The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 19: Palliative Care in Resource-Poor Settings• Availability of community resources to assist patients and their families• Physiological and psychological responses to bereavement3. Skills. 26 picas Opportunities should be provided for the application of learned knowledge throughpractice in the classroom, making use of role-plays and discussion of real case-histories.Important areas for practice include:• Goal-setting in physical, psychological, social and spiritual dimensions• Development of a family care plan• Monitoring of pain and symptom managementVarious programs in resource-poor settings for the training of healthcare professionals haveillustrated how the above-mentioned program components can be implemented. HASA initiateda model program for medical student training with a Diploma in Palliative Medicine at theUniversity of Cape Town. With no palliative medicine journals, minimal undergraduate and postgraduatetraining, and very few palliative care physicians in the country, this program is beginningto develop a standardized knowledge base within a group of educated professionals. HASAalso trains professional nurses in palliative care at nine campuses in South Africa.The Mildmay Centre for AIDS palliative care in Uganda provides specialist outpatient palliativecare and rehabilitation, using a train-the-trainer approach to disseminate its program and philosophyof symptom control throughout sub-Saharan11, 26, 27Africa.Educating Family and Volunteer CaregiversIn developing countries, empowerment of family members and volunteers to be effective palliativecaregivers may be the most realistic approach for meaningful coverage, especially inrural areas. Experts emphasize that home care should not become a version of acute care deliveryat home: it should rather “encompass personal care, personal services, social companionship,and applied medical care,” as reflected in education and training. 4 Training for volunteercaregivers is available through hospices and other care-giving bodies. St. Luke’s Hospital inSouth Africa, for example, runs intensive trainings for community volunteers who will work withprofessional teams to provide care in home-based settings.Educating Traditional HealersIn developing countries, traditional healers are a potential professional resource for the disseminationof palliative care knowledge. Government-sponsored education of these healers hassought to increase coverage areas of effective palliative care and symptom control awareness inMozambique, Zimbabwe, Uganda, and South Africa. For example, in KwaZulu-Natal, South Africa,the AIDS Foundation’s collaboration with traditional healers resulted in a training curriculumto increase the impact of AIDS prevention, education and management. 12Resources for EducationWHO’s Cancer and Palliative Care Unit developed a series of monographs addressing theprinciples and practice of palliative care for both child and adult cancer patients, which can beadapted for National AIDS Programs. These include publications on cancer pain relief, guidelinesfor opioid availability, symptom relief in terminal illness, and palliative care for children,6, 28, 29, 30all suitable for professional education in palliative care for HIV/AIDS.396U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau