security for all participants
Care is accessible wherever a person lives, either at home or within a reasonable distance, in a timely manner

9. Palliative care: guiding principles
There are adequate resources to provide care in a community
Care is provided through collaborative efforts of all involved organizations
Care is knowledge-based and education of individuals, caregivers and community is ongoing
Care is advocacy-based in order to increase awareness and develop resources
Care is research-based, and all palliative care activities are based on best available evidence

10. Developing Palliative Care in Resource-limited Settings

13. The request:
Two community-based organizations in Burkina Faso that provide services for PWHIV requested assistance in evaluating their HIV care, with a specific focus on palliative needs:
REVS+ - based in Bobo Dioulasso, a city of 1.5 million in western Burkina Faso
Association Solidarité et entraide Mutuelle au Sahel (SEMUS) – based in Yako, in northern Burkina Faso and providing HIV care to a primarily rural area, total population approx. 500,000

14. Burkina Faso – Country Profile
Area: 274,200 sq. km
Population: 17,200,000 (July 2012 est.)
Population distribution: 73.5% rural 26.5% urban
Wet season June-Oct, dry season Nov-May
Arable land 17.6%
Median age 17 years
Life expectancy at birth 55.4 years , rank 202/221
Poverty rate 44%
UN development index 181/187 (2011)
Average income $1.40 US/day (highest 10% receive 32% of income)
Unemployment rate 70% - large number of seasonal migrant workers
Literacy rate: 28% (2011)

17. Burkina Faso – Health care
Level 1: rural health centres (CSPS), infirmaries (CM) and local hospitals (CMA)
1000 CSPS sites, staffed by nurses and midwives
200 CM sites will have an assigned physician in addition to nurse
20 CMA sites
Level 2: hospital care
Regional hospitals (CHR) – 9
Level 3: university hospitals (CHU) – 3
1100 doctors (0.06/1000) (Laos 0.18/1000 in 2012)
2575 nurses, 2170 auxiliary nurses

25. Lessons Learned
The response to suffering by members of a community must be a community response
In resource-limited settings, health services can assist in addressing suffering of ill persons, but health services cannot replace the need for support from the community.