The National Palliative Care Policy for South Africa and Pain Management – The Rural Health Conference 2019, Kapenta Bay

By: Dr Thilo Govender

South Africa is a country of duality, differences and diversity. The Rural Health Conference is an important reflection of these themes in the health system of our country. The theme this year was “The rural voice – Hear our voices!”

While South Africa embarks on major health sector reforms aimed at improving equity, redressing the funding envelope for health services across the urban-rural divide in the health system remains challenging. This conference is reflective of greater, deeper-seated issues which lie at the heart of the social determinants of health. Healthcare workers who have chosen to work in rural health have an appreciation of the constant intersection between healthcare, the social determinants of health and locating health services in these communities.

Rural communities have been practising palliative care for generations – they see it as care for their community, or “Ubuntu”. In times of crisis, patients move from urban to rural settings – a safety net for caring needs. At the start of the HIV epidemic, before the roll-out of antiretroviral therapy, the weekend in rural areas was dedicated to funerals. The exorbitant cost of funerals was crippling. Grandparents buried children and grandchildren; loved ones were buried in blankets, as the cost of coffins was prohibitive. Caring for patients with terminal or life-threatening illnesses is emotionally, financially and physically demanding. It is essential for healthcare workers to recognize the disproportionate burden of palliative care that rural communities face.

The dearth of Hospices and access to private pharmacies in rural areas makes the problem more acute. It is essential for rural healthcare workers to recognize this need, and to manage pain and other distressing symptoms to alleviate serious health-related suffering, by increasing access to palliative care in their daily practice. The assessment and management of pain includes the use of strong opioids such as morphine, which is cost-effective and readily available in the public sector.

Both presentations on the “National Palliative Care Policy and Pain Management” at the Rural Health Conference highlighted the need for healthcare workers to be advocates for effective pain relief and not be afraid to prescribe the full range of opioids in the appropriate setting. Ensuring that palliative care is not overlooked in rural communities, as part of Universal Health Coverage, is crucial as South Africa embarks on National Health Insurance to address the quadruple burden of disease.

Dr Thilo Govender during her second presentation, pictured her with fellow DRILL Fellow, Dr Sindi Mthembu

Dr Thilo Govender, DRILL Fellow, presenting on the National Palliative Care Policy

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