1. TB Palliative Care in Sierra Leone Gabriel Madiye, IPPF, DPH Chief Executive The Shepherd’s Hospice Sierra Leone

2. OBJECTIVES BACKGROUND OF SERVICE NATIONAL TB BURDEN AND MDR TB TREATMENT AND PALLIATIVE CARE LESSONS A case of Palliative care in TB : Sorie

3. 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

4. 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

5. 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

6. 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

7. BACKGROUND OF SERVICE (CONTD) Mobilizes TB suspects and refer for test and treatment Manages pain in TB patients especially suspected MDR TB ( Freetown)

8. NATIONAL TB BURDEN HIV AND AIDSTUBERCULOSIS Adult HIV prevalence (%) 1.558TB prevalence, all forms (number) 56,103 People living with HIV/AIDS 48,000TB incidence, all forms (number) 29,690 People dying with AIDS 4,600TB mortality, all forms (number) 6,848 Estimated number of people needing ARV therapy 13,000TB 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)

9. TB TREATMENT AND PALLIATIVE CARE The Shepherd’s Hospice, Lower Allentown Freetown

10. TB TREATMENT AND PALLIATIVE CARE Summary of Diagnosis and treatment of pain in 3 TB Patients NameDiagnosisAg e Date 1 ST treatment start 2 ND treatment3 RD treatmentMorphine prescription Abdul K Kamar a  TB  Haemoptysis,  bilateral side pain 5/5,  chest pain 4/5,  lumbar-sacral pain 5/5 49March 2007- Nov 2008 (St John of God Catholic Hospital- Lunsar) 20 th April - 14 th Dec 2009 (TSH SL Clinic) 4 th Jan – 31 st Aug 2010 TSH SL Clinic N/A Vandi Conteh  TB,  Haemoptysis,  bilateral side pain 5/5,  chest pain 4/5 45Jul 2007 – Mar 2008 Rokupa Govt. Hospital 2009- Home Treatment 9 th Sep 2010 Ongoing @ TSHSL Clinic  Liquid Morphine 10mg 4hrly  Then 20mg Bedtime x 2/12 Fengai  TB,  Haemoptysis,  bilateral side pain 5/5,  chest pain 4/5  abdominal pain 4/5 45  Feb- Aug 1999 Stoko Hospital- Makeni  Aug 2002-Mar 2003 Rokupa Govt Hospital 7 th -26 th Dec 2009 (TSH SL Clinic) 18 th Sep 2010- (Ongoing @TSH SL) Clinic  Liquid Morphine 10mg 4hrly  Then 20mg Bedtime x 2/12

11. 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

12. 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

13. TB TREATMENT AND PALLIATIVE CARE (Contd) Patients collecting morphine

14. LESSONS Partnership with patients and affected families for advocacy

15. Multidisciplinary team Meeting Community Palliative Care Team Discussing patient care

16. Street Campaign for policy change HIV activist advocating for Universal access to HIV and TB services

17. A case of Palliative care in TB : Sorie’s Story WEIGHT LOSS OESOPHAGEAL CANDIDIASIS COUGH PAIN DEMENTIA HUNGER REJECTION EXTREME POVERTY

18. Sorie’s Story (Contd) Sorie, looking forward Sorie at home with 63 yr mother, 3 grand children Hospice meets sorie

19. Sorie’s Story (Contd) SORIE AT THE HOSPICE SORIE BY THE FRANGIPANGI

20. 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 me You accompany me with empathy. When you listen to me You affirm life When I take my drugs for pain Then you accomplish your promise When I smile broadly in comfort You get the “high” Care is for me And drugs for you

21. Gratitude Dr. James Russell, Pal Consultant Dr. Eddie Mwabesa, Pal Trainer, HAU Francis Kamara, Clinical Officer Hannah NGobeh, Snr

22. Thank you