title: Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies.
abstract: BACKGROUND
  Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa.
  
  
  METHODS
  Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics.
  
  
  RESULTS
  We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks.
  
  
  CONCLUSIONS
  Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.
authors.affiliation: Primary Palliative Care Research Group, Centre for Population Health Sciences: General Practice Section, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK. liz.grant@ed.ac.uk.
authors.forename: Liz
authors.initials: L
authors.lastname: Grant
authors.forename: Judith
authors.initials: J
authors.lastname: Brown
authors.forename: Mhoira
authors.initials: M
authors.lastname: Leng
authors.forename: Nadia
authors.initials: N
authors.lastname: Bettega
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray