Successes and Challenges of Palliative Care in Resource Limited Settings: A Case Study of Mirebalais, Haiti

Abstract

Introduction: LMICs have a disproportionate burden of locally advanced and metastatic disease which is associated with pain, psychosocial distress, and financial challenges. Palliative care is specialized medical care which strives to enhance the quality of life for patients and caregivers dealing with life-threatening illness by relief of suffering caused by physical, psychosocial, and spiritual distress. Partners in Health / Zanmi Lasante is the sole provider of free cancer care in Haiti and limited data is available on the need for palliative care within the clinic. Methods: To determine the scope of palliative care needs and services in order to set future implementation priorities, we interviewed a sample of 40 patients presenting for treatment, routine outpatient cancer care, or treatment specific support groups at the University Hospital in Mirebalais in July 2014. Utilizing an adaptation of the African Palliative Outcomes Scale, a structured interview was performed to assess demographic, physical, psychological, social and spiritual concerns of the patient and their family. The answers to questions were scored using a Likert scale from 0 to 5. A literature review of current attitudes, practices, and challenges associated with palliative care in resource limited settings was completed to contextualize the findings in the primary study. Results: The 40 patients interviewed were diverse in age (mean +/- SD) 45 +/- 11, and predominately female with 70% of the study population identified as unemployed. The study population’s most frequently cited needs included the desire for good health, help securing a job or financial income, and having a doctor or nurse visit the patient in the home. A significant number of patients also indicated moderate to severe of pain. Key findings when reviewing the literature showed a globally high prevalence of pain, poor access to analgesia, inadequate health system infrastructure dedicated to palliative care and limited palliative care workforce. Conclusions: The data reveals a moderate level of pain and unmet psychosocial needs among patients with cancer in Mirebalais, Haiti. These findings provide further evidence for the need to develop a more robust palliative care service in this setting at HUM.