The Program for Global Palliative Care Education

According to the Lancet Commission on Palliative Care and Pain Relief, the global burden of serious health-related suffering among patients with life-threatening or life-limiting illness is enormous as is the unmet need for palliative care to help provide relief especially in low-income and middle-income countries (LMICs). At a Palliative Care Consensus Workshop at Weill Cornell Medicine in 2013, Dr. Randi Diamond met the former Director of Learning and Research at the African Palliative Care Association (APCA) in Uganda who offered to connect her with that organization. APCA, which strives to adapt modern palliative care to African traditions, beliefs, cultures, and settings, connected Dr. Diamond with a hospital in rural Uganda where the administration was trying to develop a palliative care program.

For over 10 years, recognizing the need for greater global access to palliative care and pain relief, Dr. Diamond has worked collaboratively with the Palliative Care Outreach Team at Saint Francis Naggalama Hospital to develop a successful palliative care program in rural Uganda. The program which has been recognized internationally and awarded for its excellence, is now considered a model for delivering palliative care in rural Africa where there remains a great unmet need for palliative care with many patients with a terminal illness presenting too late for curative treatment and a shortage of health providers trained in palliative care. 

As a result of our sustainable partnership with Saint Francis Naggalama Hospital and our strong collaboration with APCA, we have established the Program for Global Palliative Care Education in the Division of Geriatrics and Palliative Medicine. The Program aims to develop innovative and culturally adapted programming to expand access to palliative education and palliative care, in Uganda, and in additional LMICs while also enhancing education in global palliative care within our institution. 

Considering the unique needs, challenges, resources and cultural norms of different regions, our program includes Educational Programming, Clinical Immersion Experiences, Global Palliative Care Track for our Hospice and Palliative Medicine fellows, Advocacy and Collaborative Research.

Educational Programming

We are spearheading several educational initiatives in collaboration with partners in Africa and at our home institution:

• Video-based Educational Modules for Palliative Care Training of Healthcare Workers in LMICs.
  • Created in partnership with our colleagues on the Saint Francis Naggalama Palliative Care Outreach Team, these modules are based in palliative care interactions in rural Uganda and focus on teaching PC communication skills to health workers. We are partnering with the Institute for Palliative Care Education in Africa at Hospice Africa Uganda where they are using these modules as part of their curriculum.
     
• In-person educational programs about Palliative Care for health workers and volunteer village health workers at rural hospitals in Uganda with limited internet access.
   
• Educational webinar series in collaboration with the African Palliative Care Association for health workers with internet access across the African continent and beyond. Participants have joined from 24 countries in Africa and 24 additional countries around the world.
  • Our NYPH Palliative Care social work colleagues have led a series of webinars on grief and bereavement. Webinar content was continually informed by what we learned from the participants. Specific webinar topics have included an Introduction to Grief, Bereavement and Grief Theory, How to Talk to Someone Who Has heard Bad News, Helping Grievers Grieve, and Grief Interventions 
  • Our Pediatric Advanced Care Team led a webinar on Children and Grief
  • Our Palliative Care chaplains and colleagues led a webinar on Spirituality and Palliative Care
     
• Culturally adapted patient education videos developed with our partners in Uganda targeting educational needs of the Ugandan patient population.
  • Inspired by the need and wish for more information by many patients we see in rural Uganda, we have begun to develop accessible patient education videos addressing common illnesses for which patients are enrolled into palliative care.
     
• Global Geriatrics and Palliative Medicine Grand Rounds for our faculty and learners.

Global Palliative Care Track for Trainees

Over the past several years learners including Hospice and Palliative Medicine fellows, Geriatrics fellows and WCM medical students have been involved in our global palliative care track.  Trainees participate in a 2–4-week clinical immersion experience with the Saint Francis Naggalama Palliative Care Outreach Team. While in Uganda, they also have the opportunity to visit Hospice Africa Uganda, the Palliative Care Unit at the Mulago National Referral Hospital and the African Palliative Care Association. In addition, they participate in a year-long global health education series hosted by the Department of Rehabilitation Medicine.

Clinical Immersion Experiences

Our Program in Global Palliative Care Education includes the lived experience of immersion into another culture and being embedded with a local palliative care team in a LMIC. This opportunity is an excellent way to develop an understanding of the needs, limitations, and unique challenges of palliative care delivery in LMICs. The immersion also serves to enhance understanding of the experience of being the outsider in an unfamiliar culture, valuable for professional development and to enhance our practice with our diverse patient populations in the New York metropolitan area, a commitment to diversity, equity, and inclusion. In addition, the experience of joining a palliative care team in another culture helps to finesse listening and observation skills which translate into improved patient interactions wherever we are in the world.

Advocacy

Palliative care programs require advocacy to ensure that policies and regulations support access to palliative care services. Our Program continues to work with nongovernmental advocacy organizations who are working with local governments to ensure the ongoing success of palliative care programs in different communities.