Liberia's steps towards alleviating serious health-related suffering
Authors: William E Rosa, Viola Karanja, Julius D N Kpoeh
Journal: The Lancet Global Health (2019)

Katherine Sleeman and colleagues (July, 2019)1Sleeman KE de Brito M Etkind S et al.The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions.Lancet Glob Health. 2019; 7: 883-892Summary Full Text Full Text PDF PubMed Scopus (123) Google Scholar shoulder the unfortunate task of identifying the future escalating global burden of serious health-related suffering (SHS) by 2060. They note that the largest increase in SHS (155%) will take place in low-income countries. Additionally, most people who die with SHS will be found in the world's most resource-constrained settings. Urgent action should be taken to procure appropriate and accessible palliative care services for those most in need, who also happen to be the poorest. Places like Liberia (west Africa), face economic, geographical, educational, and resource constraints. With inconsistent access to only injectable morphine and tramadol, clinicians are unequipped to manage the most common and detrimental end-of-life symptoms. The broader philosophy underpinning palliative care is widely misunderstood as a service for the imminently dying or those who have been unresponsive to disease-directed treatment. Patients and families often live in extremely rural areas without health-care access in Liberia's poor infrastructure, rough terrain, and unpredictable rainy season. Our palliative care team is in its infancy stages, having had no formal training until May, 2019. In response to the SHS of our community and the 2018 Lancet Commission report2Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar on promoting universal access, we implemented training for a nurse-led, community-based palliative care programme in Harper, Maryland county. The training fell under a broader non-communicable disease capacity building programme instituted through a collaboration between Partners in Health and the Ministry of Health. Education included the well established End-of-Life Nursing Education Consortium curriculum,3Ferrell B Buller H Paice J Anderson W Donesky D End-of-life nursing and education consortium communication curriculum for interdisciplinary palliative care teams.J Palliat Med. 2019; (published online April 13.)DOI:10.1089/jpm.2018.0645Crossref PubMed Scopus (11) Google Scholar, 4Buller H Virani R Malloy P Paice J End-of-life nursing and education consortium communication curriculum for nurses.J Hosp Palliat Nurs. 2019; 21: E5-E12Crossref PubMed Scopus (7) Google Scholar, 5Ferrell B Malloy P Virani R The end of life nursing education nursing consortium project.Ann Palliat Med. 2015; 4: 61-69PubMed Google Scholar along with programme development support, self-care skills for interdisciplinary health workers, and a writing workshop to aid in future dissemination. An emphasis was placed on communication and therapeutic presence to support health workers in creating a caring environment when medications are unavailable and effective symptom control is elusive. The Lancet Commission report2Knaul FM Farmer PE Krakauer EL et al.Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar claims a mere US$145 million is needed to eradicate SHS worldwide. Those of us in Liberia urge our global health colleagues to continue their advocacy for our wellbeing. Our annual opioid distribution is minimal, rendering us unable to appropriately treat the SHS of our people, and we have only one hospice (to our knowledge) for a population of over 4 million people. Although we hope our colleagues in the Global North will hear and elevate our voices to ensure timely alleviation of SHS in Liberia, we will continue fulfilling our end of the ethical obligation to deliver palliative care—one patient and one day at a time, and starting with the simplest of tasks (ie, gaining access to oral morphine for those we serve). We declare no competing interests. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditionsThe burden of serious health-related suffering will almost double by 2060, with the fastest increases occurring in low-income countries, among older people, and people with dementia. Immediate global action to integrate palliative care into health systems is an ethical and economic imperative. Full-Text PDF Open Access