1. Palliative care and pain treatment in Zithulele Hospital and surrounding area 30 September 2011 Annette Dekker Health Grand Challenge Summer of Learning Symposium

2. Internship: Jabulani Rural Health Foundation Located in Eastern Cape, South Africa Established in 2007 Founded by four doctors Works in conjunction with Zithulele Hospital Supervised by Dr. Ben Gaunt and Dr. Karl le Roux Advised by Professor Joe Amon

3. Research question: Pain and Palliative Care Chronic Pain o Pain that occurs over weeks, months, or years, rather than a few hours or a dew days Palliative Care o Health care that aims to improve the quality of life of people facing life-limiting illnesses, through pain and symptom relief, and through psychosocial support for patients and their families. Palliative care can be delivered in tandem with curative treatment but its purpose is to care, not to cure.

4. Common diseases in Zithulele Hospital associated with pain and palliative care o HIV and AIDS o Tuberculosis o Cancer o Chronic renal failure o Chronic heart failure Research question: Pain and Palliative Care

5. Methodology: Interviews Quantitative and qualitative Patient interviews 45 total  35 in hospital – general ward and TB ward  10 in community Provider interviews 33 total  Doctors, Nurses, Physiotherapists, Occupational therapists, Social workers

6. Conclusions: Patients’ perceptions of pain High levels of pain  52% rate their pain in last month as highest level of pain possible Limited understanding of pain  83% do not know what is causing their pain When patients do connect pain to disease they appear to do better emotionally

7. Conclusions: Availability of pain medication and palliative care Zithulele Hospital  Difficult situations to initiate palliative care Unknown diagnosis HIV  Time constraints Outside of Hospital  Lack of basic pain medications  Limited home based care  Insufficient and expensive transportation

8. Reflections… Complexity of issues – micro and macro Power of awareness Importance of passionate people …and the Future Continuation of analysis for senior thesis Development of concrete recommendations

9. Thank you!