Clinical & Public Health Services

Palliative Care


Palliative care is a medical specialty that optimizes symptom management, nurtures spiritual support, and provides psychosocial services for individuals with life-threatening illness. Palliative care is more than hospice; it seeks to address severe symptoms at diagnosis throughout the course of serious illnesses. Recent data has shown that involving palliative care in the treatment of patients with metastatic cancer will improve their quality of life, and for some cancers can increase survival. Beyond cancer, patients with any terminal disease such as heart failure, chronic obstructive pulmonary disease (COPD), and infectious diseases can benefit from palliative care services. 

While the importance of symptom management is increasingly recognized worldwide, the need in low income countries is becoming more pressing. For example, the 2008 estimated death rate from cancer in the US was 40% compared to 79% in eastern Africa. Poor prognosis for many patients is worsened by the limitations to pain management. A 2010 article from theHuman Rights Watch, "Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya," reported morphine availability in only 7 of the 250 Kenyan public hospitals and the morphine available was only sufficient enough to treat a mere 1,500 patients. During that timeframe the American Cancer Association's "Treat the Pain" initiative estimated that 51,262 Kenyans with HIV and cancer died in moderate to severe pain.

In the past several years organizations such as the African Palliative Care Association and the Kenya Hospices and Palliative Care Association have helped to bring the challenges of symptom management to the attention of government agencies; however, organizations such as AMPATH have been critical in providing the clinical care. Palliative care has been a critical component of AMPATH-Oncology since the inception of this program. Under the leadership of IU faculty member Greg Gramelspacher, MD, a team of dedicated Kenyan clinicians, nurses, and social workers organized the first palliative clinical service at Moi Teaching and Referral Hospital (MTRH). The team is embedded in the AMPATH oncology clinic and is responsible for pain and symptom management for cancer patients during and after chemotherapy treatment. Moreover, the team rounds daily throughout the adult and pediatric hospitals at MTRH. In addition to symptom management, the team plays a major role in facilitating difficult communications with patients and their family. Palliative care team members have specialized training to share bad news in a compassionate way and to help patients and their families through the difficult decisions that arise when faced with a terminal diagnosis.  

AMPATH is partnering with the Kenyan palliative care team members to develop novel ways to minimize pain and suffering, given the limited resources within western Kenya. North American physicians from Beaumont Medical Center, Duke University, Indiana University, Mount Sinai Medical Center, and St. Vincent Hospital (Indianapolis, IN) all contribute to this effort. Educational efforts have been developed to teach symptom management and compassionate communication to hospital staff as well as medical and nursing students training at MTRH. Further, clinical improvement projects are underway that aim to better understand the acceptance of hospice by patients and their family as well as a pilot study to explore the use of telecommunication as a means of delivering hospice services in remote areas. 

AMPATH also has developed an invaluable partnership with the Kimbilio Hospice. Run by Juli McGowan Boit and the Living Room Ministries, this non-for-profit hospice provides end of life services to children and adults in a peaceful, rural setting approximately one hour from MTRH. The highly skilled team from Kimbilio round with the MTRH palliative care team on a weekly basis facilitating transfer to inpatient hospice for individuals who cannot be managed at home, or have no home to care for them. This partnership will soon provide expanded services as Juli and her team build a second hospice just a short ride from MTRH. 

The MTRH Palliative Care team is honored to partner with the AMPATH. While great work is being done, the clinical need in Western Kenya is still daunting. If you would like to help the palliative care team in their efforts please donate here. Be sure to indicate "palliative care" in the comments section or through the IU Foundation mention "palliative care" in the "in honor of" section.