Africa’s Great Need

Picture16Although death is stranger to no part of the world, Africa lays claim to the majority of its most horrific statistics.  An estimated two-thirds of all reported cases of HIV/AIDS in the world are in Sub-Saharan Africa, and approximately 25.3 million[i] people on the continent are living with HIV or AIDS, which now claims even more lives than malaria.[ii]  In 2011, its estimated 1.8 million[iii] people were newly infected.

Yet despite AIDS’ infamous reputation, it is cancer that claims the most lives in Africa. By 2020, an estimated 1 million people will die every year in Africa from cancer alone, accounting for 10% of the world’s cancer deaths.[iv]  The need for palliative care is great now but will become even greater with each passing year.

This need for palliative care is multiplied due to the relative absence of curative treatments available in Africa. In the West, the majority of patients with cancer, AIDS, and otherwise fatal diseases are able to seek pain relief and medical treatment, often resulting in high cure rates.[v]  The reality in Africa is very different. Not only are more of these diseases occurring in disproportionately high numbers, but the need for palliative care is greatest here for one very simple reason: the large majority of people who fall prey to cancer, AIDS, and other diseases will soon die from them, and in excruciating pain, because they have little to no access to curative treatment.[vi]

Except for South Africa and Zimbabwe, one third of African countries do not even have one radiotherapy machine; in other countries, only a single center is available to supply radiotherapy or chemotherapy  to the entire country.[vii] Only an estimated 5% of Africa’s population will ever reach such a center, but even less than 5% of those who then reach a center will benefit from it because their disease will have advanced so far by the time they arrive for treatment.[viii]  Uganda has one cancer center for its population of more than 30 million people; 57% of Ugandans[ix] do not even have access to a health worker. Uganda has 1 doctor for every 19,000 people, and they are concentrated in urban locales.[x] In rural villages, a doctor is the source of health care for 50,000 people.[xi] Currently, HAU estimates that 200,000 Ugandans are living in a state of daily pain and need palliative care.[xii] These appalling statistics are typical of most African countries.

For millions born in Africa, their journey toward death will be one of deprivation, suffering, and steadily increasing pain. Due to cultural reasons, the majority of Africans prefer to die at home, surrounded by their families and so they can be buried next to their ancestors.[xiii] If they are fortunate, this will be their lot. The unfortunate will, all too often, be disowned and abandoned by spouses, parents, and loved ones who can no longer cope with a person in constant pain. Palliative care squarely faces the reality of massive deaths in all age groups and under circumstances in which family and social structures have often been shattered by war, terrorism, epidemics, and poverty. Palliative care steps to the bedside of the chronic and terminally ill and commits itself to relieving their suffering and easing their distress. Why, with such a great need, had only South Africa and Zimbabwe obtained the benefits of palliative care before 1990 in Africa?

 


[i] Yale AIDS Watch. Africa: AIDS effect on Africa population. Retrieved on January 8, 2013, from http://www.yale.edu/yaw/africa.html.

[ii] Ibid.

[iii] amfAR: The Foundation for AIDS research, op cit.

[iv] Merriman, A. (2010).Audacity to love: the story of hospice Africa. Dublin: Irish Hospice Foundation, pp. 36.

[v]Mayo Clinic Staff. Cancer survival rate: What it means for your prognosis. Retrieved on January 9, 2013., from http://www.stjude.org/stjude/v/index.jsp?vgnextoid=5b25e64c5b470110VgnVCM1000001e0215acRCRD

[vi] For more information on the differences between curative and palliative trajectories, see, Merriman 2010, op cit, pp. 36-41.

[vii] Ibid, pp. 39.

[viii] Ibid.

[ix] Murray 2012, op cit.

[x] Ibid.

[xi] Ibid.

[xii] Ibid.

[xiii] Sepulveda C, Habiyambere V, Amandua J, Borok M, Kikule E, Mudanga B, et al.(2003). Quality care at the end of life in Africa. BMJ. 327(7408): pp. 209-13.